Evaluation of Owner-Reported Clinical Signs and Fecal Occult Blood Tests as Predictors of Equine Gastric Ulcer Syndrome in Competition Dressage Horses.

Frippiat, Thibault; Bonhomme, Maëlle; Dyson, Sue; Votion, Dominique

doi:10.1111/jvim.70248

Article (Scientific journals)

Evaluation of Owner-Reported Clinical Signs and Fecal Occult Blood Tests as Predictors of Equine Gastric Ulcer Syndrome in Competition Dressage Horses.

Frippiat, Thibault; Bonhomme, Maëlle; Dyson, Sue et al.

2025 • In Journal of Veterinary Internal Medicine, 39 (6), p. 70248

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https://hdl.handle.net/2268/336645

DOI
10.1111/jvim.70248

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41055229

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Keywords :

clinical epidemiology; equine sports medicine; gastric ulcers; gastrointestinal agents; gastroscopy; horse; Animals; Horses; Case-Control Studies; Male; Female; Gastroscopy/veterinary; Horse Diseases/diagnosis; Horse Diseases/pathology; Stomach Ulcer/veterinary; Stomach Ulcer/diagnosis; Stomach Ulcer/pathology; Occult Blood

Abstract :

[en] [en] BACKGROUND: Equine gastric ulcer syndrome (EGUS) adversely affects the health, welfare, and performance of sports horses, requiring gastroscopy for definitive diagnosis. Owners frequently consider girth aversion as highly suggestive of EGUS. OBJECTIVES: To evaluate whether owner-reported clinical signs or fecal occult blood tests (FOBTs) can help identify horses needing gastroscopy for EGUS diagnosis or monitoring treatment, thereby reducing unnecessary procedures in unaffected horses. ANIMALS: Eighty competition dressage horses referred by veterinarians for EGUS evaluation. METHODS: Case-control study including questionnaire, clinical examination, gastroscopy, and FOBT. Based on gastroscopic findings, horses were classified as cases (presenting equine squamous gastric disease, equine glandular gastric disease, or both) or controls (no lesions). Nineteen horses underwent a follow-up examination after EGUS treatment. Predictive values of clinical signs and fecal hemoglobin were assessed using the Wilson-Brown method, and group differences were analyzed using Mann-Whitney and Fisher's exact tests. RESULTS: Fifty-five horses (69%) had EGUS. The most commonly reported clinical signs in this cohort included girth aversion (78%), poor performance (33%), and weight loss (30%), with no differences between groups (p = 0.44-0.99). Neither clinical signs nor FOBT had sufficient sensitivity or specificity for EGUS screening. Among the 19 horses reevaluated after treatment, resolution of clinical signs did not reliably predict mucosal healing, with poor agreement between owner-reported clinical response and gastroscopic outcome. CONCLUSIONS AND CLINICAL IMPORTANCE: In competition dressage horses, owner-reported clinical signs and FOBT results are unreliable predictors of EGUS or treatment outcomes. Gastroscopy remains essential for accurately diagnosing and monitoring EGUS in sports horses.

Disciplines :

Veterinary medicine & animal health

Author, co-author :

Frippiat, Thibault ; Université de Liège - ULiège > Fundamental and Applied Research for Animals and Health (FARAH) ; Sporthorse Medical Diagnostic Centre (SMDC), Heesch, the Netherlands

Bonhomme, Maëlle ; Université de Liège - ULiège > Fundamental and Applied Research for Animals and Health (FARAH) > FARAH: Médecine vétérinaire comparée

Dyson, Sue ; The Cottage, Market Weston, UK

Votion, Dominique ; Université de Liège - ULiège > Fundamental and Applied Research for Animals and Health (FARAH) > FARAH: Médecine vétérinaire comparée

Language :

English

Title :

Evaluation of Owner-Reported Clinical Signs and Fecal Occult Blood Tests as Predictors of Equine Gastric Ulcer Syndrome in Competition Dressage Horses.

