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Owner-Reported Clinical Signs and Management-Related Factors in Horses Radiographed for Intestinal Sand Accumulation

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Owner-Reported Clinical Signs and Management-Related Factors in Horses Radiographed for Intestinal Sand Accumulation Journal of Equine Veterinary Science 80 (2019) 10e15 Contents lists available at ScienceDirect Journal of Equine Veterinary Science journal homepage: www.j-evs.com Owner-Reported Clinical Signs and Management-Related Factors in Horses Radiographed for Intestinal Sand Accumulation * Kati E. Niinisto€ , Meri A. Ma€att€ a,€ Mirja O. Ruohoniemi, Maria Paulaniemi, Marja R. Raekallio Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland article info abstract Article history: Clinical problems related to intestinal sand accumulation in horses are common in certain geographic Received 17 January 2019 areas, but the clinical signs appear nonspecific and the course of the accumulation remains somewhat Received in revised form obscure. This study examined the association between the presence and size of intestinal sand accu- 21 May 2019 mulations and owner-reported clinical signs, management, and feeding practices, as well as behavioral Accepted 21 May 2019 patterns in horses with radiographic diagnosis of sand accumulation. Owners of the horses filled in an Available online 24 May 2019 online questionnaire. A total of 447 responses met the inclusion criteria. The size of the sand accumu- lation detected in the radiographs was not significantly associated with the age, body condition score, Keywords: fi Clinical signs sex, or use of the horses. Horses reported to have expressed colic had signi cantly larger sand accu- Diarrhea mulations than those without this sign, and a similar association was detected in horses with poor Poor performance performance. The highest odds ratio for sand accumulation was for the combination of colic and poor Group hierarchy performance, followed by colic combined with diarrhea/loose feces or hyperesthesia to touch of the Greedy feeder abdominal wall. Larger sand accumulations were detected in greedy horses that eat all their roughage, whereas dominant position in group hierarchy was associated with less sand. The possibility of abdominal sand accumulation should be considered as one of the differentials in horses with multiple owner-reported clinical signs such as colic, poor performance, diarrhea, and hyperesthesia to touch of the abdomen. © 2019 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). 1. Introduction poor performance, and weight loss [1e9]. The condition has been known for more than 100 years [8], but the course of the accu- In certain geographic areas, sand accumulation of the gastro- mulation remains to be elucidated. Unintentional sand intake may intestinal (GI) tract is a relatively frequent phenomenon in horses occur when horses eat their grain directly from the ground, retrieve and can be a reason for various clinical signs such as colic, diarrhea, grain dropped onto a sandy surface [10], eat hay mixed with sand, or graze on an insufficient pasture [11]. The reasons for intentional sand intake or geophagia in horses are unclear, although such ex- Animal welfare/Ethical statement: Data were collected as a questionnaire to horse planations as mineral or salt deficiency [12,13] or not getting owners. Owners have voluntarily and anonymously given the information of their horses' problems and managemental factors for research purposes. Current na- enough roughage [14] have been proposed. tional legislation does not demand the ethical statement in this kind of study, but in Sand in the GI tract causes mucosal irritation, potentially leading case the editor feels the study should have it, we can send the study to the Ethical to mechanical obstruction or motility disorder [8,13,15]. However, Committee of University of Helsinki; Viikki Campus. the aforementioned nonspecific clinical signs alone are not Conflict of interest statement: This work was supported by the Finnish Foundation for Veterinary Research (ETTS grants of 2018, no specific number). There was a unambiguously indicative of the diagnosis of sand accumulation, personal grant to Kati Niinisto€ for writing the article and material grant for sta- and examinations such as abdominal auscultation, rectal exami- tistical analysis. nation, and fecal sedimentation test are also poorly associated with Otherwise the authors declare no interest. the presence of sand [2,16,17]. Ultrasonography has been demon- * Corresponding author at: Kati E NiinistoatDepartment€ of Equine and Small strated to be reliable in revealing large and ventrally located ac- Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014 Helsinki, Finland. cumulations [18], but radiographic examination is currently the E-mail address: kati.niinisto@helsinki.fi (K.E. Niinisto).