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Definition

Withholding of enteral nutrition and use of parenteral nutrition leads to a decrease in gut mass and structural protein, decreased motility and digestive function and loss of mucosal integrity. Development of gastric ulcers also can occur.

Risk factors

Foals are at particular risk of developing gastric ulcers.

Pathogenesis

Enterocytes need food. Enteral feeding is also less expensive, more physiological, improves immunity including gastrointestinal immunity and is easier and safer. Neonatal foals that receive PPN or TPN without additional enteral feeding are prone to development of gastric ulcers during that period and after re‐feeding [70].

Prevention

Some human studies suggest that the route of administration is not as important as providing calories in itself; recommendations are still to institute early use of enteral nutrition if possible [82]. Current recommendations of the American Society for Parenteral and Enteral Nutrition are to avoid parenteral nutrition when the gastrointestinal tract can tolerate enteral nutrition [83]. Gastric protectants should be administered (0.5 mg/kg Omeprazol IV or 4.4 mg/kg omeprazole PO) to prevent gastric ulcers in adult horses and foals. Sucralfate (12 mg/kg PO q12 h) can be administered concurrently as mucosal protectant. H₂ receptor antagonists (ranitidine 6.6 mg/kg q8 h PO) can be administered instead of omeprazole if it is unavailable or has proven to be ineffective in the patient [84].

Diagnosis and clinical signs

Clinical signs of gastric ulcers include recurrent colic, salivation and bruxism.

Treatment

Enteral feeding should be reintroduced gradually. Some foals may also require help to develop normal nursing behavior after prolonged periods of being off feed.

Expected outcome

Outcome is largely dependent on the underlying disease. Gastric ulcers in foals can perforate without prior clinical signs; in these cases prognosis is grave.