Publication date :

2025

Journal title :

Journal of Veterinary Internal Medicine

ISSN :

0891-6640

eISSN :

1939-1676

Publisher :

Wiley, United States

Volume :

Issue :

Pages :

e70248

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jvim.70248

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since 10 October 2025

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Bibliography

B. W. Sykes, M. Bowen, J. L. Habershon-Butcher, M. Green, and G. D. Hallowell, “Management Factors and Clinical Implications of Glandular and Squamous Gastric Disease in Horses,” Journal of Veterinary Internal Medicine 33, no. 1 (2019): 233–240.
B. W. Sykes, M. Hewetson, R. J. Hepburn, N. Luthersson, and Y. Tamzali, “European College of Equine Internal Medicine Consensus Statement—Equine Gastric Ulcer Syndrome in Adult Horses,” Journal of Veterinary Internal Medicine 29, no. 5 (2015): 1288–1299.
C. M. Lo Feudo, L. Stucchi, B. Conturba, G. Stancari, E. Zucca, and F. Ferrucci, “Equine Gastric Ulcer Syndrome Affects Fitness Parameters in Poorly Performing Standardbred Racehorses,” Frontiers in Veterinary Science 9 (2022): 1014619.
B. Perron, A. B. A. Ali, P. Svagerko, and K. Vernon, “The Influence of Severity of Gastric Ulceration on Horse Behavior and Heart Rate Variability,” Journal of Veterinary Behavior 59 (2023): 25–29.
T. Frippiat and D. M. Votion, “Warm-Up Strategies and Effects on Performance in Racing Horses and Sport Horses Competing in Olympic Disciplines,” Animals 14, no. 6 (2024): 945.
S. R. McClure, L. T. Glickman, and N. W. Glickman, “Prevalence of Gastric Ulcers in Show Horses,” Journal of the American Veterinary Medical Association 215, no. 8 (1999): 1130–1133.
S. K. Pedersen, A. E. Cribb, M. C. Windeyer, E. K. Read, D. French, and H. E. Banse, “Risk Factors for Equine Glandular and Squamous Gastric Disease in Show Jumping Warmbloods,” Equine Veterinary Journal 50, no. 6 (2018): 747–751.
R. Hepburn, “Endoscopic Examination of the Squamous and Glandular Gastric Mucosa in Sport and Leisure Horses: 684 Horses (2005–2011),” in Proceedings of the 11th International Equine Colic Research Symposium (BEVA, 2014), 5.
Y. Tamzali, C. Marguet, N. Priymenko, and F. Lyazrhi, “Prevalence of Gastric Ulcer Syndrome in High-Level Endurance Horses,” Equine Veterinary Journal 43, no. 2 (2011): 141–144.
M. J. Murray and E. S. Eichorn, “Effects of Intermittent Feed Deprivation, Intermittent Feed Deprivation With Ranitidine Administration, and Stall Confinement With Ad Libitum Access to Hay on Gastric Ulceration in Horses,” American Journal of Veterinary Research 57, no. 11 (1996): 1599–1603.
Y. Gharehaghajlou, S. L. Raidal, F. Freccero, and B. Padalino, “Effects of Transport and Feeding Strategies Before Transportation on Redox Homeostasis and Gastric Ulceration in Horses,” Journal of Equine Veterinary Science 126 (2023): 104268.
B. Padalino, G. L. Davis, and S. L. Raidal, “Effects of Transportation on Gastric pH and Gastric Ulceration in Mares,” Journal of Veterinary Internal Medicine 34, no. 2 (2020): 922–932.
J. Mönki, M. Hewetson, and A.-M.K. Virtala, “Risk Factors for Equine Gastric Glandular Disease: A Case-Control Study in a Finnish Referral Hospital Population,” Journal of Veterinary Internal Medicine 30, no. 4 (2016): 1270–1275.
