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Prospective studies documenting the efficacy and side effects of medical treatment for colonic sand accumulation in horses are limited. The purpose of the study was to compare the effect of enteral administration of magnesium sulphate (MgSO 4 ), psyllium mucilloid (psyllium), and a combination of MgSO 4 and psyllium on the evacuation of large accumulations of sand in the large colon of adult horses. Thirty-four horses with naturally acquired, large sand accumulations (>5 cm × 15 cm) identified on abdominal radiography were randomly allocated to one of three treatment groups: (1) 1 g/kg psyllium ( n = 12); (2) 1 g/kg MgSO 4 ( n = 10), or (3) their combination ( n = 12). Treatments were administered once a day via nasogastric intubation and continued for a total of 4 days. Lateral radiographs of the ventral abdomen were repeated on day 4 of treatment. If the area of sand in the radiographic image was 2 on day 4, the sand accumulation was considered resolved. Of 12 horses treated with a combination of psyllium and MgSO 4 , nine evacuated the sand from the ventral colon within 4 days. In comparison, only 3/12 horses treated with psyllium and 2/10 horses treated with MgSO 4 resolved (both significantly different from the combination; P 0.05). Large accumulations of sand in the large colon of horses can be treated medically. Administering a combination of psyllium and MgSO 4 via nasogastric intubation once daily for a total of 4 days was a more effective treatment than either constituent alone.

Four cases of ulceration and stricture of the right dorsal colon were encountered. Ulceration of the right dorsal colon is generally associated with nonsteroidal anti-inflammatory drug (NSAID) toxicosis but there are few reports of stricture following ulceration. All four horses had recent phenylbutazone use: three had been given doses well in excess of the recommended dose and in one the dose was marginally above those recommended but was combined with administration of other NSAIDs. All four horses presented with intermittent low-grade colic, weight loss and ventral oedema. Diarrhoea was also seen in three of them. All had hypoproteinaemia due to severe hypoalbuminaemia, and hyperfibrinogenaemia. Hypoalbuminaemia was less severe in one horse and this horse was successfully managed medically. Two cases were definitively diagnosed at exploratory celiotomy and two at necropsy. Exploratory celiotomy was performed in two horses: one was euthanased at surgery and one was managed successfully with medical treatment and remained normal 1 year after surgery. Medical management included feeding of a low-roughage pelleted ration, corn oil, psyllium mucilloid, and discontinuation of NSAID administration.

Objective—To examine the efficacy of psyllium mucilloid in evacuating sand from the equine large intestine. Animals—12 clinically healthy pony geldings. Procedure—Twelve ponies were assigned to 2 groups of six each. One group was treated with psyllium and the second was a control group. All ponies had an exploratory celiotomy and 10 g/kg body weight of sand was placed into the cecum. Ponies were fed a grain mixture alone at 1 g/kg (controls), a grain mixture plus psyllium pellets, each at 1 g/kg body weight (3 ponies), or fed a grain mixture and given psyllium powder by nasogastric tube at 1 g/kg body weight divided into two daily doses in 3 L of water (3 ponies). Radiographs were taken on days 1 (3 per group), 5 (all ponies), and 11 (3 per group) to monitor sand transit through the large intestine. Ponies were euthanatized 11 days after surgery. Sand was collected from the contents of the cecum, ventral colon, dorsal colon, and small colon. Dry weight of the recovered sand was compared between the two treatment groups as a percentage of the dry weight of sand placed in the cecum. Results—No significant differences were detected in the mean percentage of sand recovered between the two treatment groups (P < .05), with 39.2% recovered in ponies treated with psyllium and 27.4% recovered in control ponies. Clinical Relevance—Psyllium mucilloid had no apparent effect on sand evacuation from the equine large intestine. When intake of sand is prevented, the equine large intestine can reduce and possibly eliminate its sand burden.

Excerpt To the Editor:Misoprostol (Cytotec, G.D. Searle and Co., Chicago, Illinois) is a prostaglandin E1analog that was developed in an effort to protect the stomach from nonsteroidal anti-inflamm...

Dietary fiber has important hypocholesterolemic effects and may reduce risk for coronary artery disease. Careful clinical studies indicate that foods such as oat bran or beans, rich in water-soluble fiber, can decrease serum total cholesterol by 19% while decreasing serum low density lipoprotein cholesterol by 22%. Food supplements rich in soluble fiber such as psyllium mucilloid are well tolerated and may lower serum cholesterol by 15%. Thus, high fiber foods or soluble fiber food supplements may decrease serum cholesterol by 15% to 19% and decrease estimated risk for coronary heart disease by greater than 30%.

To test whether combining psyllium mucilloid with half the usual dose of colestipol reduces the adverse effects associated with colestipol and maintains or increases its efficacy in the treatment of hyperlipidemia. This strategy might make bile acid sequestrants, which are seldom used because they cause adverse effects such as bloating and constipation, more tolerable and less expensive.A randomized, parallel-group, double-blind, controlled trial.An outpatient clinic in a tertiary care hospital.121 patients who had moderate primary hypercholesterolemia (total cholesterol level6 mmol/L and8 mmol/L; triglyceride level3 mmol/L) after following a low-fat diet for 1 year (National Cholesterol Education Program Step Two diet).5 g of cellulose placebo; 5 g of colestipol; 2.5 g of colestipol plus 2.5 g of psyllium; or 5 g of psyllium three times daily before meals for 10 weeks.At baseline and at weeks 4 and 10, fasting blood lipid levels and apoprotein concentrations were measured and a quality-of-life instrument was completed.A combination of 2.5 g of psyllium and 2.5 g of colestipol was better tolerated than and as effective as either 5 g of colestipol alone or 5 g of psyllium alone. The combination therapy and colestipol alone did not differ significantly with respect to changes in individual lipid values. The ratio of total cholesterol to high-density lipoprotein cholesterol (HDL) was reduced by 18.2% (95% CI, 12.3% to 24%) with the combination therapy; by 10.6% (CI, 2.0% to 15.4%) with colestipol alone; by 6.1% (CI, 1.5% to 10.6%) with psyllium alone; and by 0.1% (CI, -4.8% to 7%) with placebo (P = 0.0002). Combination therapy reduced the ratio of total cholesterol to HDL significantly more than did colestipol alone or psyllium alone (P0.05).These findings suggest that adding psyllium to half the usual dose of bile acid sequestrant resins maintains the efficacy and improves the tolerability of these resins.