Gastric Ulceration causing poor performance in a horse!!

A 12 year-old event horse presented for poor performance that was best described as unwilling to "go forward". The gelding was evaluated for lameness and was described as sound. The gelding maintained a good appetite and there were no signs of colic behavior reported. A gastroscopy was scheduled and the owner was instructed to fast the horse for 18 hours. When the gastroscope was passed into the stomach a large volume of fluid was present mixed with feed material. Approximately 3 liters of fluid was removed from the stomach in order to visualize the non-glandular compartment. The remaining fluid was filled with feed material and was not removed. However, a clear pattern of non-glandular ulceration was noted throughout the exposed stomach wall (Figures 1-3).

 

 

Figure 1

 These ulcers appear full thickness thru the layer coating the inside of the stomach and are evenly spread through out the stomach. We were not able to visualize the glandular stomach or the pyloric region which may be abnormal in this horse. The fact that the gelding's stomach was filled with fluid and some feed after 18 hrs of fasting would suggest a delay in gastric emptying which may be associated with inflammation of the pyloric region. As such, this gelding will be treated with omeprazole for the appropriate period of time. In addition, the horse will be treated with a stomach coating medicine for the first 48 hrs to alleviate any immediate discomfort due to the ulcerations.

Figure 2

 This case presents yet another example of the types of clinical signs that may be associated with gastric ulcers. Classically we consider horses that have sings of colic, weight loss, poor appetite or failure to thrive. However, in my expereince, horses with gastric ulcers may present in many ways and this condition should be considered on our lists of differentials!!

Figure 3

Guttural Pouch Fungal Infection Resolved!!

Back in January, a gelding presented for a history of recurrent nasal discharge. Endoscopic exam revealed the presence of a fungal infection within one of the guttural pouches (Figures 1 and 2) . A bacterial and fungal culture was performed on fluid/debris collected from the pouch. The bacterial culture was negative however the fungal culture was positive for Cladosporium spp. This species of fungi is very common in the environment, especially in the presence of moist or wet wood. In humans, it is a big player in fungi induced allergies. Interestingly, this species of fungi has not been described in the guttural pouch of a horse previously!

Figure 1

Figure 2

The gelding was treated with a specific anti-fungal medication given by mouth daily. After 4 weeks of treatment, there was a 50% reduction in the size of the fungal plaque and the degree of inflammation (Figures 3 and 4).

Figure 3

Figure 4

After 2 months of treatment there has been complete resolution of the fungal infection and inflammation (Figures 5 and 6). The stylohyoid bone remains slightly thickened compared to the opposite stylohyoid bone (Figure 7) however this will like resolve over the next 3-6 months. This case is unusual in several ways. First, the species of fungi has not been described before in the guttural pouch of a horse, secondly, most guttural pouch fungal infections include bleeding (epistaxis) thirdly, there are few reports of successful treatment of guttural pouch fungal infections in horses with JUST systemic anti-fungals.

Figure 5

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Figure 7