Duodenitis-proximal Jejunitis Research Articles

Geographic Disparities in Clinical Characteristics of Duodenitis–Proximal Jejunitis in Horses in the United States

Duodenitis–proximal jejunitis (DPJ) is an idiopathic and potentially fatal disease of horses characterized by abdominal pain, proximal intestinal inflammation, and subsequent gastric and small intestinal fluid accumulation. Although this disease is known to be costly and life threatening in the equine industry, the severity of clinical signs can vary widely, and an exact etiology has yet to be elucidated. This study looked to identify differences in clinical parameters of horses with DPJ between geographic regions in an effort to corroborate anecdotal reports and support theories of differing etiologies. Case records were compared from veterinary academic referral hospitals in three different geographic locations in the United States to determine if significant differences in clinical, clinicopathologic, and prognostic characteristics exist among horses with DPJ. Clinical measurements on presentation that were significantly different between regions included heart rate, peritoneal total protein, albumin, anion gap, aspartate aminotransferase, gamma-glutamyl transferase, sodium, chloride, potassium, and creatinine. Duration of hospitalization and maximum body temperature while hospitalized were also different between regions. There were no significant differences in peritoneal cell count, total white blood cell count, neutrophil count, band neutrophils, calcium, total plasma protein, temperature on presentation, duration of reflux, total reflux volume, or age between hospitals. The mortality rates between hospitals were not significantly different. Increased severity of clinical signs and biochemical abnormalities were identified in the Southeastern United States hospital compared with the Northeastern and Western hospitals. A prospective, multicenter case–control study could identify risk factors contributing toward regional differences in this disease in the future.

Nasogastric Intubation as Health and Safety Risk in Equine Practice—A Questionnaire

Placing a nasogastric tube can be a life-saving act for a horse but is considered an occupational hazard for veterinarians. An online questionnaire was performed to assess and specify potential risks. 123 equine veterinarians completed the survey, and the majority admitted using the mouth to handle the end of the nasogastric tube (sucking or blowing air) and having accidentally swallowed or aspirated stomach content or medications. This can potentially lead to aspiration pneumonia or pneumonitis. Mineral oil seems to be especially dangerous as aspiration may be asymptomatic at the beginning and lipoid pneumonitis may develop. Furthermore, 60% of responders would also handle the tube with their mouth if the horse was presented with fever and diarrhea or reflux formation, which might be affected by Salmonella sp. or Clostridium difficile producing toxins. The fact that nasogastric tubes are rarely being disinfected increases the risk of infection. 50% of veterinarians would use their mouth to suck or blow air into the tube during nasogastric intubation, even if the patient was presented with suspected poisoning. Rodenticide zinc phosphide is particularly dangerous as its breakdown product is a highly toxic gas. Inhalation leads to serious symptoms in humans, including pulmonary edema and neurological signs. Alternatives to mouth use (lavage, big syringe, or suction pump) when passing a tube should be considered, especially if a patient is presented with duodenitis—proximal jejunitis, diarrhea, or suspected poisoning. Awareness needs to be raised among veterinarians that nasogastric intubation is an extremely hazardous occupational practice.

EVALUATION OF LIVER FUNCTION IN HORSES WITH DUODENITIS-PROXIMAL JEJUNITIS Avaliação da função hepática em equinos com duodeno-jejunite proximal

Previous reports of duodenitis-proximal jejunitis (DPJ) have noted histopathologic changes in the liver. However, there have been few studies evaluating the hepatic function during the process of DPJ in horses. The objective of this study was to investigate the hypotheses that there is a correlation between DPJ and hepatic dysfunction. Blood samples from 8 horses with DPJ were collected for aspartate aminotransferase (AST), gama-glutamyl transferase (GGT), total (TB), direct (DB) and indirect bilirubin (IB), total serum protein and albumin analysis. The blood samples were collected from horses that survived on the moment of admission at the veterinary hospital, at the time of nasogastric reflux (NGR) end, and at the time the animals were allowed to eat. At the same time, heart rate, respiratory rate, rectal temperature and packed cell volume (PCV) were performed and the volume and duration of NGR were evaluated. Blood samples and parameters of horses that have died were collected at the moment of admission at the hospital. The values of respiratory rate, rectal temperature, volume of NGR, AST, GGT, total protein and albumin were not statistically significant during the trial. By the time of admission at the hospital, the values of heart rate and PCV were significantly greater in horses that have died compared to the survivors. In the survivors there were significant values for heart rate, PCV and for bilirubins. This study did not confirm the hypothesis that DPJ causes hepatic dysfunction in horses when serum biochemical analyses were performed.

