EQUINE VETERINARY EDUCATION / AE / MARCH 2016


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Review Article Nutritional management of recurrent colic and colonic impactions


A. M. House*† and L. K. Warren‡ †Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, USA; and ‡Department of Animal Sciences, University of Florida, Gainesville, USA. *Corresponding author email: housea@ufl.edu


Keywords: horse; recurrent colic; colonic impactions; nutrition; feeding


Summary Although diagnosis and treatment of horses with colic have improved in the last 30 years, horses with recurrent colic can be a diagnostic and management challenge for both owners and veterinarians, and colic remains a high priority health concern of owners (Mellor et al. 2001). Nutritional management of these cases is often based on previous experience combined with recommendations from the evidence-based literature. This review will briefly summarise the aetiologies of recurrent colic and primarily focus on evidence-based nutritional management of colonic impactions, sand enteropathy, inflammatory bowel disease, and idiopathic recurrent colic, which is limited. Additional topics to be covered elsewhere in this series that are relevant to this topic include nutritional management of gastric ulceration, liver disease, colitis, geriatric horses, and feeding the horse pre- and post surgery.


Introduction


Recurrent colic can be defined as repeated episodes of abdominal discomfort over weeks to years with normal periods in between; while chronic colic refers to evidence of colic signs being observed daily for 3 or more days (Schramme 1995; Mair and Hillyer 1997). The causes of recurrent colic are varied and reported aetiologies include parasitism, ulcers, large intestinal obstructions, intestinal neoplasia, small intestinal stenosis, obstruction or muscular hypertrophy, abdominal abscess, abdominal adhesions, chronic grass sickness, enteroliths, intra- or extra-luminal masses resulting in partial obstructions, inflammatory bowel disease (such as eosinophilic or lymphoplasmacytic enteritis or enterocolitis), spasmodic colic, colonic displacements, and many others (Schramme 1995; Hillyer and Mair 1997). Although a definitive aetiology cannot always be determined, many diagnostics are currently available to assist in determining the most likely cause. Nutritional management of these cases can be challenging to direct without the establishment of a definitive aetiology. In one study (Mair and Hillyer 1997), causes of chronic


colic included colonic impaction (31%), peritonitis (16%), no diagnosis (8%), enteritis/colitis (7%), colonic displacement/ torsion (6%), lymphosarcoma (4%), and, to lesser extent, intestinal adhesions, ileal obstructions, liver disease, caecal impactions, thromboembolic disease and intussusceptions. Exploratory celiotomy may be recommended to attempt to make a definitive diagnosis, but owners should be aware that some cases are not amenable to treatment. The prognosis for successful surgical resolution is determined by the lesion, as for any type of colic, but is probably comparable to the


prognosis for acute surgical forms of colic. In some horses in which a specific cause is not found at surgery, clinical signs can persist after surgery, and usually dietary and management changes are recommended for these horses. Treatment and management of affected horses are most effective when they can be targeted at a specific established diagnosis.


Nutritional management of colonic impactions


The most frequent type of simple obstruction resulting in colic is impaction (Tinker et al. 1997a; White and Dabareiner 1997). An association between feeding practices and disturbances in gastrointestinal function has long been hypothesised, but the mechanisms linking diet with the development of intestinal dysfunction are poorly understood (Clarke et al. 1990; Geor and Harris 2007). Recent changes in type of feed or amount of concentrate fed have been associated with increased risk of colic in general (Cohen et al. 1995, 1999; Tinker et al. 1997b; Hudson et al. 2001), as well as increased impaction and distension colic (Clarke et al. 1990; Hillyer et al. 2002). A 2007 study of impaction colic in donkeys indicated that the risk of colic was more than doubled in those fed extra concentrate rations (Cox et al. 2007). Changing to a poorer-quality, less digestible hay may also predispose horses to large colon impaction (Cohen et al. 1999).


Many prospective studies have identified specific


feedstuffs that may present greater colic risk. Although it has not been a consistent finding, pelleted feeds have been proposed to represent a colic risk in some studies (Tinker et al. 1997b). A study in the UK reported increased risk of large colon volvulus in horses fed sugar beet pulp and those fed hay rather than haylage or grass in the month preceeding veterinary treatment (Suthers et al. 2013). In a subpopulation of crib-biting/wind-sucking horses, colic risk was found to be higher in horses fed either hay or haylage compared to grass (Escalona et al. 2014). It is important to note that the composition of feedstuffs can vary greatly, and prospective studies are limited in their definitive evaluation of feeding management and other associative effects that may also influence colic risk (e.g. feed/forage quality, amount fed, number of feedings, group competition at feeding time, how quickly new feed sources are introduced); thus, the association of colic events with specific feedstuffs are not universal to all horses or feeding programmes. Understanding some of the aetiologies and predisposing


factors of colonic impactions, we can focus the discussion on nutritional management of these cases. Horses suffering from simple colic rarely need significant alterations in their diet.


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