N. Luthersson, K. H. Nielsen, P. Harris, and T. D. H. Parkin, “The Prevalence and Anatomical Distribution of Equine Gastric Ulceration Syndrome (EGUS) in 201 Horses in Denmark,” Equine Veterinary Journal 41, no. 7 (2009): 619–624.
B. Bezděková, P. Jahn, and M. Vyskočil, “Gastric Ulceration, Appetite and Feeding Practices in Standardbred Racehorses in the Czech Republic,” Acta Veterinaria 77, no. 4 (2008): 603–607.
S. P. Daniels, L. Scott, I. De Lavis, A. Linekar, and A. J. Hemmings, “Crib Biting and Equine Gastric Ulceration Syndrome: Do Horses That Display Oral Stereotypies Have Altered Gastric Anatomy and Physiology?,” Journal of Veterinary Behavior 30 (2019): 110–113.
M. J. Murray, C. Grodinsky, C. W. Anderson, P. F. Radue, and G. R. Schmidt, “Gastric Ulcers in Horses: A Comparison of Endoscopic Findings in Horses With and Without Clinical Signs,” Equine Veterinary Journal 21, no. S7 (1989): 68–72.
F. M. Andrews and J. A. Nadeau, “Clinical Syndromes of Gastric Ulceration in Foals and Mature Horses,” Equine Veterinary Journal 31, no. S29 (1999): 30–33.
C. M. Lo Feudo, L. Stucchi, B. Conturba, G. Stancari, E. Zucca, and F. Ferrucci, “Medical Causes of Poor Performance and Their Associations With Fitness in Standardbred Racehorses,” Journal of Veterinary Internal Medicine 37, no. 4 (2023): 1514–1527.
J. Vokes, A. Lovett, and B. Sykes, “Equine Gastric Ulcer Syndrome: An Update on Current Knowledge,” Animals 13, no. 7 (2023): 1261.
S. H. Franklin, T. J. Brazil, and K. J. Allen, “Poor Performance Associated With Equine Gastric Ulceration Syndrome in Four Thoroughbred Racehorses,” Equine Veterinary Education 20, no. 3 (2008): 119–124.
S. Gough, G. Hallowell, and D. Rendle, “Evaluation of the Treatment of Equine Glandular Gastric Disease With Either Long-Acting-Injectable or Oral Omeprazole,” Veterinary Medicine and Science 8, no. 2 (2022): 561–567.
S. Gough, G. Hallowell, and D. Rendle, “A Study Investigating the Treatment of Equine Squamous Gastric Disease With Long-Acting Injectable or Oral Omeprazole,” Veterinary Medicine and Science 6, no. 2 (2020): 235–241.
E. M. Millares-Ramirez and S. S. Le Jeune, “Girthiness: Retrospective Study of 37 Horses (2004-2016),” Journal of Equine Veterinary Science 79 (2019): 100–104.
M. Hewetson, F. Hoksbergen, S. Berger, et al., “Association Between Owner-Perceived Clinical Signs and the Presence of Equine Glandular Gastric Disease on Endoscopy,” Equine Veterinary Journal 53, no. S55 (2021): 7–8.
R. van den Boom, “Equine Gastric Ulcer Syndrome in Adult Horses,” Veterinary Journal 283–284 (2022): 105830.
J. A. Spanton, L. Smith, and T. S. Mair, “A Clinical Audit of the Prevalence of Colic in the 48 Hours After Gastroscopy in 436 Horses,” Equine Veterinary Education 32, no. S11 (2020): 12–15.
A. G. Bonilla, S. D. Hurcombe, R. W. Sweeney, M. Hewetson, and M. C. Mudge, “Small Intestinal Segmental Volvulus in Horses After Gastroscopy: Four Cases (2011–2012),” Equine Veterinary Education 26, no. 3 (2014): 141–145.
S. Busechian, M. Sgorbini, S. Orvieto, et al., “Evaluation of a Questionnaire to Detect the Risk of Developing ESGD or EGGD in Horses,” Preventive Veterinary Medicine 188 (2021): 105285.
