Gastric retention associated with a pyloric mass in two horses

Partial pyloric obstruction causing gastric retention is described in 2 young female horses. Gastric retention was confirmed by contrast radiography of the upper gastrointestinal tract. In both horses a large mass was palpated in the wall of the pyloric antrum at exploratory laparotomy. Post-mortem examination of the first case confirmed that this mass was associated with chronic gastric ulceration. Gastric ulceration was not confirmed in the second case but this horse recovered after the pylorus and duodenum were bypassed by gastro-jejunostomy.     

Megaesophagus and aspiration pneumonia secondary to gastric ulceration in a foal

A 3-month-old foal with a history of persistent fever and leukocytosis was found to have pneumonia, ulceration of the squamous portion of the stomach, and dilatation of the distal portion of the esophagus. The foal was euthanatized and necropsied. The distal portion of the esophagus was severely dilated, and there was severe ulceration and mural thickening of the stomach at the cardia. Because of the severe gastric ulceration and mural thickening, the gastroesophageal junction was fixed in an open position, permitting gastroesophageal reflux. The megaesophagus and pneumonia were considered to have resulted from chronic gastroesophageal reflux.     

Perforated gastric ulcer v associated with pyloroplasty for chronic hypertrophic pyloric gastropathy in a dog

A six-year-old male silkie terrier presented with a history of chronic vomiting. A diagnosis of gastric outflow obstruction was made using contrast radiography of the upper gastrointestinal tract. Surgical examination of the stomach revealed thickened pyloric antral mucosa. A Heineke-Mikulicz pyloroplasty combined with resection of the hypertrophic pyloric mucosa were performed to increase the patency of the pyloric lumen. The dog recovered well from surgery and his condition remained stable until the sixth day postoperatively when his condition deteriorated rapidly resulting in his death that night. At autopsy a perforated gastric ulcer was found in the cardiac region of the pylorus with evidence for a generalised peritonitis. An association between gastric outflow obstruction and gastric ulceration has been reported in human clinical literature and in canine experimental models. No such association has been previously documented in the veterinary clinical literature.     

Heineke–Mikulicz pyloroplasty for the treatment of pyloric stenosis secondary to gastro-duodenal ulcer disease in three foals

The objective of the study was to describe a modified Heineke–Mikulicz pyloroplasty for the treatment of pyloric stenosis in foals due to gastric ulceration and assess the short- and long-term outcome of foals receiving the pyloroplasty. Medical records of foals undergoing a modified Heineke–Mikulicz pyloroplasty due to gastric outflow obstruction secondary to a pyloric stenosis were included in this retrospective case series. The pyloroplasty consisted of an oral to aboral full thickness longitudinal incision on the ventral aspect of the pylorus and proximal duodenum, which was sutured closed with 0 polydioxanone in a transverse orientation, thereby, enlarging the pyloric lumen diameter. Long-term outcome was obtained from medical and race records. The pyloroplasty was successfully performed in three foals with a surgical time of 95–121 min, with immediate return to nursing and hospital stay of 4–14 days. Complications included a small intestinal volvulus and intra-abdominal adhesions in a foal that did not survive. Another foal had an incisional infection. Two of the three foals went on to race. It was concluded that the pyloroplasty procedure is an acceptable option for the treatment of pyloric stenosis and secondary gastric outflow obstruction due to gastric ulceration. The limited amount of bowel manipulation with no change in intestinal flow, along with the successful outcomes achieved, make this another surgical option available for the correction of pyloric stenosis in foals.     

GASTROINTESTINAL NUCLEAR MEDICINE

Nuclear medicine has achieved an important role in the diagnosis of gastrointestinal (GI) disease in humans. Esophageal and gastric motility problems, gastroesophageal reflux, abnormal gastric secretory function, GI bleeding, and inflammatory diseases of the GI tract can all be evaluated using nuclear scintigraphy. The use of these techniques in human medicine, their advantages and disadvantages relative to other available diagnostic tests, and their potential application to veterinary medicine are discussed. Examples of esophageal and gastric motility studies performed on normal and abnormal dogs are included.     

