Journal of Veterinary Advances Risk Factors Associated with Impaction Colic in Horses at rth Western Area of Libya Sawesi O., Milad K. K. and El-Khodery S. A. J Vet Adv 15, 5(8): 64-70 DOI:.5455/jva.1508014434 Online version is available on: www.grjournals.com
ISSN: 2251-7685 SAWESI ET AL. Risk Factors Associated with Impaction Colic in Horses at rth Western Area of Libya Sawesi O., Milad K. K. and El-Khodery S. A. Original Article * Department of Internal Medicine, Faculty of Veterinary Medicine, University of Tripoli, Tripoli, Libya. Abstract Colic is a serious clinical condition affecting the welfare and survival of horses at the studs worldwide. However little is known about the incidence or risk factors associated with this condition among different horse groups or populations in Libya. In this work, we assessed the risk factors associated with impaction colic in horses in western part of Libya. Diagnosis was based on clinical findings and rectal examination. A questionnaire was constructed to assess the risk factors. Data analysis was performed by logistic regression analysis. Eighty-three horses were showing signs of impaction colic. Final multivariate logistic regression model showed that there was a significant association between the occurrence of impaction colic and previous exposure to colic (p < 0.5 ; OR: 1.9; 95% CI: 7.5-8.9 ), Dental diseases (p < 0.05 ; OR: 3.2 95% CI:1.1-9.5), racing (p < 0.5 ; OR: 4.2 95% CI: 3.9-4.5 ), and breed (d < 0.05; OR: 86.9; 95% CI:2.3-3.2. The results of the present study indicate that managemental risk factors are the major risks for impaction colic in race horses. Identification of risk factors may assist the clinician to construct effective preventive measures. Keywords: Impaction colic, horses, risk factors, Libya. Corresponding author: Department of Internal Medicine, Faculty of Veterinary Medicine, University of Tripoli, Tripoli, Libya. Received on: 28 Jun 15 Revised on: 08 Jul 15 Accepted on: Aug 15 Online Published on: 30 Aug 15 64 J. Vet. Adv., 15, 5(8): 64-70
RISK FACTORS ASSOCIATED WITH IMPACTION COLIC IN Introduction Colic in horses is a significant problem in terms of morbidity, mortality and economics; in some equine populations (Archer & Proudman 06). Impactions are a common cause of colic (Reeves 1997), and occur when ingesta causes obstruction of the digestive tract. They can occur throughout the gastrointestinal tract, but most frequently affect the large colon. The location of the impaction affects both treatment and prognosis. Caecal and small colon impactions have a high rate of surgical intervention, with referral hospital based case studies reporting surgical intervention rates of 43% of 114 cases of caecal impaction (Plummer 09), and 44% of 84 cases of small colon impaction (Rhoads et al., 1999). Impaction of the Caecum has a high risk of rupture, with a mortality rate of 25% (Plummer et al., 07). In contrast, large colon impactions usually have a successful outcome with simple medical treatment, but a small number may require prolonged fluid therapy or surgical treatment (Kaneene et al., 1997). Reports on a case series of large colon impactions from a referral hospital population showed that impaction represents 16% of cases requiring surgery (Lopes et al.,). Epidemiological study has established that colic is complex and some studies have produced differing results about the effect of individual risk factors. However, several potential factors have been identified, for example, feeding practice, changes in management practices, lack of access to pasture or to water (Jennings et al., 14). prevalence and risk factors have been studied not only in horses, but also donkeys (Dabareiner & White 1995, Durham 09). A number of risk factors are linked with large intestinal impactions, where management factors are the major factors (Hillyer et al., 02). It has been found that the evidence on risk factors, clinical findings and outcome in large colon impaction cases is based on referral hospital populations (Hillyer et al., 01, Hillyer et al., 02). However, there is no evidence from first opinion practice on the wider population, and on how large colon impaction cases initially