Risk factors for epiploic foramen entrapment colic: An international study

Reasons for performing study: Epiploic foramen entrapment (EFE) is one of the most common causes of small intestinal strangulation in the horse. Identification of risk factors would generate hypotheses about causation and may suggest preventive strategies. Hypothesis: Horses exhibiting certain behavioural patterns and those exposed to particular management practices are at increased risk of EFE. Methods: A matched case-control study was conducted on EFE cases admitted to hospitals in the UK, Ireland and USA. Data on 109 cases and 310 control horses were obtained by telephone questionnaire and conditional logistic regression was used to identify associations between horse- and management-level variables and the risk of EFE. Results: Crib-biting/windsucking behaviour was strongly associated with increased risk of EFE (OR 67.3, 95% CI 15.3-296.5). A history of colic in the previous 12 months (OR 4.4, 95% CI 1.5-12.7) and horses of greater height (OR/cm 1.05, 95% CI 1.01-1.08) were also at increased risk. The person(s) responsible for horses' daily care (nonowner/ relative/spouse OR 5.5, 95% CI 2.3-13.3) and a number of behavioural features, including response to a stimulus causing fright (easily frightened OR 0.4, 95% CI 0.1-1.0) or excitement (sweats up easily/occasionally OR 0.3, 95% CI 0.1-0.8), reaction to their surroundings (inquisitive OR 0.4, 95% CI 0.2-0.8) and feeding behaviour when stressed (goes off food in full/part OR 0.3, 95% CI 0.1-1.0) were also associated with altered risk of EFE. Conclusions: The association between horses of greater height and those with a previous history of colic and increased risk of EFE suggests that some horses may be inherently predisposed to EFE. Furthermore, a behavioural pattern has been characterised that is common to horses at increased risk of EFE. Further research is required to investigate the causal pathway linking behavioural traits with gastrointestinal dysfunction and to determine whether behavioural modification reduces the risk of EFE. Potential relevance: The findings of the present study have relevance to horses in the UK, Ireland and USA.