Upper gastrointestinal surgery for ulcer disease in foals

The goals of surgical therapy in foal gastroduodenal ulcer disease are the elimination of abdominal pain, healing of mucosal ulcerations, and prevention of complications. Gastrojejunostomy has been used with success in both pyloric and duodenal ulcerations that have progressed to gastric outflow obstruction. Gastrojejunostomy has resulted in rapid healing of gastritis and esophagitis and resolution of aspiration pneumonia and biliary stasis without recurrence of duodenal ulceration.     

Rethinking equine gastric ulcer syndrome: Part 2 – Equine squamous gastric ulcer syndrome (ESGUS)

It has recently been highlighted that significant differences in prevalence, risk factors and the response to treatment exist between ulceration of the squamous gastric mucosa and ulceration of the glandular gastric mucosa in the horse. In the first article in the series, the term equine squamous gastric ulcer syndrome (ESGUS) was used to describe disease of the squamous gastric mucosa with clinical signs and diagnosis discussed. The purpose of this article is to review the pathophysiology, risk factors, prevalence, treatment and prevention of ESGUS.     

Congenital pyloric mucosal fold resulting in an antral valve outflow obstruction in a bull terrier

An under‐sized three‐month‐old female bull terrier was referred with a history of regurgitation since three days of age. Thoracic radiographs were unremarkable, while abdominal radiographs showed a distended stomach, despite a 12 hour fast. Abdominal ultrasonography revealed gastric outflow obstruction of unclear aetiology. Coeliotomy was performed, during which an excessive mucosal fold at the pyloric antrum was excised. Histopathology of the pyloric fold revealed mild oedema and fibrosis of the mucosal tissue. The dog made a complete recovery, with resolution of regurgitation and grew to within the expected breed size. In the authors’ opinion, this is the first canine report of congenital antral mucosal valve resulting in gastric outflow obstruction, and only the second report in any species.     

Pylorectomy and gastroduodenostomy in the dog: technique and clinical results in 28 cases

Pylorectomy and end-to-end gastroduodenostomy are surgical procedures that allow excision of abnormal pyloric tissue and provide improved gastric outflow. These techniques were used for the treatment of benign, malignant, and ulcerative conditions that were judged to be not adequately treatable with pyloromyotomies or pyloroplasties. End-to-end gastroduodenostomy was not much more difficult than a standard intestinal anastomosis; however, a thorough knowledge of the pyloric area anatomy was required to avoid serious surgical errors. In addition, gentle tissue manipulation and precise suture placement reduced the chance of iatrogenic pancreatitis, biliary obstruction, tissue ischemia, and/or suture line leakage. The results of surgery depended on the underlying disease process. Dogs with benign lesions such as chronic hypertrophic pyloric gastropathy responded favorably to treatment. Dogs with malignant disease and perforated ulcers had low long-term survival rate. Pyloric adenocarcinoma was not adequately treated with this method alone.     

Paraesophageal hiatal hernia and pyloric obstruction in a dog

Paraesophageal hiatal herniation and pyloric obstruction were diagnosed in a pup with a history of vomiting. Findings of contrast radiography included esophageal reflux, delayed gastric emptying time, and paraesophageal herniation. Exploratory celiotomy revealed increased firmness of the pylorus and a primary defect in the esophageal hiatus, which allowed gastric herniation. Nissen fundoplication was performed following reconstruction of the esophageal hiatus, and pyloroplasty was performed to relieve the gastric outlet obstruction. Pyloric biopsy findings were consistent with a diagnosis of chronic gastritis. Recovery from surgery was initially unremarkable; however, the dog died suddenly 3 weeks after surgery. Necropsy revealed a large diaphragmatic hernia adjacent to the esophageal hiatus; the hernia had resulted in incarceration of the abdominal organs. The hiatal hernia reconstruction remained intact and was not the cause of the diaphragmatic disruption.     

The prevalence and distribution of gastric ulceration in 345 racehorses

OBJECTIVE: To report the prevalence and distribution of gastric ulceration within a group of racehorses and to describe the endoscopic appearance of gastric antrum and pyloric ulceration. DESIGN: Retrospective clinical study. PROCEDURE: Medical records from gastroscopic examinations of 345 racehorses (331 Thoroughbreds and 14 Standardbreds) were reviewed. Prevalence, distribution and severity of gastric ulcers were recorded. Lesions involving the squamous mucosa and the glandular mucosa of the antrum and pylorus were graded and compared. RESULTS: Gastric ulceration was found in 86% of racehorses. The squamous mucosa around the margo plicatus was most commonly affected. The pylorus was examined in 175 horses and 47% were ulcerated. No association was found between presence of lesions of the squamous mucosa and those of the pylorus. Low correlation was found between grade and location of lesions, with the pyloric lesion score being significantly less than the squamous mucosal lesion score. CONCLUSION: Gastric ulceration was present in a large proportion of racehorses. The pylorus was also an important site of ulceration. There was no association between presence of lesion at one site and the other, although there was a low correlation between grade of lesion and location, with the pyloric ulcer grade being lower.     