T. Shawaf, W. M. El-Deeb, and M. Elgioushy, “The Contribution of Specific and Nonspecific Biomarkers in Diagnosis of Equine Gastric Ulcer Syndrome (EGUS) Under Field Condition,” Journal of Equine Veterinary Science 84 (2020): 102853.
M. Hewetson, B. W. Sykes, G. D. Hallowell, and R. M. Tulamo, “Diagnostic Accuracy of Blood Sucrose as a Screening Test for Equine Gastric Ulcer Syndrome (EGUS) in Adult Horses,” Acta Veterinaria Scandinavica 59, no. 1 (2017): 15.
A. Muñoz-Prieto, E. Llamas-Amor, J. J. Cerón, and S. Hansen, “Changes in Saliva Analytes in Equine Gastric Ulcer Syndrome (EGUS) After Treatment: A Pilot Study,” Research in Veterinary Science 176 (2024): 105346.
G. Ferlini Agne, B. E. May, A. Lovett, et al., “Horse Grimace Scale Does Not Detect Pain in Horses With Equine Gastric Ulcer Syndrome,” Animals 13, no. 10 (2023): 1623.
S. Dyson, J. Berger, A. D. Ellis, and J. Mullard, “Development of an Ethogram for a Pain Scoring System in Ridden Horses and Its Application to Determine the Presence of Musculoskeletal Pain,” Journal of Veterinary Behavior 23 (2018): 47–57.
V. Pineau, F. ter Woort, F. Julien, et al., “Improvement of Gastric Disease and Ridden Horse Pain Ethogram Scores With Diet Adaptation in Sport Horses,” Journal of Veterinary Internal Medicine 38, no. 6 (2024): 3297–3308.
I. A. Rebalka and M. I. Lindinger, “In Vitro Validation Assessment of a Fecal Occult Blood Protein Test for Horses,” Journal of Equine Veterinary Science 104 (2021): 103695.
D. C. Rockey, J. Koch, J. P. Cello, L. L. Sanders, and K. McQuaid, “Relative Frequency of Upper Gastrointestinal and Colonic Lesions in Patients With Positive Fecal Occult-Blood Tests,” New England Journal of Medicine 339, no. 3 (1998): 153–159.
T. H. Chiang, Y. C. Lee, C. H. Tu, H. M. Chiu, and M. S. Wu, “Performance of the Immunochemical Fecal Occult Blood Test in Predicting Lesions in the Lower Gastrointestinal Tract,” Canadian Medical Association Journal 183, no. 13 (2011): 1474–1481.
S. L. Munch, S. S. Nielsen, M. A. Krogh, and N. Capion, “Evaluation of Two Fecal Occult Blood Tests for Detecting Non-Perforating Abomasal Lesions in Cattle,” Animals 10, no. 12 (2020): 2356.
S. Neubert, C. Puff, S. Kleinschmidt, et al., “Gastric Ulcers in Alpacas-Clinical, Laboratory, and Pathological Findings,” Frontiers in Veterinary Science 9 (2022): 877257.
F. L. Pellegrini, “Results of a Large-Scale Necroscopic Study of Equine Colonic Ulcers,” Journal of Equine Veterinary Science 25, no. 3 (2005): 113–117.
B. Sykes, J. Jokisalo, and G. Hallowell, “Evaluation of a Commercial Faecal Blood Test for the Diagnosis of Gastric Ulceration in Thoroughbred Racehorses: A Preliminary Report,” in Proceedings of the 11th International Equine Colic Research Symposium (BEVA, 2014), 4.
D. Ramey, J. Murrell, T. Fischer, T. Brauer, A. Klohnen, and M. Lee, “Fecal Blood Hemoglobin and Albumin Test Does Not Diagnose Gastric Ulceration in the Horse,” in Proceedings of the 62nd Annual Convention of the American Association of Equine Practitioners (AAEP, 2016), 232.
R. Videla and F. M. Andrews, “New Perspectives in Equine Gastric Ulcer Syndrome,” Veterinary Clinics of North America: Equine Practice 25, no. 2 (2009): 283–301.
