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→Diagnosis
===Endoscopy===
===Endoscopy===
(cannot do in foals as need to starve prior to exam)
Oesophagogastroscopy or duodenoscopy can be performed under mild sedation in the standing horse.(Sanchez) Of these, duodenoscopy is the more specific but more technically demanding method(Sanchez). Endoscopic examination requires preparatory starving of the patient, eliciting a certain degree of stress. As such, it is preferable not to carry out this technique in foals.
ante mortem using a 2.5–3.0 m endoscope and utilising an established scoring system (Nadeau 2009)
ante mortem using a 2.5–3.0 m endoscope and utilising an established scoring system (Nadeau 2009)
Adults - margo plicatus and squamous epithelium
Adults - margo plicatus and squamous epithelium
Based on a consensus, the Equine Gastric Ulcer Council (EGUC) publised an EGUS Lesion Scoring System which they claimed to be simple and applicable to both regions of the equine gastric mucosa(EGUC). This last point has been debated, since most of the acquired data on gastric lesions refers only to the squamous mucosa(Merritt). At the time of writing however, the EGUC system appears to be the most well established and useful in practice:
Based on a consensus, the Equine Gastric Ulcer Council (EGUC) publised an EGUS Lesion Scoring System which they claimed to be simple and applicable to both regions of the equine gastric mucosa(EGUC). This last point has been debated, since most of the acquired data on gastric lesions refers only to the squamous mucosa(Merritt). At the time of writing however, the EGUC system appears to be the most well established and useful in practice:
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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)
Diffuse inflammation may be the only lesion observed in foals with early GDUD.(Sanchez) 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) 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(Martineau 2009). This is important as varying lesions may have different causes, requiring a range of treatment approaches.
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.
===Radiography===
===Radiography===
In foals, abdominal radiography can be used to highlight gastric outflow obstruction. Liquid barium will demonstrate very delayed or no outflow depending on the degree of obstruction. Without contrast medium, a large, gas filled stomach will be obvious.<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref>
In older foals with GDUD, detection of gastric outflow obstruction via abdominal radiography is essential to treatment and prognosis.(Sanchez) Liquid barium will demonstrate very delayed or no outflow depending on the degree of obstruction. Without contrast medium, a large, gas filled stomach will be obvious.<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref>. The need to perform contrast radiography must be weighed against the stress it would place upon the foal.
===Biopsy===
===Biopsy===