present to the veterinary surgeon (Hillyer et al., 02). To the best of our knowledge, the studies on colic and associated risk factors in Libya have not been studied. Therefore, the aim of the present study was to assess the initial clinical presentation and risk factors associated with impaction colic in horses in western Libya. Materials and Methods Study Area The present study was carried out on a random stable in the western part of Libya on an area, which extends from Misrata east to Sabrata west and further south to include sahl Gavara and western mountain south of Tripoli to cover areas of equine rearing in western part of the country. Horses A total of 4 horses at 3- years of age and 300-450 kg weight were studied. Questionnaired horses or cases were raised in single stud with large yard or single farms for training for race. On a sandy ground, well ventilated studs and approximately similar adopted feeding regime twice daily (morning and evening for concentrate and dry food) on a suspended or elevated bucket or container. Horses included in the study were Thoroughbred, Arabic and mixed breeds 50% or 75% (Libyan horses). In addition, selected horses were either racing or just started breeding programme during the study time. Questionnaires cases were selected randomly with regard to geographical distribution. Questionnaire A questionnaire was constructed to address the inquires concerned with age, gender, breed, management and nutritional status of horses (Table 1). 65 J. Vet. Adv., 15, 5(8): 64-70
SAWESI ET AL. Table 1: Risk factors and levels that associated with impaction colic in horses. Factor Level Age <5 years =0, 5-=1, > = 2 Season Winter = 1, Spring = 2, Summer = 3, Autumn = 4 Gender Male = 1, Female = 2 Breed Arabian = 0; Mixed = 1; Thoroughbred = 2 Add wheat bran to ration = 0; Yes = 1 Feeding on green fodders Yes = 0; = 1 Concentrate feeding < 5kg= 0; > 5kg = 1 Regular use of anthelminitics Yes = 0; = 1 Presence of gastrointestinal parasites = 0; Yes = 1 Dental diseases Present = 0; absent = 1 Previous exposure to colic present = 0; Absent = 1 Body condition Good = 0; Poor = 1 Water source Well = 0; Soft water = 1 Access to water/day One time = 0; Two = 1; Three = 2; more than three = 3 Muscloskeletal diseases Present = 0; Absent = 1 Bad vices Absent = 0, Present= 1 Clinical Examination Each horse was subjected to competent clinical examination for diagnosis of impaction colic. Horses admitted to clinic with signs of colic showed the signs summarized in Table 2. Table 2: Distribution of clinical sings of impaction colic in race horses. Variable +ve (n=83) % Abdominal pain Curling upper lips up Kicking at the belly Looking at belly Paw at the ground Rolling Abdominal distenstion Present Absent Dehydration Mild Moderate Sever Intestinal movement Constipation Diarrhea Absent Intestinal sound Present Absent Appetite Good Poor Off food Heart rate Below 80 beat/min Above 80 beat/min 66 J. Vet. Adv., 15, 5(8): 64-70 71 66 76 81 69 68 15 24 51 08 58 11 14 36 47 17 28 38 34 49 85.5 79.5 91.5 97.5 83.1 81.9 18.0 28.9 61.4 9.6 69.8 13.2 16.8 43.3 56.6.4 33.7 45.7 40.9 59.0
RISK FACTORS ASSOCIATED WITH IMPACTION COLIC IN Profuse sweating Frequent urination Congested MM Elevated body temperature 83 76 81 66 0 91.5 97.5 79.5 Statistical Analysis Analysis of data was carried out using statistical software program (SPSS for Windows, Version 16.0, SPSS Inc., and USA). Firstly, descriptive statistics and distribution of risk factors among cases of equine colic were presented. Association between the occurrence of colic and the potential risk factors were studied using logistic regression. At first step the univariate logistic regression was carried out. In this method, the dependent dichotomous variable was the status of the horses (with or without colic). However, the independent variables were the hypothesized risk factors.. Factors with significant association (p<0.1) were subjected to the multivariate backward stepwise logistic regression analysis. Hosmer and Lemeshow s goodness of fit statistic test greater than 0.05 was used to imply that the model s estimates fit the data at an acceptable level in multivariate analysis. The p