Disparities in Clinical Characteristics of Duodenitis-Proximal Jejunitis

Also known as proximal enteritis or anterior enteritis this is an important disease to recognize because it looks like a surgical colic (small intestinal strangulation) but instead is a medical condition where treatment will improve outcome. Always suspicious is when the degree of systemic inflammation (vital signs and CBD) seems to be coming on faster than one would expect with a small intestinal strangulation. Very helpful early is a peritoneal tap where enteritis has a more normal look than that of intestinal strangulation.
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Geographic Disparities in Clinical Characteristics of Duodenitis-Proximal Jejunitis in Horses in the United States

J Equine Vet Sci. 2020 Oct;93:103192.
Authors
Sara K T Steward 1 , Diana M Hassel 2 , Holly Martin 1 , Courtney Doddman 1 , Amy Stewart 3 , Elizabeth J Elzer 4 , Louise L Southwood 4
Affiliations

1 Department of Clinical Sciences, Colorado State University, Fort Collins, CO.
2 Department of Clinical Sciences, Colorado State University, Fort Collins, CO.
3 Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA.
4 Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, PA.

Abstract

Duodenitis-proximal jejunitis (DPJ) is an idiopathic and potentially fatal disease of horses characterized by abdominal pain, proximal intestinal inflammation, and subsequent gastric and small intestinal fluid accumulation. Although this disease is known to be costly and life threatening in the equine industry, the severity of clinical signs can vary widely, and an exact etiology has yet to be elucidated. This study looked to identify differences in clinical parameters of horses with DPJ between geographic regions in an effort to corroborate anecdotal reports and support theories of differing etiologies. Case records were compared from veterinary academic referral hospitals in three different geographic locations in the United States to determine if significant differences in clinical, clinicopathologic, and prognostic characteristics exist among horses with DPJ. Clinical measurements on presentation that were significantly different between regions included heart rate, peritoneal total protein, albumin, anion gap, aspartate aminotransferase, gamma-glutamyl transferase, sodium, chloride, potassium, and creatinine. Duration of hospitalization and maximum body temperature while hospitalized were also different between regions. There were no significant differences in peritoneal cell count, total white blood cell count, neutrophil count, band neutrophils, calcium, total plasma protein, temperature on presentation, duration of reflux, total reflux volume, or age between hospitals. The mortality rates between hospitals were not significantly different. Increased severity of clinical signs and biochemical abnormalities were identified in the Southeastern United States hospital compared with the Northeastern and Western hospitals. A prospective, multicenter case-control study could identify risk factors contributing toward regional differences in this disease in the future.