Chronic severe pyloric lesions in horses: 47 cases.
Authors: Bezdekova B, Wohlsein P, Venner M
Journal: Equine veterinary journal
Summary
# Chronic Severe Pyloric Lesions in Horses: Clinical Presentation and Prognosis This retrospective review of 47 horses (median age 3 years) with chronic severe pyloric lesions reveals a clinical syndrome characterised by poor body condition (87%), slow eating (83%), recurrent colic (74%) and selective appetite (64%), often accompanied by delayed gastric emptying demonstrable on endoscopy or ultrasonography. All affected horses displayed severe squamous gastric disease alongside fibrinosuppurative pyloric ulceration, with nearly one-fifth also showing distal oesophagitis; hypoalbuminaemia was the most common laboratory finding, detected in 36% of cases. Despite anti-ulcer medication in 32 treated horses—with four undergoing surgical gastrojejunostomy—clinical recurrence occurred in at least 11 cases, and long-term survival (>6 months) was achieved in only 41% of horses with follow-up data. Most strikingly, age at diagnosis proved a critical prognostic factor: horses diagnosed at three years or younger had a survival rate of 28% compared with 72% in older horses, suggesting substantially different disease trajectories between young and mature animals. For practitioners, this data underscores the guarded prognosis of chronic pyloric disease, particularly in young stock where early recognition through endoscopy and ultrasonography may guide more intensive intervention or informed client counselling regarding realistic treatment expectations.
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Practical Takeaways
- •Chronic pyloric lesions should be considered as a differential diagnosis in young horses presenting with weight loss, slow eating, and recurrent colic, particularly if squamous gastric disease is identified on endoscopy
- •Medical management with anti-ulcer therapy achieves initial improvement in most cases (88%), but recurrence is common and long-term prognosis remains poor, especially in horses under 3 years old
- •Early recognition and discussion of realistic prognosis is important, as only 41% achieve long-term survival regardless of treatment approach
Key Findings
- •47 horses with chronic severe pyloric lesions presented with poor body condition (87%), slow eating (83%), and recurrent colic (74%)
- •Hypoalbuminaemia was the most common laboratory abnormality (36%), and delayed gastric emptying was confirmed in 62% of cases
- •Only 41% of horses survived long-term, with significantly worse prognosis in horses diagnosed at ≤3 years of age (27.8% survival vs 72.2% in older horses)
- •Clinical signs recurred after medical treatment in at least 11 of 32 treated cases, and gastrojejunostomy did not prevent recurrence