While gastric impactions are rare in horses, they do occur, with Friesians particularly at risk. Common causes of gastric impaction include rapid eating, overeating, poor dentition, improper mastication, feed that swells or forms a coagulum, coarse roughage, high-fiber diets, and inadequate water consumption. Gastric impaction can also occur when the horse has a condition that negatively affects gastric motility, such as neurologic dysfunction or liver or pancreatic disease. In Friesians, underlying neurologic or motility disorders are suspected as contributing factors.
Using Cola to Resolve Gastric Impactions
Practitioners have reported administering cola (carbonated soda) via nasogastric tube to resolve gastric impactions. Researchers at Utrecht University in the Netherlands retrospectively reviewed cases of gastric impaction to evaluate whether treatment with cola was associated with improved survival.
Historically, gastric impaction in horses has a poor outcome. In one study, 16 of 17 horses were euthanized; in another study, only five of 12 horses were treated successfully. Overall, studies report that only 60% of horses with gastric impaction survive to discharge.
The idea for using cola (or other carbonated beverages) came from successful treatment of human gastric bezoars: In one human study, 91.3% of phytobezoar cases resolved with this method. Car mechanics have also successfully used cola to loosen nuts and bolts by soaking them overnight.
Retrospective Study
In this retrospective study, the researchers reviewed 125 cases of gastric impaction that presented to Utrecht University’s equine hospital between 2003 and2019. The breeds represented included Friesians (31.2% of the cases), warmbloods (40.0%), ponies (10.4%), Haflingers (6.4%), and various other breeds (12.0%). Mean age was 9.2 years for Friesians and 12.2 years for warmbloods.
Horses were fasted until the impaction resolved and then reintroduced to feed slowly. The average time to resolution of the gastric impaction was 2.6 days (range 1-11 days). The horses were treated with 1.5-2 liters of cola via nasogastric tube. Repeat treatments depended on the severity of the impaction and how well it was resolving based on gastroscopy. (The authors noted that transabdominal ultrasound can also help define the size and extent of stomach distention.)
Study Findings
Of the 125 cases, 57.6% were discharged from the hospital. Horses treated with cola had a greater likelihood of survival: 82.8% vs. 35.8%. However, because this was a retrospective study, treatment protocols were not standardized, and the exact volume and frequency of cola administration were often not recorded. Friesians treated with cola were less likely to survive (66.7%) compared to other breeds (90%).
The authors stated that enteral fluid therapy is contraindicated in horses with complete gastrointestinal obstruction. However, a gastric impaction is not always a complete obstruction; mineral oil can pass, although it cannot necessarily penetrate the mass. Isotonic enteral fluid therapy can also pass an impaction. Authors of previous case reports recommend administering 2-10 liters of enteral fluid via stomach tube every few hours to soften stomach contents while also activating the gastrocolic reflex and stimulating motility.
Horses receiving cola were approximately eight times more likely to survive, although causality cannot be established from this retrospective study. The Utrecht equine clinic treats each gastric impaction horse with 1.5-2 liters during each nasogastric intubation. It does not seem to matter whether diet or regular cola is used unless a horse is prone to insulin dysregulation. Cola’s low pH can rarely cause bruxism or colic in sensitive horses after administration.
Friesians are not only most likely to develop gastric impactions but are also less likely to recover, even with cola treatment. The authors suggested that the poor prognosis for Friesians might relate to a predisposition to gastric impaction due to abnormal collagen and/or elastin tissue components. In addition, this breed might be more likely to develop increased stomach wall thickness and reduced motility related to chronic gastric impaction. These mechanical changes coupled with the breed’s more stoic disposition can lengthen the time between diagnosis and treatment, negatively affecting prognosis.
Take-Home Message
In this study, 58% (72/125) of gastric impaction cases survived. Among horses treated with cola, 83% (48/58) survived. Non-Friesian horses treated with cola had 90% (36/50) survival.
Reference
Witt p, Hagedoom S, Kranenburg LC, van den Boom R. The use of cola for the treatment of gastric impactions in equids. Pferdeheilkunde–Equine Medicine 2021, vol 37, no. 6; DOI 10.21836/PEM20210604
Related Reading
- Preventing Strangulating Lipoma Colic: New Insights on Equine Risk Factors
- Disease Du Jour: Equine Intestinal Disease Research
- How to Manage Surgical Site Infections in Colic Patients
Stay in the know! Sign up for EquiManagement’s FREE weekly newsletters to get the latest equine research, disease alerts, and vet practice updates delivered straight to your inbox.
