What is the situation with IBD in horses in Finland at the moment? We tried to find answers to this question in "Hevosten IBD", in English "IBD in Horses", survey organized by Ykkössijalla hevonen website. The survey was aimed at owners of horses diagnosed with IBD. 360 people answered. With the help of the survey, we tried to find out the living conditions of IBD horses, the diet, the symptoms related to the disease, the diagnostics used, the possible medications and their effectiveness. In addition, we asked, how the owners would describe the horse's performance at the present time and which forms of treatment have best helped the horses of the owners who responded to the survey. The survey focused on the time period 29.9. - 14 October 2022 and it was implemented as an anonymous online survey.

A few years ago, we thought it was difficult to find information about IBD in horses and there was no peer support available to the owners of horses suffering from IBD. In 2021 we decided to start an IBD group on Facebook, where horse owners could share their experiences and get support from other owners regarding intestinal problems in horses. We had also just founded the Ykkössijalla hevonen website. The aim for the website was to share information related to horse wellbeing, training and pain recognition. IBD in horses became one of the main themes on the site, because we felt that sharing information about the disease was necessary. The blog article (in Finnish) about IBD in horses on our website has been read more than 8000 times, and the Horse IBD group, called Hevosten IBD, has grown significantly (currently the group has almost 3000 members).

At this moment, it can be stated that nationally the awareness of the existence of the disease has increased considerably compared to previous years. It is comforting that more and more horses with abdominal pain are understood, so that they can also be helped, instead of being labeled as, for example, difficult due to their nature. However, there is still relatively little scientific international research on the disease. Research understandably requires a lot of resources and time. We pondered what we could do in the meantime while we wait for more information from the researchers. We got the idea to collect valuable information from horse owners by means of a survey.

When reading the results, it is good to take the following points into account:

• The horse owner's evaluation of the horse's condition is always somewhat subjective.

• The owner answered the question based on the moment, for example the horse's medication or other treatment trial may still be in progress. The follow-up time can be relatively short.

• The survey has not necessarily reached the owners of the horses that have already been euthanized.

• The possible heredity of IBD or its different forms were not included as a topic in this survey, as we believe that these topics require further scientific research.

• In the survey, there was an option not to answer the question, if the question or the answer options did not seem appropriate. Some of the questions also had a free answer field.

• If the owner had more than one IBD horse, he had the opportunity to answer the survey more than once.

The basis of the survey

The basis of the survey was the basic information about horses. The survey wanted to find out at what age horses are most often diagnosed with IBD. The largest age group was 5-year-olds (11,7 %), followed by 7-year-olds (10,9 %). 66,4 percent of the horses were 1-10 years old when they received the diagnosis. 54,3 percent of the horses were geldings, 42,9 percent were mares and 2,8 percent stallions. Most of the diagnosed horses (47,2 %) were warmbloods, 35,3 % coldbloods, 9,7 % ponies, 6,7 % standardbreds and 1,1 % thoroughbreds. 60,6 percent of the horses were born in Finland and 39,4 percent abroad.

Living conditions

76,7 percent of the horses in this survey lived in a stable and 23,3 percent in an open shed. Free exercise was part of the everyday life of all horses, 58,3 percent of them were turned out in a herd and 41,7 percent were turned out alone. If the owner had the opportunity to offer the horse the opportunity to graze, 79,9 percent felt that grazing had positive effects on the horse's well-being, while 20,1 felt the opposite.

Diet

Next we look at the horse's diet (in addition to hay, water and salt) before the IBD diagnosis. 87,2 percent of the horses received mineral and vitamin supplements, 47,5 percent energy feed and 36,1 percent protein feed. After the IBD diagnosis, it can be noticed on a general level that the proportion of hay pellets (41,3 % of all horses) and fiber feeds (27,1%) in the feeding had increased compared to the time before the diagnosis. Correspondingly, the supply of energy and protein feeds had decreased among all respondents. It is also noteworthy that after an IBD diagnosis, 11,5 percent of the owners did not feed their horse any additional feed. The answer may be related to a short term decision to go on an elimination diet, or to a longterm decision to leave all supplements out of feeding.

Before the diagnosis, 38,9 percent of the horses ate haylage, 31,9 percent hay, and 29,2 percent both hay and haylage. After the diagnosis, the ratios regarding roughage were as follows: 58,7 % of the horses ate hay, 20,7 % haylage and 20,7 % hay and haylage together.

After the diagnosis, 40,8 percent of the owners who responded to the survey fed their horses hay/haylage with a sugar content of 100-150 g per one kilo of dry matter and 29,9 percent hay/haylage containing sugar less than 100 g/kg per kilo of dry matter. 27,4 % of the respondents did not know the sugar content of the roughage they fed.

Symptoms

When asked what kind of symptoms the diagnosed horses had, up to 76,6 % owners answered that their horse had performance problems. Other symptoms occurred as follows:

• Stomach discomfort when touched (67,4 % of the horses)

• Behavior problems (61 %)

• Diarrhea (53,2 %)

• Phlegmatic (44, 8 %)

• Weight loss (37,3 %)

• Problems in shoeing situations (35,9 %)

• Skin problems (30,6 %)

• Colics (29,2 %)

• Problems with transportation (16,4 %)

Respondents had the opportunity to write other symptoms in the free text field. These included: Aggressiveness, nervousness, bloating, lack of appetite, swelling, eye symptoms, problems related to the SI area and challenges in urination.