Prevalence of gastric squamous ulceration in horses with abdominal pain

Prevalence of gastric ulcerations differs widely according to breed and circumstances of management. Further study of the biological variables involved is required in order to identify more exactly the reasons for the reported range. The objectives of this present study, which do not appear to have been addressed previously in the literature, were 1) the prevalence of gastric ulceration in horses with abdominal pain. 2) difference in prevalence in horses responding to medical therapy and those requiring surgical intervention. 3) whether gastric ulceration is associated with any particular gastrointestinal tract lesion. Horses were included in the study if gastroscopy was performed within 24 h of presentation. The presence and grade of gastric ulceration was recorded together with the medical records. Data were analysed categorically using a Fisher's exact test or Chi-squared test. One hundred horses met the selection criteria. Forty-nine percent (49/100) of horses had gastric ulceration, 63% (63/100) responded to medical therapy and 37% (37/100) to surgical intervention, and prevalence was higher in the former (59%) than the latter (32%). Horses with duodenitis-proximal jejunitis (DPJ) had a trend towards higher prevalence of gastric ulceration compared to those with other GI lesions. Sixty-eight percent (13/19) of horses diagnosed with DPJ, 32% (8/25) with a large colon impaction and 14% (1/7) with large colon volvulus had gastric ulceration. The presence of gastric ulceration in all horses with abdominal pain was moderate. Horses responding to medical therapy had a higher prevalence of gastric ulceration compared to horses requiring surgery and there was a trend towards higher prevalence in cases of DPJ compared to other GI lesions. There was not a statistically significant difference in gastric ulceration detected between specific lesions, including large colon impactions and large colon volvulus. The clinical relevance of ulceration is still unclear and further studies are required to differentiate between incidental and clinically important gastric ulceration.

Prevalence of and Risk Factors for Postoperative Ileus after Small Intestinal Surgery in Two Hundred and Thirty‐Three Horses

To determine the incidence of postoperative ileus (POI) in a population of horses after small intestinal surgery and the effect of multiple variables on development of POI. Case series. Horses (n=233) aged > or =1 year that had exploratory celiotomy for small intestinal disease that recovered from surgery from 1995 to 2005. Sixty-eight variables were collected from medical records (1995-2005) for each horse. POI was defined as nasogastric reflux volume >20 L over 24 hours or >8 L at any single time after surgery. Twenty-seven percent (64/233) of horses developed POI; 29 of 64 (46%) horses with POI had duodenitis proximal jejunitis (DPJ). When no intestinal resection was required at surgery, excluding horses with DPJ, 15% of horses had POI; 30% horses had POI after intestinal resection. Ten percent of horses had POI for >24 hours. When horses with DPJ were excluded, factors associated with increased risk of POI included high packed cell volume at hospital admission (P=.024), increasing age (P=.0004), and length of intestinal resection (P=.05). Risk factors for POI in this study were nonspecific although horses with intestinal resection are at higher risk compared with horses without intestinal resection. Predicting with certainty which cases will develop POI remains elusive.

Complications and survival associated with surgical compared with medical management of horses with duodenitis‐proximal jejunitis

Based on clinical observation, it is hypothesised that horses with duodenitis-proximal jejunitis (DPJ) that are treated surgically have a shorter duration, smaller volume, and slower rate of nasogastric reflux (NGR) compared to horses treated medically, are more likely to develop diarrhoea than medically managed cases, and have a higher incisional infection rate than a sample population of horses undergoing abdominal exploration for gastrointestinal disease other than DPJ. To compare: 1) duration, volume and rate of NGR and the percentage of horses with diarrhoea between medically and surgically treated DPJ cases; and 2) incisional infection rate in horses with DPJ undergoing abdominal exploration to a sample population of horses undergoing abdominal exploration for gastrointestinal disease other than DPJ. Medical records of cases with DPJ diagnosed 1995-2006 were reviewed. Information obtained included subject details, presenting clinical findings, treatment category (medical/surgical), complications (diarrhoea, incisional infection), and outcome (survival/nonsurvival). Data were analysed using a Chi-squared test and a mixed model analysis of variance. Level of significance was P<0.05. Compared to medical cases, surgical cases had significantly decreased survival, a longer duration and larger total volume of NGR, and were more likely to develop diarrhoea. The incisional infection rate for horses with DPJ undergoing abdominal exploration was 16% compared to 7% for the sample population of horses. Surgical treatment of horses with DPJ did not lead to resolution of NGR faster than medical treatment. Surgical cases were more likely to develop diarrhoea and did not have a significantly higher incisional infection rate than the sample population.

Are feeding practices associated with duodenitis-proximal jejunitis?