Chronic hypertrophic pyloric gastropathy as a cause of pyloric obstruction in the dog

Six small-breed, middle-age dogs with a history of chronic intermittent vomiting had benign pyloric lesions causing gastric outlet obstruction. Marked similarities were found in clinical signs, pathologic changes, and treatment results. The condition was classified as a syndrome and was named chronic hypertrophic pyloric gastropathy. The appearance of the obstructive lesions at surgery were various forms of mucosal hypertrophy. Microscopically, the syndrome was characterized by mucosal foveolar and glandular hyperplasia, cystic glandular dilatation, superficial mucosal ulcerations, and various cellular infiltrates. The affected dogs were successfully treated by surgical correction of the gastric outlet obstruction.     

Gastroduodenal ulceration in foals

Gastroduodenal ulceration is becoming recognised as an important disease in foals during the first few months of life. Aetiopathogenesis is presumed to be similar to peptic disease in humans associated with back diffusion of hydrogen ions into the mucosa. Many factors have been incriminated as predisposing foals to ulceration but few have been proven. To date, use of non-steroidal anti-inflammatory agents has been the only documented cause of gastroduodenal ulceration in foals. The clustering of affected foals on certain farms suggests an infectious aetiology but attempts to identify a causative organism have been unsuccessful. Four clinical syndromes defined for foals with gastroduodenal ulceration include: silent ulcers, which occur most often in the non-glandular stomach along the margo plicatus and are identified as incidental findings at necropsy; active ulcers which are often manifested by abdominal pain, excessive salivation and bruxism; perforating ulcers which usually result in a severe, diffuse peritonitis; and pyloric or duodenal obstruction from a healing ulcer. General approaches to therapy of a foal with active ulceration consist of reduction of gastric acidity and enhancement of mucosal protection. Antacids and type 2 histamine receptor antagonists are used most often to neutralise or decrease acid secretion, respectively. Sucralfate, a locally active sulphated sucrose preparation, is commonly used as a cytoprotective agent. The efficacy and safety of many products used have not been evaluated adequately in foals. Perforating ulcers are usually associated with death or humane destruction of the foal because of fulminating peritonitis. Surgical intervention and bypass procedures are indicated in foals that develop pyloric or duodenal obstructions from healing ulcers.     

Gastritis-associated adenocarcinoma and intestinal metaplasia in a Syrian hamster naturally infected with Helicobacter species

The objective of this study was to evaluate stomachs of 2-year-old Syrian hamsters that were naturally colonized by multiple Helicobacter species including Helicobacter aurati. A previous report on 7- to 12-month-old Syrian hamsters described chronic gastritis and intestinal metaplasia, a putative preneoplastic lesion in the stomach, without cancer. This report describes an invasive adenocarcinoma at the pyloric-duodenal junction in one of nine hamsters at a site of helicobacter-associated inflammation and marked intestinal metaplasia. Ceca of nine of nine animals were culture positive and polymerase chain reaction positive for Helicobacter spp. Furthermore, immunohistochemical analysis of the stomach using a H. pylori polyclonal antibody detected positive-staining bacteria within the pyloric region of three of nine hamsters including the neoplastic glands. However, argyrophilic bacteria were demonstrated only within the stomach of the hamster with gastric adenocarcinoma. This is a first report of gastric adenocarcinoma in helicobacter-infected hamsters. Syrian hamsters appear suitable as potential model for studying development of helicobacter-associated gastric adenocarcinomas.     

Use of gastrotomy to relieve esophageal obstruction in a horse

Esophageal obstruction of 1 week's duration in a gelding was diagnosed by contrast radiography and esophagoscopy. A food bolus was found at the junction of the caudal thoracic portion of the esophagus and the cardia. A gastrotomy was performed through a cranial abdominal incision and a phytobezoar was manually broken down and removed. The gelding was started on complete pellet food and water on the fifth day after surgery. The horse remained clinically normal more than 1 year after surgery.     

