Diagnostic evaluation and short-term outcome as indicators of long-term prognosis in horses with findings suggestive of inflammatory bowel disease treated with corticosteroids and anthelmintics

Abstract

BackgroundRecurrent colic and unexplained weight loss despite good appetite and adequate feeding and management practices are common conditions in the horse. However, little information has been published on the systematic diagnostic evaluation, response to treatment, prognostic factors or outcome of either presentation. The aims of this study were to 1) identify possible prognostic indicators and 2) report the short- and long-term response to treatment with corticosteroid therapy of a variety of horses with a presumptive diagnosis of inflammatory bowel disease (IBD).Thirty-six horses with a history of recurrent colic and/or unexplained weight loss were screened with a detailed clinical, clinicopathological and diagnostic imaging examination. Twenty horses were subsequently selected that had findings consistent with inflammatory bowel disease based on the fulfilment of one or more of the following additional inclusion criteria: hypoproteinaemia, hypoalbuminaemia, malabsorption, an increased intestinal wall thickness on ultrasonographic examination or histopathological changes in rectal biopsy. These 20 horses were treated with a standardized larvicidal anthelmintic regime and a minimum of three weeks of corticosteroid therapy.ResultsThe initial response to treatment was good in 75% (15/20) of horses, with a 3-year survival rate of 65% (13/20). The overall 3-year survival in horses that responded to initial treatment (12/15) was significantly higher (P = 0.031) than in those that did not respond to initial treatment (1/5). The peak xylose concentration was significantly (P = 0.048) higher in survivors (1.36 ± 0.44 mmol/L) than non-survivors (0.94 ± 0.36 mmol/L).ConclusionsThe overall prognosis for long-term survival in horses with a presumptive diagnosis of IBD appears to be fair to moderate, and the initial response to anthelmintic and corticosteroid therapy could be a useful prognostic indicator. The findings of the present study suggest that a low peak xylose concentration in absorption testing is associated with a less favourable prognosis, supporting the use of this test.

Progressive lymphocytic-plasmocytic enteritis in a horse

“…Disorders of motility associated with chronic inflammation may cause displacement and torsion of the intestine (Samsel and Witkowski 2012). The most constant clinical sign in horses with LPE described in the literature is weight loss (Kaikkonen et al (2014), Kemper et al (2000), MacAllister et al (1990). Diarrhoea is present only in 50 % of horses with LPE (Kemper et al 2000).…”

“…The animal may have a normal or decreased appetite depending on the severity of the disease (Kalck 2009). Some patients may also suffer from chronic diarrhea (Kaikkonen et al 2014), Schumacher et al 2000). According to Durham and Rendle (2010) recurrent colic is the dominating symptom in all types of enteritis.…”

“…An antiparasitic therapy is recommended regardless of the results of the parasitic examination (Kaikkonen et al 2014, Lyons et al 2000. Fenbendazole should be administered at 10 mg/kg for five successive days together with ivermectin and praziquantel (Kaikkonen et al 2014). Fenbendazole administered at the above mentioned doses also acts against encysted Cyathostominae (Lyons et al 2000).…”

“…During the initial stages of the disease dexamethasone is administered at 0.05 -0.1mg/kg intramuscularly or intravenously every 24 hours and then is tapered to the lowest maintenance dose, usually 0.02 mg/kg administered orally (Kaikkonen et al 2014). An antiparasitic therapy is recommended regardless of the results of the parasitic examination (Kaikkonen et al 2014, Lyons et al 2000. Fenbendazole should be administered at 10 mg/kg for five successive days together with ivermectin and praziquantel (Kaikkonen et al 2014).…”

“…LPE is one of the most common types of bowel inflammation in dogs and cats ). However, there have been only a few reports of LPE in horses (Clark et al (1988), Kaikkonen et al (2014), Kemper et al (2000), MacAllister et al (1990), Scott et al (1999)). In this case report, the authors describe a very well documented case of lymphocytic-plasmacytic enteritis, supplemented by the description of the presentation of the disease, which, to date, has not been described in horses.…”