Feeding concentrate has been putatively associated with risk of development of duodenitis-proximal jejunitis (DPJ); however, this association has not been evaluated systematically in a controlled study. To determine whether there was evidence that feeding practices were associated with increased odds of developing DPJ employing a case control study. The amount of concentrate fed daily to horses is significantly greater among horses that develop DPJ than control horses with either lameness or other types of colic. Feeding practices of cases of DPJ diagnosed between 1997 and 2003 were compared with those of 2 populations of control horses (colic controls and lameness controls) admitted to the clinic from the same time period. Following multiple imputation of missing data, comparisons were made using polytomous logistic regression. Horses with DPJ were fed significantly more concentrate and were significantly more likely to have grazed pasture than either control populations; DPJ horses were significantly more likely to be female than were lameness horses. Results were unchanged after adjusting for bodyweight of the horse. Feeding and grazing practices differ among horses with DPJ relative to horses with other forms of colic and lame horses. The observed magnitudes of association were not sufficiently strong to merit diagnostic/predictive application; however, these observations, if substantiated by other studies, might provide important aetiological clues.

Potential role of Clostridium difficile as a cause of duodenitis-proximal jejunitis in horses

Duodenitis-proximal jejunitis (DPJ) is an idiopathic condition in the horse characterized by inflammation and oedema of the duodenum and proximal jejunum. Clinical signs include colic, ileus, depression, fluid accumulation in the small intestine and stomach, and endotoxaemia. The objective of this study was to investigate prospectively the role of Clostridium difficile in this idiopathic disease. Nasogastric reflux from 10 consecutive cases with DPJ and 16 consecutive horses with other causes of nasogastric reflux was cultured for C. difficile, other Clostridium spp., and Salmonella. Toxigenic strains of C. difficile were isolated from 10/10 (100%) of horses with DPJ and 1/16 controls (P<0.0001). No other known pathogenic clostridia were isolated from either group. Results of this study suggest that C. difficile might be an important cause of this syndrome.

Revisão de 26 casos clínicos de duodeno-jejunite proximal em eqüinos (1996-2000)

Os dados de 26 eqüinos com duodeno-jejunite proximal (DJP), examinados no HOVET-FMVZ-USP entre dezembro de 1996 e novembro de 2000, foram revisados. Durante esse período, foram atendidos 1555 animais, dos quais 205 apresentavam distúrbios gastrintestinais (13,2%). Os casos de DJP representaram 1,7% do total de eqüinos atendidos. A idade, os achados clínico-laboratoriais e a evolução clínica foram comparados entre eqüinos sobreviventes (grupo 1) e eqüinos não sobreviventes (grupo 2). Vinte eqüinos (76,9%) sobreviveram. Todos os animais foram submetidos exclusivamente a tratamento médico. A análise dos resultados foi feita através de comparação entre médias pelo teste t de Student com significância de 5%. Houve diferença significativa entre os dois grupos em relação aos seguintes parâmetros analisados: contagem total de leucócitos no sangue, creatinina sérica e freqüência cardíaca. A principal complicação nos animais recuperados foi laminite (30,8%).

Phar Lap and duodenitis-proximal jejunitis

Phar Lap and duodenitis-proximal jejunitis

Use of bethanechol and metoclopramide in horses with duodenitis/proximal jejunitis: 13 cases (1987–1993)

All horses diagnosed with duodenitis/proximal jejunitis (DPJ) at the Texas Veterinary Medican Center between January 1, 1987 and July 1, 1993 were included in a retrospective study to evaluate the therapeutic and prognostic value of bethanechol and metoclopramide as gastrointestinal prokinetic drugs in horses with DPJ treated at our clinic, and to compare the clinical outcome of horses with DPJ treated with these drugs and those with DPJ that were not treated. During the study period, 70 horses diagnosed with DPJ were admitted to the clinic. Of these 70 horses, 18(25.7%) were treated with bethanechol, metoclopramide, or both; 13 of the 18 treated horses received more than one dose of either drug. No adverse effects of treatment with these drugs were noted. A precise therapeutic plan and clinical benefit of bethanechol, metoclopramide, or both coul not be determined from this retrospective study. The use of these gastrointestinal prokinetic drugs in horses with DPJ appeared to have prognostic value. Horses that did not respond to treatment with these gastrointestinal prokinetic drugs within 24 hours were not discharged alive.

Prognostic indicators for horses with duodenitis-proximal jejunitis. 75 horses (1985-1989).

The medical records of 75 horses with duodenitis-proximal jejunitis (DPJ) were reviewed. Ages, physical parameters, laboratory values, and treatment data were compared between horses surviving DPJ and horses not surviving DPJ (Table 1). Fifty of 75 horses (66.6%) survived. Sixty-six horses (88.0%) were managed with medical treatment alone and nine horses (12.0%) were managed with medical treatment plus surgical intervention. Using a logistic regression model, the association of each of the 19 physical and laboratory parameters with death was evaluated retrospectively in the 75 horses. Three parameters (anion gap, abdominal fluid total protein concentration, and volume of gastric fluid for the first 24 hours of hospitalization) were significantly associated with death by univariate analysis. Using a stepwise multiple logistic regression, two parameters remained significantly associated with death (P < 0.05), anion gap and abdominal fluid total protein concentration.