A. M. Hartmann and R. L. Frankeny, “A Preliminary Investigation Into the Association Between Competition and Gastric Ulcer Formation in Non-Racing Performance Horses,” Journal of Equine Veterinary Science 23, no. 12 (2003): 560–561.
C. L. Carroll and P. J. Huntington, “Body Condition Scoring and Weight Estimation of Horses,” Equine Veterinary Journal 20, no. 1 (1988): 41–45.
F. Andrews, W. Bernard, D. Byars, et al., “Recommendations for the Diagnosis and Treatment of Equine Gastric Ulcer Syndrome (EGUS): The Equine Gastric Ulcer Council,” Equine Veterinary Education 11, no. 5 (1999): 262–272.
B. W. Sykes and J. M. Jokisalo, “Rethinking Equine Gastric Ulcer Syndrome: Part 1—Terminology, Clinical Signs and Diagnosis,” Equine Veterinary Education 26, no. 10 (2014): 543–547, https://doi.org/10.1111/eve.12236.
L. C. Kranenburg, S. H. van der Poel, T. S. Warmelink, D. A. van Doorn, and R. van den Boom, “Changes in Management Lead to Improvement and Healing of Equine Squamous Gastric Disease,” Animals 13, no. 9 (2023): 1498.
L. Brown, T. Cai, and A. DasGupta, “Interval Estimation for a Binomial Proportion,” Statistical Science 16, no. 2 (2001): 101–117.
E. B. Wilson, “Probable Inference, the Law of Succession, and Statistical Inference,” Journal of the American Statistical Association 22, no. 158 (1927): 209–212.
J. Baptista and M. C. Pike, “Exact Two-Sided Confidence Limits for the Odds Ratio in a 2 × 2 Table,” Journal of the Royal Statistical Society. Series C, Applied Statistics 26, no. 2 (1977): 214–220.
S. Busechian, F. Bindi, C. Pieramati, et al., “Is There a Difference in the Prevalence of Gastric Ulcers Between Stallions Used for Breeding and Those Not Used for Breeding?,” Animals 14, no. 11 (2024): 1531.
S. Dyson, A. Bondi, J. Routh, et al., “An Investigation of Behaviour During Tacking-Up and Mounting in Ridden Sports and Leisure Horses,” Equine Veterinary Education 34, no. 6 (2022): e245–e257.
S. Dyson, A. Bondi, J. Routh, and D. Pollard, “An Investigation Into the Relationship Between Equine Behaviour When Tacked-Up and Mounted and Epaxial Muscle Hypertonicity or Pain, Girth Region Hypersensitivity, Saddle-Fit, Rider Position and Balance, and Lameness,” Equine Veterinary Education 34, no. 6 (2022): e258–e267.
T. Frippiat, L. van den Wollenberg, E. van Erck-Westergren, K. van Maanen, and D. M. Votion, “Respiratory Viruses Affecting Health and Performance in Equine Athletes,” Virology 603 (2025): 110372.
T. Frippiat, T. Art, and I. Tosi, “Airway Hyperresponsiveness, but Not Bronchoalveolar Inflammatory Cytokines Profiles, Is Modified at the Subclinical Onset of Severe Equine Asthma,” Animals 13, no. 15 (2023): 2485.
T. Frippiat, C. van Beckhoven, E. Moyse, and T. Art, “Accuracy of a Heart Rate Monitor for Calculating Heart Rate Variability Parameters in Exercising Horses,” Journal of Equine Veterinary Science 104 (2021): 103716.
E. van Erck, V. Jakesova, P. Lekeux, and T. Art, “Field Evaluation of Poor Performance in Standardbred Trotters,” Pferdeheilkunde 22, no. 5 (2006): 625–631.
B. Sykes and A. Lovett, “Can All Behavioral Problems be Blamed on Equine Gastric Ulcer Syndrome?,” Animals 15, no. 3 (2025): 306.
C. Torcivia and S. M. McDonnell, “Behavioral Signature of Equine Gastric Discomfort? Preliminary Retrospective Clinical Observations,” Animals 15, no. 1 (2025): 88.
