Equine glandular gastric disease: prevalence, impact and management strategies

Figures & data

Figure 1 (A) Normal glandular mucosa (Grade 0, all scoring systems). (B and C) Hyperemia (Grade 1, modified EGUS council, Grade 0 MacAllister). (D) Grade 2 (modified EGUS council), Grade 1 severity and number (MacAllister), moderate, focal, flat and fibrinosuppurative, antrum (ECEIM). (E) Grade 3 (modified EGUS council), Grade 2 severity and number (MacAllister); flat, hemorrhagic, and fibrinosuppurative, antrum (ECEIM). (F) Grade 4 (modified EGUS council), Grade 4 severity and number (MacAllister), raised, hemorrhagic and fibrinosuppurative, pylorus (ECEIM). Photo courtesy Ashley Whitehead.

Abbreviations: EGUS, equine gastric ulcer syndrome; ECEIM, European College of Equine Internal Medicine.

Table 2 EGUS council score

Score	Explanation
0	The mucosa is intact and there is no appearance of hyperemia
1	The mucosa is intact, but there are areas of reddening
2	Small single or multifocal superficial lesions (<5)
3	Large single or multifocal lesions or extensive superficial lesions (≥5)
4	Extensive lesions with areas of apparent deep ulceration

Note: © 2014 EVJ Ltd. Reproduced with permission from Sykes B, Jokisalo J. Rethinking equine gastric ulcer syndrome: part 1–terminology, clinical signs and diagnosis. Equine Vet Educ. 2014;26(10):543–547. John Wiley & Sons, Inc.⁵

Abbreviations: EGUS, equine gastric ulcer syndrome; EGGD, equine glandular gastric disease.

Table 1 ECEIM consensus qualitative scoring system

Severity	Distribution	Appearance	Location
Mild	Focal	Flat and hemorrhagic	Cardia
Moderate	Multifocal	Flat and fibrinosuppurative	Fundus
Severe	Diffuse	Raised and hemorrhagic	Antrum
		Raised and fibrinosuppurative	Pylorus
		Depressed ± blood clot
		Depressed and fibrinosuppurative
		Other (describe)

Note: John Wiley & Sons, Inc. © 2015. Modified with permission from Sykes B, Hewetson M, Hepburn R, Luthersson N, Tamzali Y. European College of Equine Internal Medicine Consensus Statement—equine gastric ulcer syndrome in adult horses. J Vet Intern Med. 2015;29(5):1288–1299.¹

Figure 2 Primary pathways contributing to gastric acid secretion of the parietal cell, and site of action of H2 antagonists and PPIs.

Abbreviation: PPIs, proton pump inhibitors.

Table 3 Doses of medications commonly used to treat EGGD

Medication	Dose/route	Frequency	Mechanisms
Omeprazole	4 mg/kg, PO	q. 24 hours	Proton pump inhibitor
Misoprostol	5 µg/kg, PO	q. 12 hours	Prostaglandin analogue
Sucralfate	12–20 mg/kg, PO	q. 6–12 hours	Promotes epithelial restitution

Abbreviations: PO, orally; q, every.

Sykes B, Jokisalo J. Rethinking equine gastric ulcer syndrome: part 1–terminology, clinical signs and diagnosis. Equine Vet Educ. 2014;26(10):543–547. doi:10.1111/eve.2014.26.issue-10

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Sykes B, Hewetson M, Hepburn R, Luthersson N, Tamzali Y. European College of Equine Internal Medicine Consensus Statement—equine gastric ulcer syndrome in adult horses. J Vet Intern Med. 2015;29(5):1288–1299. doi:10.1111/jvim.1357826340142

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