ISSN 2398-2977      

Intestine: enteritis - granulomatous

pequis

Introduction

  • Cause: form of inflammatory bowel disease (IBD) similar to Crohn's disease in humans. Malabsorptive and maldigestive condition most commonly affecting the small intestine, although the large intestine can be affected in advanced cases. Unknown cause, although Mycobacterium avium has been implicated in a few cases and familial predisposition is suspected in Standardbred horses Standardbred.
  • Signs: insidious or rapid weight loss, poor condition, lethargy, dependent edema +/- diarrhea, intermittent colic Abdomen: pain - adult and alopecia. Demeanor can remain bright with good appetite or anorexia may be reported.
  • Diagnosis: gastrointestinal evaluation Gastrointestinal: physical examination, including rectal palpation Urogenital: rectal palpation (enlarged mesenteric lymph nodes, thickened small intestinal wall Duodenum: transmural thickening - ultrasound), abdominal ultrasound, duodenal and rectal biopsies; granulomatous enteritis confirmed by histopathology of affected intestine (diffuse and patchy infiltrates, distinct granulomas, with epithelioid, lymphoid and giant cells, macrophages; lymphoid hyperplasia, perilymphatic and transmural inflammation, lymphangiectasia, villous atrophy, mucosal ulceration, fibrosis, crypt abscesses, serosal fibrosis).
  • Treatment: dietary management and corticosteroids are the treatment of choice, with prolonged courses of treatment necessary.
  • Prognosis: generally poor, due to advanced nature of disease at the time of diagnosis.

Pathogenesis

Etiology

  • Possible abnormal host inflammatory response to intestinal bacteria or dietary components.
  • Acid-fast bacteria may have been found in the intestinal tissue of some horses affected by granulomatous enteritis. Mycobacterium avium was identified in the majority of these cases.
  • Possible role for Mycobacterium pseudotuberculosis (similar to Johne's disease in cattle).

Specific

Pathophysiology

  • Thought to be similar Crohn's disease in humans, whereby activation of mucosal T cells leads to transmural inflammation. This is amplified and perpetuated by pro-inflammatory cytokines.

Timecourse

  • Often advanced at time of diagnosis.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Silva F S, Lorenzett M P, Bianchi M V et al (2019) Mycobacterium branderi infection in a horse with granulomatous mesenteric lymphadenitis. J Comp Pathol 168, 30-34 PubMed.
  • Kalck K A (2009) Inflammatory bowel disease in horses. Vet Clin North Am Equine Pract 25 (2), 303-315 PubMed.
  • Mair T S, Pearson G R & Divers T S (2006) Malabsorption syndromes in the horse. Equine Vet Educ 18 (6), 299-308 VetMedResource.
  • Swain J M, Licka T, Rhind S M & Hudson N P (2003) Multifocal eosinophilic enteritis associated with a small intestinal obstruction in a standardbred horse. Vet Rec 24 (152), 648-651 PubMed.
  • Schumacher J, Edwards J F & Cohen N D (2000) Chronic idiopathic inflammatory bowel diseases of the horse. J Vet Intern Med 14 (3), 258-265 PubMed.
  • Fogarty U et al (1998) A cluster of equine granulomatous enteritis cases, the link with aluminum. Vet Hum Toxicol 40 (5), 297-305 VetMedResource.
  • Duryea J H et al (1997) Clinical remission of granulomatous enteritis in a standardbred gelding following long-term dexamethasone administration. Equine Vet J 29 (2), 164-167 PubMed.
  • Lindberg R et al (1996) Rectal biopsy diagnosis in horses with clinical signs of intestinal disorders, a retrospective study of 116 cases. Equine Vet J 28 (4), 275-284 PubMed.

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