value, odds ratio (OR) with a 95% confidence interval (CI 95%), regression coefficient (β) and standard error (SE) were recorded for each variable. For interpretation of the OR, value of OR greater than one indicates that the colic is more likely to take place than not. While OR less than one, indicates the colic is less likely to occur than not. A chi-square test was also used to assess the possible association between the colic and the variables of clinical signs. Chisquare of linear trend was used when variables had more than two categories. In all statistical analyses, the results were considered to be significant at p<0.05. Results Prevalence Eighty-three horses 79.8% out of 4 were showing the signs of impaction colic. The horses were showing typical signs of colic (Table 2). Descriptive Statistics Table 3 summarizes the distribution of risk factors associated with impaction colic in horses. All managemental and nutritional factors were included. Table 3: Distribution of the risk factors in horses with impaction colic. Variable and category Colic (n=83) Gender Male 4 Female 79 Age < 5 years 5- years 30 > years 43 Season Winter 60 Spring 4 Summer 17 Fall 2 Wheat bran 83 Yes 0 Anthelminitics 63 rmal (21) 1 9 5 6 13 0 7 1 16 5 67 J. Vet. Adv., 15, 5(8): 64-70
Yes Previous colic Yes Dental diseases Yes Racing 0 1 Breed Arabian Thoroughbred Mixed Vices Yes SAWESI ET AL. 8 75 63 67 16 13 50 26 57 11 1 15 6 11 3 8 11 Multivariate Logistic Regression Final multivariate logistic regression model showed that there was a significant association between the occurrence of impaction colic and previous exposure to colic (p < 0.5; OR: 1.9; 95% CI: 7.5-8.9), where 75 cases (90.3%) with colic had previous exposure to colic. Dental diseases significantly increased the prevalence of the impaction colic ((p < 0.05; OR: 3.2 95% CI: 1.1-9.5). Thus, 63(75%) horses with colic were suffering from dental diseases. Horses were more likely to show impaction colic after racing (p < 0.5; OR: 4.2 95% CI: 3.9-4.5). Thus 67 (80.7%) horses with impaction colic appeared after racing. The prevalence of impaction colic is prevalent or higher in Thoroughbred horses than other breed (p < 0.05; OR: 86.9; 95% CI: 2.3-3.2), where 50 cases (60.2%) with colic were thoroughbred and 13 were Arabian. Table 4: Final multivariate logistic regression model for risk factors associated with impaction colic in horses. B S.E Wald P OR 95% CI Previous exposure to colic 9.895 2.889 11.7.001 1.9 5.7 8.9 Dental problems 19.599 8.850 4.9.027 3.2 1.1 9.523 Breed 4.465 1.851 5.8.016 86.9 2.3 3.27 Racing.653 4.657 5.2.022 4.2 3.9 4.599 Constant -6.289 2.555 6.1.014.002 - - B = Regression coefficient, SE = Standard error, P = P valur, OR = Odds ratio, 95% CI = Confidence interval at 95%. Discussion Equine colic represents a major concern for horse holders not only in Libya, but also worldwide. Although the incidence rate and factors associated with colic were discussed at various localities of the world (Radodostits et al., 07), the geography and management practice in Libya may add other factors for this condition. The present study provided an overview about the prevalence and risk factors contributed in the impaction colic in horses. Of 51% is considerably higher than that reported in horses, which varies from 6.7% 15.6% depending on the population and colic type (Cohen et al., 1999, Hassel et al., 1999). The final multivariate logistic regression form included five risk factors including; previous exposure to colic, dental problems, breed and excitement of racing horses. 68 J. Vet. Adv., 15, 5(8): 64-70
