Diagnosis and management of sand enteropathy in the horse

Sand enteropathy is an important disease condition in the horse, particularly in geographically predisposed regions. The reasons why some horses eat sand, or why some horses accumulate sand when exposed and others do not are poorly understood. Weak evidence exists that deficiencies in iron or copper may play a role in geophagia, while factors such as the provision of supplemental feeding while at pasture, or the role of an individual animal within a herd hierarchy, may influence an individual animals' disease risk. Diagnosis in the field is challenging. Current evidence does not support the use of the faecal glove sedimentation test for screening horses at risk of sand accumulation as it lacks both the sensitivity and specificity to accurately diagnose sand accumulation under field conditions. Instead, ultrasound is a useful screening test under field conditions, especially in ruling out sand accumulation. In contrast, ultrasound appears to be of limited value in the assessment of sand accumulations in acute disease and radiography remains the reference standard for diagnosis. Current evidence does not support the feeding of psyllium for the removal of sand accumulation. Instead, daily administration of psyllium and MgSO4, both at 1 g/kg bwt once a day via nasogastric tube, has been reported to be effective in removing the majority of sand accumulations over a 3-7 day period in a number of studies. Prevention remains challenging in horses at risk due to ongoing exposure to sandy pastures but, based on epidemiological evidence, small management changes may be beneficial in reducing disease risk.