Page 800 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Gastrointestinal system: 4.1 The upper gastrointestinal tr act 775

VetBooks.ir are also available to reduce the likelihood of aspira- Management
Treatment with NSAIDs such as phenylbutazone
tion during irrigation. The process can be repeated
at 2–4 hourly intervals, until the NG tube can be
of the healing lesion, and the feeding of moistened
passed into the stomach. With patience, most cases will delay fibrosis. Repeated endoscopic monitoring
will eventually clear. Once cleared, the oesophagus softened food, are advisable before re-introducing
should be lavaged with saline to clear residual food a normal diet. Fibrosed strictures can involve all
and subsequently oesophagoscopy should be per- layers or just the muscular and adventitious layers.
formed to inspect for mucosal ulceration or a pri- Full-thickness strictures, which form after deep, cir-
mary cause. Food should be restricted for the first cumferential ulcers, can be observed endoscopically
24–48 h and introduced gradually with moistened and demonstrated on contrast oesophagrams.
food or grazing. In some cases, a functional oesoph- Treatment by resection of the scar and anastomosis
ageal spasm remains temporarily after clearance of
luminal obstructions, especially where ulcers are
present. Treatment of any aspiration pneumonia is 4.102
essential.

OESOPHAGEAL ULCERATION

Definition/overview
Full-thickness erosion of the oesophageal mucosa.

Aetiology/pathogenesis
Ulceration of the oesophagus can occur second-
ary to impaction and may lead to re-impaction.
Circumferential ulceration is particularly hazardous
since the cicatrisation of the healing ulcer can lead to
a permanent oesophageal stricture, which will result
in repeated episodes of oesophageal obstruction
at this site. Ulceration is also observed in the dis-
tal oesophagus associated with gastro-oesophageal
reflux. Fig. 4.102 Circumferential ulcer secondary to
prolonged choke.
Clinical presentation
Affected horses may present with hypersalivation, 4.103
recurrent oesophageal obstruction, discomfort when
swallowing food and chronic colic.

Differential diagnosis
Squamous cell carcinoma of the oesophagus.

Diagnosis
Diagnosis is by oesophagoscopy, when the red sub-
mucosa is visible surrounded by the frayed edges
of the eroded stratified squamous epithelium
(Fig. 4.102). Contrast oesophagrams may show Fig. 4.103 Contrast oesophagram showing
some stricture at the site of a circumferential ulcer narrowing of the oesophageal lumen due to a
(Fig. 4.103). circumferential oesophageal stricture.