Clinical management of gastroduodenitis and equine gastric ulcer syndrome grade IV of unknown origin in an Arabian mare
Authors: S. Alonso-Sousa, M. D. Rijck, M. Lores, J. Brunsting
Journal: Vlaams Diergeneeskundig Tijdschrift
Summary
# Editorial Summary A two-year-old Arabian filly presenting with acute colic and endotoxaemic signs was found to have severe gastroduodenitis with grade IV equine gastric ulcer syndrome (EGUS) on gastroscopy, accompanied by significant gastric distention and eight litres of haemorrhagic reflux retrieved via nasogastric intubation. The clinical team employed a staged pharmaceutical approach: parenteral pantoprazole was initiated immediately, then supplemented with enteral ranitidine and sucralfate once reflux cessation allowed safe oral dosing. At discharge (day 11), ulcer healing had reached 75%, progressing to 90% (grade I) on follow-up gastroscopy 30 days later, representing the first documented case of this specific three-drug combination's use in severe EGUS management. Whilst the underlying cause remained unidentified, this case demonstrates that aggressive dual-acid suppression via different mechanisms—combined with cytoprotective therapy—can achieve substantial healing even in grade IV ulceration, potentially offering a valuable treatment protocol for practitioners managing refractory or severe gastric disease when standard single-agent therapy proves inadequate.
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Practical Takeaways
- •Severe EGUS grade IV can present acutely as colic with endotoxemia signs; consider gastroscopy in colic cases with prolonged nasogastric reflux
- •Combining parenteral pantoprazole with enteral ranitidine and sucralfate may be an effective protocol for severe ulceration, achieving substantial healing within 30 days
- •Close monitoring with repeat gastroscopy is valuable to confirm healing progression and guide ongoing medical management
Key Findings
- •A 2-year-old Arabian filly with severe EGUS grade IV and gastroduodenitis presented with 8 liters of hemorrhagic gastric reflux and severe gastric distention
- •Combined parenteral pantoprazole, enteral ranitidine, and sucralfate treatment achieved 75% ulcer healing by day 11 and 90% healing (EGUS grade I) by day 30
- •This is the first reported case of this three-drug combination for treating severe (grade IV) EGUS in horses