Summary: The aim of this study was to summarize and evaluate clinical appearance, laboratory parameters, special ancillary diagnostic tests, treatments and post-mortem pathological findings of chronic gastric impaction and dilatation in horses. Chronic gastric impaction and dilatation is a rare, progressive disease, which is usually detected in its advanced stage. Its aetiology has not yet been fully clarified. Acute primary gastric impaction (from excess volume intake) and secondary gastric impaction (from reflux from the small intestine) must be differentiated from chronic gastric impaction and dilatation. Suspected causes of chronic gastric impaction and dilatation include pyloric stenosis, gastric ulcers, gastric tumours, indigestible feed, feed with high fibre content and dental problems. Motility disorders with resulting gastric impaction and dilatation have also been described in the context of liver diseases. Additional theories suggest damage to the vagus nerve or the intramural nervous system of the stomach and aplasia of the autonomous ganglia of the myenteric and submucosal plexus. It is a retrospective case study of four cases of chronic gastric impaction and dilatation between 2010 and 2013 concerning clinical appearance, laboratory parameters, ancillary diagnostic tests, treatment options and post-mortem pathological findings. For comparison, an additional case of delayed gastric emptying with successful conservative treatment is presented. In one case, nerve degeneration was confirmed and could possibly explain the chronic gastric impaction. A recurrent finding was the adaptive enlargement of the stomach with significant thinning of the muscularis, which was evident in all cases. This is likely to be the result of chronic dilation with a gradually prolonged filling of the stomach leading to 'stretching' of the stomach wall and therefore also a loss of motility, which could be equated to dilated cardiomyopathy, where cardiac output volume decreases with dilation. Gross pathology revealed greatly enlarged stomachs with dry impacted feed material of 43 kg, 46 kg and 108 kg. The treatment options for the disease, whether conservative or surgical depend on the severity and cause of the gastric impaction, and are said to have a very poor or unfavourable prognosis. Chronic gastric impaction can lead to a rupture of the stomach and therefore the prognosis is generally suspected to be grave. Perhaps early identification of delayed gastric emptying and chronic gastric impaction via repetitive gastroscopy could allow for a more successful treatment.

Rationale The clinical relevance of sensitization to Aspergillus (A) fumigatus in cystic fibrosis (CF) is unclear. Some researchers propose that specific A fumigatus IgE is an innocent bystander, whereas others describe it as the major cause of TH‐2‐driven asthma‐like disease. Objectives Lung function parameters in mild CF patients may be different in patients with and without A fumigatus sensitization. We aimed to ascertain whether allergen exposure to A fumigatus by bronchial allergen provocation (BAP) induces TH‐2 inflammation comparable to an asthma‐like disease. Methods A total of 35 patients, aged 14.8 ± 8.5 years, and 20 healthy controls were investigated prospectively. The patients were divided into two groups: group 1 (n = 18): specific (s)IgE negative, and group 2 (n = 17): sIgE positive (≥0.7 KU/L) for A fumigatus. Lung function, exhaled NO, and induced sputum were analysed. All sensitized patients with an FEV1 > 75% (n = 13) underwent BAP with A fumigatus, and cell counts, and the expression of IL‐5, IL‐13, INF‐γ, and IL‐8 as well as transcription factors T‐bet, GATA‐3, and FoxP3, were measured. Results Lung function parameters decreased significantly compared to controls, but not within the CF patient group. After BAP, 8 of 13 patients (61%) had a significant asthmatic response and increased eNO 24 hours later. In addition, marked TH‐2‐mediated inflammation involving eosinophils, IL‐5, IL‐13, and FoxP3 became apparent in induced sputum cells. Conclusion Our study demonstrated the clinical relevance of A fumigatus for the majority of sensitized CF patients. A distinct IgE/TH‐2‐dominated inflammation was found in induced sputum after A fumigatus exposure.

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