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Pioneering research in practice
  1. Richard Hepburn

Abstract

Practitioner Richard Hepburn recently completed a Masters in gastric ulceration in horses, during which he identified what he believes is a new gastric condition. He is in his first year of a PhD to continue his studies

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MY study of gastric ulceration in horses began in February 2012, and I presented the initial findings of my work at the American College of Veterinary Internal Medicine's annual forum in New Orleans in June last year.

I now want to raise awareness and understanding of what I believe is a separate, and poorly understood, condition, which I have called ‘Equine glandular gastritis-erosion syndrome’ (EGGeS). In order to study this condition I am about to embark on a PhD with the Institute of Translational Medicine, University of Liverpool. The aim is to achieve a baseline description of what EGGeS actually is, what might cause it and how we can avoid it!

Collaboration

I chose Liverpool because of its exceptional record of research in equine gastroenterology, and its interest in clinical research. Large clinical population-based studies such as this give a great opportunity for collaboration between private practice and academia, but are still unusual in equine medicine. The Institute of Translational Medicine is especially exciting as I am part of a group that includes basic scientists, microbiologists and pathologists, as well as specialists from both human and veterinary medicine.

There are two parts to the study – the first is a retrospective analysis of over 500 cases of glandular disease, looking at endoscopic appearance, clinical signs and initial epidemiology. The next part is prospective investigation into the pathophysiology and epidemiology of the condition. This involves histological description of lesion types, metagenomic investigation into the role of bacteria, assessment of the role of mucus dysfunction and identification of risk factors for lesion development. In both parts we are using clinical cases.

Current knowledge

There is an increasing awareness that glandular disease is different – it involves a different population, shows different clinical signs and requires different treatment and management techniques. In general it appears more common in older sport and leisure horses, so it is general equine practitioners rather than those in racetrack practice who see these cases.

EGGeS is not just an acid injury, it is a combination of mucosal inflammation and erosion. Acid suppression is a vital component of treatment, in addition to mucosal protectants, cellular restitution promoters and potentially antibiotics.

Identification of suitably suggestive clinical signs in a particular population will help to identify appropriate cases for endoscopy. Appreciation of the cause of particular lesion types will help to focus therapy and improve healing rates.

Identifying cases

I hope to complete the study within the next four years, although we plan to publish parts of the data as we go.

Clearly the more cases, the better the data. I plan to produce an information sheet to give to referring vets in order to identify suitable cases for endoscopy. This will hopefully be one of the first products of our analysis of the retrospective data. If anyone would like to get involved, please contact me, e-mail: richard.hepburn@liverpool.ac.uk

InnerVision national gastroscopy event

Richard is organising the UK's first national gastroscopy survey, the aim of which is to better understand the prevalence of equine gastric ulcer syndrome (EGUS) in performance horses. Gastroscopies will take place during May. He is inviting equine vets to apply to scope approximately 10 horses per practice (ideally during one day). The horses must be British Showjumping, British Dressage or British Eventing registered and must have been in work for four weeks before the scoping day. To get involved with the survey e-mail: richard.hepburn@liverpool.ac.uk

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