Changes

Performed under mild sedation in standing horse or foal (Sanchez)

Performed under mild sedation in standing horse or foal (Sanchez)

Duodenoscopy is most specific diagnostic method but is technically me chanllenegng than gastrocopy

Duodenoscopy is most specific diagnostic method but is technically me chanllenegng than gastrocopy(Sanchez)

EGUS Lesion Scoring System publsihed based on consens by Equine Gastric Ulcer Council(2 in Sanchez)

 

Note that no mention of bleeding is made in assigning lesion grades, because bleeding does not determine lesion severity. Small superficial erosions (Fig 3) may bleed, whereas deep ulcers may not have active haemorrhage at the time of endoscopic examination.(EGUC)

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While these systems are useful for assessing the extent of disease and monitoring response to treatment, little work has been done to correlate gross observations with the histological picture. Lesions that appear alike grossly and receive similar numerical scores may have dissimilar histological appearances and underlying pathogeneses.(Martineau 2009)

In contrast to other scoring systems(MacAllistaer et al 1997), the EGUC approach does not include bleeding when assigning lesion grades. The justification is that the 'snapshot' provided by endoscopy may by chance identify bleeding of superficial erosions whilst missing the intermittent haemorrhage of more severe lesions.(EGUC)

The endoscopist may underestimate the n u m b e r of gastric ulcers and may not be able accurately to p redict the severity or depth of those ulcers present in the n o n g l a n d u l a r equine stomach. Furt h e r m o re, the endoscopist may miss glandular gastric ulcers. (Andrews 2002

 

Endoscopy may assist in understanding the severity of the disease and assessing the therapeutic response, but it is not without disadvantages.  Ulcer severity may be underestimated, particularly in the squamous region and glandular ulcers may be missed altoghether(Andrews 2002).  Lesions that appear grossly similar may have different grades on histopathology(Martinaeu 2009).  This is important as varying lesions may have different causes, requiring a range of treatment approaches.

Diffuse reddeing or inflammation may be only lesion seen in cases of early duodenal disease

Diffuse reddeing or inflammation may be only lesion seen in cases of early duodenal disease