In the free text field, the owners had the opportunity to list the symptoms that appear during exercise. Among other things, the following symptoms were repeatedly mentioned:

• Reluctance to move, braking, stopping, kicking against leg aids, not in front of the leg

• Rushing

• Spooking, nervousness, overreactivity

• Bucking, rearing

• The pain face

• Grinding the teeth, head shaking, resistance to the rein connection

• Aggressiveness towards the handler

• Biting the sides, looking at the stomach, swishing of the tail

• Difficulties in cantering

• Difficulties in collecting

• Stumbling

• Crookedness

• Gets into the urinating position

• Passes manure often, possibly becoming more willing to move after manuring, flatulence

Diagnosis

When examining the possibility of intestinal inflammation, veterinarians often use more than one method. According to this survey IBD was diagnosed using these methods in order of frequency: Abdominal ultrasound examination (80 percent of the horses in the survey), rectal biopsy (67,8 %), gastroscopy (36 %), blood test (20,6 %), absorption test (5,1 %) . (350 owners answered the question.) 50,3 percent of the horses which had a gastroscopy, had gastric ulcer findings.

In connection with IBD examinations, the horse can also be tested for possible allergies. 55 percent of the owners (340 answers together) say that their horse has been diagnosed with allergies using allergy tests.

Medication

Based on the survey, different drugs have been used in the treatment of IBD as follows:

• Sucralfate (72,3 % of the respondents used it for their horses)

• Prednisolone 54,4 %

• Dexamethasone 24,6 %

• Metronidazole 23,3 %

• Azathioprine 22,7 %

• Sulfasalazine 18,5 %

• Of the 357 owners who answered the question, 6,4 percent have not given their horse any medication at all.

32,9 percent (out of 331 respondents) told that the medication period lasted for 1 month and 23 percent treated their horse for 2 months. 87,1 percent (out of 333 respondents) said that the horse responded to the medication.

Unfortunately, the symptoms often returned after ending the medication. 26,2 percent (out of 302) said that the symptoms returned after just one month. On the other hand, it should be noted that 29,1 percent say that the symptoms have not returned, at least for now.

Those owners, who had to renew the medication after the horse's symptoms returned, 41,9 percent of them had had to renew the medication once, 25,1 percent twice, 18,3 percent three times and 14,7 percent more than three times. 191 people answered this question.

In the open field, respondents had the possibility to tell about the possible side effects of medication. Among the 151 responses, the following symptoms were repeated: Stomach pain, colics, poor appetite, fatigue, nervousness, aggressiveness and urination problems.

Elimination diet as a form of treatment

75,6 percent of the respondents had used an elimination diet as one form of treatment (352 answers in the question). In the context of this survey, elimination diet means that the horse is initially fed only water, hay and salt. When the horse is symptom-free, one can try adding feeds to the diet one at a time and thus see what effect the diet has on the horse's health. When asked about the effects of the elimination diet, 71,2 percent of horse owners consider their horses to have benefited from it (264 answers to the question).

The horse's current condition

49 percent say that the horse shows signs of pain from time to time. 31,3 percent of the respondents state that they have not noticed any signs of pain at the moment, while 12,1 percent of horses have been euthanized due to symptoms. (355 answers)

When it comes to performance, 40,9 percent of horses are trained according to the condition of the day. 31,4 percent are currently in full training and 12,6 percent of the horses can only be trained very lightly. The rest can't be trained at all or are already euthanized. (350 answers)

If the horse has returned in regular training in such a way that no symptoms appear, the survey sought to find out how long this regular training could have been continued. 29,3 percent of the owners (out of 229) have been able to train continuously for 1-3 months, 30,1 percent for 4-6 months and 23,1 percent for 6-11 months. It must be taken into account that some of the respondents may have just returned to full training with their horses, and they do not yet have information on how long the horses will remain symptom-free. This may distort the results.

The owner's perception of the effectiveness of the treatments

At the end of the survey, the owners subjectively evaluated which treatments they think have helped the horse. There were 348 respondents, the question had the possibility to answer several points and it also had a free text field. It is to be noted, that not all the owners have used all the treatments and some of the treatments may be more widely used than others.

• Avoiding allergens (54 % of respondents felt it was beneficial)

• Low-sugar, digestible, protein-rich hay (41,7 %)

• Reducing stress in the horse's life (42 %)

• Elimination diet (37,9 %)

• Prednisolone medication (31,3 %)

• The horse is slowly getting used to changes in feeding (28,7 %)

• Giving the horse additional water/drinks (27 %)

• Sucralfate medication (26,4 %)

• Low starch content of concentrates (21,8 %)

• Azathioprine (Imurel) (14,4 %)

• Dexamethasone medication (11,2 %)

• Sulfasalazine medication (8,9 %)

• Nothing, the horse had to be euthanized due to symptoms (8,6 %)

• Metronidazole medication (7,8 %)

Conclusions

As the survey shows, there is no one treatment for this disease that works for everyone. Some of the horses seem to respond to dietary changes, while some of the horses are so sick that they have to be euthanized despite all attempts to help. It has already been speculated that this disease, which is currently called IBD, is a group of intestinal-related diseases ranging from severe autoimmune diseases to various intestinal pain related to dietary and lifestyle changes. In order to help horses even better, further research is much needed on the subject.