€ most reliable and commonly used diagnostic method for sand https://doi.org/10.1016/j.jevs.2019.05.012 0737-0806/© 2019 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). K.E. Niinisto€ et al. / Journal of Equine Veterinary Science 80 (2019) 10e15 11 Table 1 Table 1 (continued ) Response options of the questionnaire and frequency of the responses filled out by owners. Question Response options N % Other 10 2 Question Response options N % Not present 359 81 Breed Finnhorse *(#) 213 47 Not known/not reported 7 1 Warmblood 85 19 The traits that were significantly (P < .05) associated with the size of the sand Pony 59 13 accumulation are indicated with an asterisk * and further defined by # (significantly Icelandic horse 38 9 larger) and x (significantly smaller sand accumulation). The total number of re- Standardbred 19 4 sponses was 447. Other cold-blooded breed 19 4 a Scoring of body condition with Henneke et al. method [21]. Other than these 10 2 b It was possible to select several options. Arabian or Thoroughbred 4 1 c Diarrhea includes loose feces and feces with water. Sex Gelding 212 47 Mare 210 47 Stallion 25 6 Body condition scorea 3 - 8/9, median 5 447 100 accumulation [2e4,7,17,19,20]. The quantity of sand needed to Age of the horse 3 mo - 30 y, mean 9.5 ± 5.2 y 447 100 affect the health of the horse is not well defined, although one Use of the horse Pleasure riding 295 66 study noted a considerably larger area of sand in the radiographs of Competition 78 18 Â Riding school 14 3 horses with GI signs (median length and height 26.5 9.0 cm) than Breeding 10 2 in asymptomatic horses (8.3 Â 0.9 cm) [19]. Size of sand grain may Foals and yearlings 32 7 affect the radiographic opacity, with coarse sand being more opa- Resting 9 2 que than fine sand [17,18]. In our article, sand therefore refers to any Other 9 2 Season when Autumn 209 47 geosediment type of mineral opacity in the radiograph. radiographed Winter 135 30 The aim of this survey was to assess the association between Spring 65 15 owner-reported clinical signs in horses and the presence and size of Summer 38 8 intestinal sand accumulations detected in abdominal radiographs Presence and size of No sand 89 20 based on owner recollection. The relation of selected management sand accumulation Mild 79 18 Moderate 130 29 practices and behavior of horses to intestinal sand accumulation Large 149 33 was also evaluated. Reason for abdominal Recommendation of veterinarian 195 44 radiographyb Owner's suspicion of sand 262 59 Owner has seen horse eating sand 69 16 2. Materials and Methods Clinical signs observed Diarrheac 241 53 by owners Colic * (#) 164 37 Hyperesthesia poor performance 166 37 2.1. Survey Design and Distribution *(#) Miscellaneous gastrointestinal 174 39 Horse owners in Finland were approached using a web-based signs questionnaire. The link to the survey was distributed in horse Not known/no signs reported 80 18 Other: 13 different signs, total 66 29 6 shows, via social media online, and in the web pages of a nation- times wide equine magazine. Owners were asked to answer the ques- Housing of horse Stable 368 82 tionnaire if their horse's abdomen had been radiographed to detect Walk in walk out 75 17 intestinal sand accumulation. Radiographs had been taken at Other/not described 4 1 equine clinics around Finland, and the accumulation size reported Access to paddock or Lives in walk-in/walk-out stable, 63 14 field i.e., free access by the owner in the survey was expected to be based on the vet- Every day 383 86 erinarian's assessment. As Finland is one of the countries with a 5 d per week 0 0 high prevalence of sand accumulations in horses, veterinarians at e 2 4 d per week 1 0 equine clinics are familiar with performing radiography of the Once per week or less frequently 0 0 Grouping of horse in No 151 34 cranioventral abdomen [2,4]. There were no limitations on horses' the paddock Yes, with one horse 172 38 age, breed, or use. The survey was made accessible for respondents Yes, with many horses 124 28 for 15 months, between September 2015 and November 2016. Re- Position of horse in Dominant *(x) 120 27 sponses were given anonymously. group hierarchy Neutral 122 27 The web-based survey consisted of 55 questions. Part of the data Subordinate 78 17 Horse is not grouped 127 29 was used only for a pregraduate thesis and was not relevant in this Salt lick Yes 280 63 study. Here, we include 17 questions with a multiple choice format Yes, but does not use it 89 20 (Table 1). In addition to preset choices, some questions had an No, but salt is added to food 68 15 additional category “Other”, where respondents could provide No salt lick or added salt 8 2 Not known 2 0 another answer or additional information in an open answer sec- Feeding management Feeding directly from ground 190 43 tion.
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