RISK FACTORS ASSOCIATED WITH IMPACTION COLIC IN In the present investigation, thoroughbred horses seem to be particularly at risk for developing colic. Thoroughbred horses may not accustomed to the local environmental condition. In previous reports, it has been shown that Arabian multiplies the risk for colic by about (Cohen et al., 1995, Cohen et al., 1999). The authors propose that management characteristics are responsible for this prevalence of colic. Enterolithiasis is more frequent in Arabians or in miniature breeds (Cohen et al., 00). In another study, Thoroughbred horses were found to be the only breed at higher risk for colic (Tinker et al., 1997b). A horse is more likely to develop colic if it previously suffered from colic (Cohen et al., 1995 Cohen & Peloso 1996, Fielding & Dechant 12). This risk is even greater if the horse has an abdominal surgery history: studies conducted on cases and controls showed that a horse with a surgical history has a risk about five times greater than a horse with no surgical history (Cohen et al., 1995, Cohen & Peloso 1996). But, the mortality rate is not significantly different between horses suffering from colic for the first time and horses with a recurrent colic history (respectively 12% and 17%) (Cohen & Peloso 1996). Medical treatment or vaccination increases the risk for colic due to stress, especially if they have an effect on intestinal motility (Proudman 1992, Kaneene et al., 1997).On the contrary, no significant association was shown between recent vaccination and colic (Cohen et al., 1995). In several studies, no relation was found between dental disorders or the lack of dental care and colic, but many of these horses received regular dental care (Tinker et al., 1997b). In the current investigation, dental affections significantly influenced the prevalence of impaction colic. Similar findings has been reported in horses (Goncalves et al., 02). The association between different dental affections and the occurrence of colic has been well established also in donkeys (du Toit et al., 09) There was an association between the colic and activity. This result is in agreement with that of (Tinker et al., 1997a). On the contrary, no relation has been shown between the activity of the horse and the occurrence of colic (Reeves 1997). Activities associated with stress have the same effects (Kaneene et al., 1997). Race is associated with serous fatal condition in horses (Ryu et al., 01). Moreover, an increased risk is associated with any change in activity (Cohen et al., 1995, Cohen 1997). This result could also be explained by the correlated change in diet (Tinker et al., 1997b) or in stabling (Cohen et al., 1995, Cohen 1997). Although the feeding regimen was not included in the final multivariate logistic model, a change in the quality or the quantity of food, as well as a change in the time of feeding or in the schedule of feeding result in an increased risk of colic (Proudman 1992, Kaneene et al., 1997, Archer & Proudman 06). In previous report, the risk of colic was multiplied by 2 during the 2-week period that followed any change in feeding (Cohen et al., 1995). A study, performed on 948 horse-years, revealed that one change in feeding during the year multiplies the risk factor for colic by 3.6. More than one change during the year only multiplies the risk factor by 2.2 (Tinker et al., 1997b). Irregular, watering increases the risk of colic; a reduction in watering is caused by several factors: Deficiency of bucket in the stall (Cohen et al., 1999), a limited access to water, in paddocks or on dry lands (Reeves 1997), very cold water or a lack of water in cold weather (Kaneene et al., 1997). Housing system appear to influence the risk for colic; horses maintained on pastures all year long are less subjected to colic than horses living indoors (Cohen et al., 06). Furthermore, a comparative risk factor of 1.6 was measured for horses kept in stalls more than 50% of the time (Cohen et al., 06). It has been suggested that stress associated with confinement could increase the risk for chronic colic (Clarke et al., 1990). (Cohen et al., 1999). Impaction colic often appears just after a change of bedding, particularly if there is no other source of fiber. Other studies showed also that changes in housing management particularly predispose horses to colic (Cohen et al., 1995). A change in housing is often associated with a change in diet and a change in activity. The limitation of the present study is that small sample size, which does not allow obtaining concrete conclusion about the risks associated with impaction colic in Libya. Moreover, limited number of risk factors and narrow geographical area. Thus, 69 J. Vet. Adv., 15, 5(8): 64-70
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