Section: Treatment In-depth
The most important initial treatment is to get a nasogastric tube into the horse quickly. It is possible for the stomach to burst if the fluid load is not relieved, and distension of the stomach and intestine can cause excruciating pain. Distention of the intestines themselves can contribute to intestinal dysfunction, so good and consistent decompression leads to a more rapid recovery. It is usually necessary for the horse with proximal enteritis to have a nasogastric tube left in place, because these horses must often be refluxed every two to four hours due to the rapid build-up of fluid.
Your horse will usually have an intravenous catheter place in one of his jugular veins, and will receive fluid through this catheter. Horses with proximal enteritis often require as much as 60 to 100 liters of fluid per day (approximately 30 to 50 gallons), which is one of the reasons that this disease is so labor-intensive and expensive.
Although no specific bacteria have been identified as a cause of proximal enteritis, many veterinarians choose to give broad-spectrum antibiotics. It seems that antibiotics are more useful in some areas of the country than others, confirming the clinical suspicion that there are many different causes for proximal enteritis, and the level of severity differs according to the cause.
Anti-inflammatory drugs, especially Banamine, can help to relieve your horse's pain and inflammation. However, Banamine can potentiate kidney disease, especially if your horse is dehydrated, so it is important to monitor the horse's kidney function and level of hydration.
Any systemic disease or inflammation can cause horses to develop laminitis, or founder. Laminitis is a particularly dreaded sequel to proximal enteritis, as it can sometimes be harder, and more frustrating, to treat than the original disease. There are few good ways to prevent laminitis, but deep, soft bedding may be helpful, as is good hoof care. Many clinicians now choose to ice the horse's feet in the initial stages of disease, in order to keep inflammatory mediators from reaching the hoof.
There are many ancillary treatments, such as DMSO to decrease inflammation, pentoxyfylline to counter the toxins associated with proximal enteritis, and acepromazine to possibly improve circulation in the foot. None of them has been proved effective, but they may be of some help.
If the horse with proximal enteritis is not able to eat for longer than 3 to 5 days, it may be necessary to pursue parenteral nutrition, or nutrition that is given through a catheter in the vein. This can be extremely expensive, but can also be very valuable in maintaining the horse's strength.