N. J. Vatistas, J. R. Snyder, G. Carlson, et al., “Cross-Sectional Study of Gastric Ulcers of the Squamous Mucosa in Thoroughbred Racehorses,” Equine Veterinary Journal 31, no. S29 (1999): 34–39.
F. M. Andrews, P. Camacho-Luna, P. G. Loftin, et al., “Effect of a Pelleted Supplement Fed During and After Omeprazole Treatment on Nonglandular Gastric Ulcer Scores and Gastric Juice pH in Horses,” Equine Veterinary Education 28, no. 4 (2016): 196–202.
C. Williams, B. E. Sahagún, and M. K. Su, “Biostatistics and Epidemiology Principles for the Toxicologist: The “Testy” Test Characteristics Part II: Positive Predictive Value and Negative Predictive Value,” Journal of Medical Toxicology 19, no. 3 (2023): 298–302.
T. Frippiat, C. Paindaveine, J. N. Duprez, C. Delguste, J. Mainil, and T. Art, “Evaluation of the Bactericidal Effect of Nebulized Silver Nanoparticles on Common Respiratory Bacteria in Horses– In Vitro Studies,” Journal of Equine Veterinary Science 103 (2021): 103635.
B. W. Sykes, K. M. Sykes, and G. D. Hallowell, “A Comparison of Three Doses of Omeprazole in the Treatment of Equine Gastric Ulcer Syndrome: A Blinded, Randomised, Dose–Response Clinical Trial,” Equine Veterinary Journal 47, no. 3 (2015): 285–290.
B. W. Sykes, K. M. Sykes, and G. D. Hallowell, “A Comparison of Two Doses of Omeprazole in the Treatment of Equine Gastric Ulcer Syndrome: A Blinded, Randomised, Clinical Trial,” Equine Veterinary Journal 46, no. 4 (2014): 416–421.
J. Bush, R. van den Boom, and S. Franklin, “Comparison of Aloe Vera and Omeprazole in the Treatment of Equine Gastric Ulcer Syndrome,” Equine Veterinary Journal 50, no. 1 (2018): 34–40.
N. Luthersson, C. Bolger, P. Fores, et al., “Effect of Changing Diet on Gastric Ulceration in Exercising Horses and Ponies After Cessation of Omeprazole Treatment,” Journal of Equine Veterinary Science 83 (2019): 102742.
L. N. R. Kjærulff and C. Lindegaard, “Performance and Rideability Issues in Horses as a Manifestation of Pain: A Review of Differential Diagnosis and Diagnostic Approach,” Equine Veterinary Education 34, no. 2 (2022): 103–112.
T. Frippiat, C. van Beckhoven, V. J. Gasselt, A. Dugdale, and J. M. Vandeweerd, “Effect of Gait on, and Repeatability of Heart Rate and Heart Rate Variability Measurements in Exercising Warmblood Dressage Horses,” Comparative Exercise Physiology 19, no. 5 (2023): 461–472.
S. Dyson, “The Ridden Horse Pain Ethogram,” Equine Veterinary Education 34, no. 7 (2022): 372–380.
M. A. Rothschild, M. Oratz, J. Mongelli, and S. S. Schreiber, “Effects of a Short-Term Fast on Albumin Synthesis Studied In Vivo, in the Perfused Liver, and on Amino Acid Incorporation by Hepatic Microsomes,” Journal of Clinical Investigation 47, no. 12 (1968): 2591–2599.
X. C. Zeng, C. M. Yang, X. Y. Pan, et al., “Effects of Fasting on Hematologic and Clinical Chemical Values in Cynomolgus Monkeys (Macaca fascicularis),” Journal of Medical Primatology 40, no. 1 (2011): 21–26.
G. Nunes, M. Guimarães, H. Coelho, et al., “Prolonged Fasting Induces Histological and Ultrastructural Changes in the Intestinal Mucosa That May Reduce Absorption and Revert After Enteral Refeeding,” Nutrients 16, no. 1 (2023): 128.