Researchers assess three treatment methods for sand colic in horses

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Daily nasogastric tubing of horses with psyllium and/or magnesium sulfate for three to seven days proved effective in removing large accumulations of sand from their colon, researchers in Finland report.

The ingestion of sand can cause weight loss, diarrhea and acute or recurrent colic in horses. It poses a particular risk to horses living in areas with sandy soils or kept on other sandy surfaces.

The researchers, Ritva Kaikkonen, Kati Niinistö, Tiina Lindholm and Marja Raekallio, noted that several treatments have been used to medically manage sand accumulations in horses, but their effectiveness were largely unknown.

Treatments used for clinical cases and in some experimental studies included nasogastric intubation and the feeding of psyllium mucilloid, magnesium sulfate, dioctyl sodium succinate, mineral oil, and their combinations.

They noted that although research papers had been published on the effects of psyllium on evacuation of sand from the digestive tract, studies directly comparing psyllium feeding with administration by nasogastric intubation were lacking. Moreover, the outcomes of previous studies were contradictory.

The study team set out to compare the effectiveness of three treatment protocols in clearing colonic sand.

They undertook a retrospective clinical study involving 1097 horses and ponies who had been x-rayed for the presence of colon sand between 2009 to 2014. The x-rays were taken at either Clinic A at the Helsinki University Veterinary Teaching Hospital or Clinic B at the Evidensia Equine Clinic Oulu, a private practice.

In all, 246 horses and ponies were ultimately included in the study, all of whom had evidence of more then 75 square centimeters of sand showing on their gut x-rays.

The study team, writing in the journal Acta Veterinaria Scandinavica, described how they assigned the horses into three groups based on their given treatment:

  • Group 1 had been fed psyllium from the desert Indian wheat Plantago ovata at a rate of 1 gram per kilogram of body weight daily at home for a minimum of 10 days. In all, 57 horses had received this treatment.
  • Group 2 horses had been treated once with psyllium or magnesium sulfate by nasogastric tubing, followed by daily feeding of psyllium (at 1 gram per kilogram of body weight) at home for a minimum of 10 days. Nineteen horses received this treatment.
  • Group 3 horses had been treated by daily nasogastric tubing for 3–7 days with psyllium and/or magnesium sulfate (both at 1 gram for each kilogram of body weight). Some horses with very loose feces or high serum magnesium concentrations had received a lesser dose of 0.5 grams per kilogram of magnesium sulfate and/or only psyllium, and a small number had received only the magnesium sulfate. In all, 170 horses received one of protocols listed within Group 3.

The horses treated at home were all x-rayed again within 40 days to assess the result, and those treated in hospital were x-rayed again eight days after the start of treatment. Sand issues were categorized as resolved if the area of sand accumulation was less than 25 square centimeters in control x-rays.

The researchers found that the Group 3 horses had significantly less residual sand than Groups 1 and 2, and the proportion of resolved horses was higher in Group 3 than in Groups 1 and 2.

They concluded: “Daily nasogastric tubing with psyllium and/or magnesium sulfate for 3–7 days removes large accumulations of sand from the colon in horses more effectively than feeding psyllium for at least 10 days.

“More than half of the horses treated with nasogastric tubing where considered resolved within eight days, whereas less than one-third of the horses fed psyllium at home had resolved the sand in the control radiographs taken within 40 days.

“Although keeping the horse in hospital for daily nasogastric intubation is costly, it is not only more efficient, but could eventually be more cost-effective than feeding psyllium at home, because the need for repeated radiological examinations and the delayed recovery increases the costs, as well as the risk of developing colic due to the accumulated sand.

“A single nasogastric intubation of psyllium in addition to further feeding of psyllium at home did not result in any additional benefit, compared with psyllium feeding only,” they noted.

All horses included in the study were fed hay, haylage or a grass based diet.

Kaikkonen is with Oulu Equine Clinic (previously the Evidensia Equine Clinic Oulu); Niinistö, Lindholm and Raekallio are affiliated with the University of Helsinki.

Comparison of psyllium feeding at home and nasogastric intubation of psyllium and magnesium sulfate in the hospital as a treatment for naturally occurring colonic sand (geosediment) accumulations in horses: a retrospective study
Ritva Kaikkonen, Kati Niinistö, Tiina Lindholm and Marja Raekallio.
Acta Veterinaria Scandinavica 2016 58:73 DOI: 10.1186/s13028-016-0254-z

The study, published under a Creative Commons License, can be read here

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