1例犬食道阻塞的诊治及体会

犬食道异物阻塞是宠物临床医疗中常见的疾病,早期往往伴随吞咽困难,采食后很快即返流等症状,但随着病程延长病犬往往食欲废绝。临床可通过X线检查而确诊,一旦确诊要及时进行治疗。以1例犬食道异物阻塞为例,对其临床诊断、治疗及术后护理过程进行了介绍,旨在对今后临床实践提供一定的借鉴指导。     

Rethinking equine gastric ulcer syndrome: Part 3 – Equine glandular gastric ulcer syndrome (EGGUS)

It has recently been highlighted that significant differences exist between ulceration of the squamous gastric mucosa and ulceration of the glandular gastric mucosa in the horse. The first article in this series discussed terminology, clinical signs and diagnosis and the second reviewed ulceration of the squamous gastric mucosa in detail. The purpose of this article, the third and last in the series, is to review the pathophysiology, risk factors, prevalence, treatment and prevention of ulceration of the glandular gastric mucosa.     

Gastric impaction and obstruction of the small intestine associated with persimmon phytobezoar in a horse

Signs of mild colic, intermittent lethargy, and weight loss of 6 weeks' duration in a 2-year-old Quarter Horse gelding were attributed to persimmon (Diospyros virginiana) phytobezoar formation. Diagnosis of the phytobezoar was facilitated by gastric endoscopy. Signs of gastrointestinal tract obstruction were associated with a large phytobezoar in the lumen of the stomach, gastric ulceration, and obstruction of the small intestine (as a consequence of fragmentation of the primary bezoar). Conservative treatment, using mineral oil and dioctyl sodium sulfosuccinate, was unsuccessful. A celiotomy was performed, and gastric impaction and partial obstruction of the small intestine associated with phytobezoar formation and fragmentation were identified. The horse made a complete recovery following removal of all phytobezoars. Persimmon phytobezoar should be considered in the fall and winter as a possible cause of lethargy, colic, and weight loss in horses allowed access to persimmon fruit.     

Pathomorphological study on gastroduodenal ulceration in horses: localisation of lesions

Gastroduodenal ulceration is a prevalent disease in foals and adult horses. Decreased performance as well as fatal complications relate to this syndrome. The objective of our study was to determine the prevalence of gastric ulceration in a mixed population of horses by postmortem examination and to evaluate a possible association between equine gastric ulcer syndrome (EGUS) and sex or age of the examined horses, to evaluate the localisation of lesions in the proximal part of the gastrointestinal tract and to determine the occurrence of gastric parasites. Postmortem examinations were performed on 71 horses over a period of 24 months. Gastric ulcers were found in 52 horses (73.2%). There was no significant association between age or sex and occurrence of gastric ulcers. In all horses the squamous mucosa lesions were localised near the margo plicatus (100% of the cases), whereas in 23 horses the lesions were near the margo plicatus and lesser curvature and in 7 horses at the greater curvature. In 18 horses the mucosa was affected in the whole extent of the margo plicatus and in 1 horse diffuse lesions of the squamous mucosa were noted. Lesions of the glandular mucosa were localised in 11 horses at the fundic area, in 1 horse they occurred in the pylorus, and in 10 horses diffuse lesions of the glandular mucosa were recorded. A low prevalence of Gasterophilus intestinalis infection was detected (1 horse, 1.4%). We have confirmed that gastric ulcers are a common problem in horses and duodenal or oesophageal ulceration is rare (not a single case of the latter was found in this study). Lesions in the glandular mucosa of the stomach are more frequent in suckling foals than in older animals. Lesions of the glandular mucosa are also common in adult horses, and a complete gastroscopic examination including examination of the pylorus is advisable to evaluate this syndrome.     

Cholangiohepatitis and pancreatitis secondary to severe gastroduodenal ulceration in a foal

A 2-month-old foal was presented with clinical signs of colic. Gastroduodenal ulceration was suspected. A poor response to medical treatment and signs of gastroduodenal obstruction led to celiotomy and an attempted bypass procedure. The foal was euthanized and postmortem examination revealed gastric ulceration, segmental duodenal stenosis, and severe chronic cholangiohepatitis and pancreatitis.