Comparison of endoscopic, necropsy and histology scoring of equine gastric ulcers.
Authors: Andrews F M, Reinemeyer C R, McCracken M D, Blackford J T, Nadeau J A, Saabye L, Sötell M, Saxton A
Journal: Equine veterinary journal
Summary
# Endoscopic Assessment of Equine Gastric Ulcers: Significant Limitations Revealed Equine gastric ulcer syndrome (EGUS) affects a substantial proportion of performance horses, yet considerable uncertainty surrounds the reliability of endoscopic scoring systems for predicting ulcer depth and severity—the focus of this 2002 study comparing endoscopic findings against necropsy and histopathological examination in 23 yearling horses. The researchers scored ulcers using two endoscopic systems (number/severity and practitioner simplified) during live examination under general anaesthesia, then repeated assessment at necropsy and performed histopathological analysis to grade ulcer depth. Whilst all 23 horses presented with nonglandular ulcers, endoscopic examination significantly underestimated ulcer numbers compared to necropsy findings, and only one horse showed glandular ulcers endoscopically despite six horses having glandular lesions confirmed at necropsy and histology—suggesting clinicians may miss important pathology in up to 26% of cases. The number/severity endoscopic score showed only weak correlation with histopathological depth (r = 0.453), whilst the simplified scoring system showed no meaningful correlation whatsoever, indicating that severity grading during live examination poorly predicts actual ulcer depth. For practitioners, these findings underscore that endoscopic assessment, whilst valuable for diagnosis, should be interpreted cautiously regarding ulcer numbers and severity; negative endoscopic findings do not exclude glandular disease, and treatment decisions should incorporate clinical presentation and response to management rather than relying exclusively on endoscopic scoring.
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Practical Takeaways
- •Endoscopic examination alone may significantly underestimate both the number and severity of gastric ulcers; negative or mild endoscopic findings should not exclude EGUS as a diagnosis
- •Glandular ulcers are frequently missed during endoscopy—clinical signs suggestive of EGUS warrant treatment even if endoscopic findings appear minimal
- •The practitioner simplified (PS) scoring system performed better for consistency between endoscopy and necropsy for ulcer counts, though neither system accurately predicted ulcer depth
Key Findings
- •Endoscopic examination significantly underestimated nonglandular ulcer numbers compared to necropsy (P = 0.0024), with mean ENGN scores lower on endoscopy than at necropsy
- •Endoscopic severity scores showed only weak correlation with histopathological ulcer depth (r = 0.453, P = 0.045) using the N/S system, with no correlation using the PS system
- •Glandular ulcers were missed by endoscopy in most horses: only 1/23 detected endoscopically versus 6/23 at necropsy and histopathology
- •All 23 stalled yearling horses had gastric ulcers in the nonglandular mucosa, indicating high EGUS prevalence in this population