Sand enteropathy is a well-recognized condition in horses and donkeys, particularly in regions with sandy soil. It occurs when sand accumulates in the gastrointestinal tract, leading to colic, diarrhea, weight loss, and in severe cases, intestinal obstruction requiring surgical intervention. While medical treatments involving laxatives such as psyllium, magnesium sulphate, and paraffin oil have been commonly recommended, there has been limited research evaluating their combined effectiveness.

A recent study, published in the Australian Veterinary Journal, investigated the efficacy of a combined treatment approach using psyllium, magnesium sulphate, and paraffin oil in 54 equids diagnosed with sand enteropathy. This retrospective case series reviewed cases presented to The Animal Hospital at Murdoch University over a four-year period (2019–2023), assessing the success of treatment, complications, and factors influencing treatment outcomes.

The findings provide valuable insights into how veterinarians can improve treatment strategies for sand accumulation and highlight important considerations for horse owners managing this condition in sandy environments.

Symptoms of sand accumulation vary, with colic being the most commonly reported sign. Other signs include:

• Weight loss or poor weight gain
• Diarrhea or loose manure
• Decreased appetite
• Mild to severe colic episodes
• Behavioral changes (e.g., girthiness, reluctance to move)

The diagnosis of sand enteropathy is commonly made using abdominal radiographs, which allow veterinarians to estimate the sand burden within the intestines. In some cases, auscultation of the ventral abdomen may detect the sound of sand moving within the gut, further supporting the diagnosis.

Study Objectives

The primary goal of the study was to assess the effectiveness of a combined treatment protocol using psyllium, magnesium sulphate, and paraffin oil for clearing sand accumulations in equids. Researchers also aimed to identify factors influencing treatment success, including breed differences, complications, and treatment duration.

Methods and Study Population

A total of 54 equids (52 horses and 2 donkeys) diagnosed with sand enteropathy were included in the study. Cases were identified retrospectively through medical records from a veterinary hospital in Western Australia.

• Treatment protocol: Horses received daily nasogastric intubation with:
  • Psyllium (1 g/kg)
  • Magnesium sulphate (1 g/kg in water)
  • Paraffin oil (6–8 mL/kg)
• Treatment success was defined as at least 75% reduction in sand area on follow-up radiographs.
• Radiographs were taken every 2–3 days to monitor sand clearance.

Key Findings

1. Treatment Success and Duration

• 81% of horses responded successfully, clearing more than 75% of their sand burden.
• The median treatment duration was 4 days (range: 2–12 days).
• Most horses required only 3–5 days of treatment to achieve significant improvement.

2. Breed Differences: Miniature Ponies at Higher Risk

• Miniature Ponies had a significantly lower success rate (44%) compared to other breeds.
• Miniatures were more likely to be poor responders to treatment.
• The higher sand burden per kilogram of body weight in Miniatures likely contributed to treatment failure.

3. Complications and Side Effects

• 30% of horses experienced complications, though most were mild:
  • Mild colic (10 cases)
  • Temporary inappetence (4 cases)
  • Hyperlipidemia in Miniature Ponies (3 cases)
• One Miniature Pony died from severe colic, possibly due to an underlying surgical lesion.

4. Seasonal Risk Factors

• Cases were most commonly diagnosed in winter (44%), suggesting seasonal changes in grazing behavior contribute to increased sand ingestion.

Discussion: What Do These Findings Mean?

Effectiveness of Psyllium, Magnesium Sulphate, and Paraffin Oil

The study confirms that a combination of psyllium, magnesium sulphate, and paraffin oil is an effective non-surgical treatment for sand enteropathy. The 81% success rate aligns with previous research suggesting that psyllium and magnesium sulphate together are more effective than either agent alone. The addition of paraffin oil in this study likely aided in psyllium administration but did not appear to enhance or reduce treatment effectiveness.

These findings reinforce the importance of a multi-agent approach to clearing sand accumulation and suggest that a 4-day treatment period is generally sufficient for most cases.

Why Did Miniature Ponies Respond Poorly?

The poor response rate in Miniature Ponies is a significant finding, indicating that standard sand clearance protocols may be less effective in smaller breeds. Possible reasons include:

• Higher sand burden per kg of body weight, making clearance more difficult.
• Potential breed-specific differences in colonic motility, which may impair sand movement.
• Chronicity of sand accumulation, as Miniature Ponies often present later with long-standing cases.

These results suggest that alternative or extended treatment strategies may be needed for Miniature Ponies and other small equids.

Importance of Early Intervention and Prevention

Given the seasonal trend observed in the study, horse owners should be especially vigilant during winter months when sand ingestion may be higher due to changes in pasture quality. Preventative measures include:
✔ Feeding hay off the ground to minimize sand ingestion.
✔ Providing rubber mats or feeders in paddocks.
✔ Regularly monitoring horses for colic signs.
✔ Performing routine abdominal radiographs in at-risk horses.
✔ Administering monthly psyllium supplements as a preventive measure.

Conclusion: Practical Takeaways for Veterinarians and Horse Owners

This study provides strong evidence that a combination of psyllium, magnesium sulphate, and paraffin oil is effective for treating sand enteropathy in most equids. However, Miniature Ponies require special consideration due to their lower response rate and higher risk of treatment failure.

Key Recommendations:

🔹 Veterinarians should use abdominal radiographs to assess sand burden and guide treatment decisions.
🔹 Horse owners should implement sand prevention strategies and monitor horses, particularly in high-risk environments.
🔹 Miniature Ponies with sand accumulation may need alternative management, including prolonged treatment or environmental modifications.

By recognizing early signs of sand enteropathy, implementing preventative care, and using effective treatment strategies, both veterinarians and horse owners can improve outcomes and reduce the risk of recurrent colic associated with sand accumulation.