The Problem

Protein Losing Enteropathy (PLE) occurs when a horse loses plasma proteins through tiny spaces along the surface of the gut. Technically speaking, this is when the interstitial proteins enter the intestinal lumen at an increased rate because the epithelial barrier is lost. (The epithelium is the cellular covering which consists of cells and cement-like substances that protect the internal and external surfaces of the intestine.) This is either due to mucosal ulceration, or when interstitial edema disrupts the tight junctions in between epithelial cells.

PLE is a disease process that can be caused by high NSAID use, specifically bute toxicity. Dosing bute to a dehydrated horse can also lead to an acute onset. In addition to other more serious disease processes, PLE can also be caused by heavy parasitism. This disease must be diagnosed by a veterinarian, and laboratory tests will be necessary. Outward signs and symptoms include diarrhea, chronic weight loss, intermittent colic and edema along the ventral line.

How We Address It

GastroPLUS has been successful in nutritionally supporting the PLE horse. GastoPLUS must be dosed aggressively by double dosing, at 6cc powder per 100 lbs bodyweight for horse breed, with ponies/drafts at 12cc per 100 lbs bodyweight. Dose a minimum of 2-3x daily or as directed by your veterinarian. Dosing can be gradually decreased as horse continues showing significant improvement.

Case Study

A Shetland pony approximately 10 years of age, lightly ridden by two small girls. This pony was experiencing intermittent mild lameness in the summer and fall of 2006. In early fall of 2006 he was having a bout of lameness and the owner proceeded to treat him.  She administered 2 grams of phenylbutazone that evening, again the next morning and another 2 grams the evening of the second day. This amount is over twice the maximum initial dose for a pony this size. About 7 days later, the pony quit eating and acted somewhat lethargic. His manure was soft as well. Upon exam, he was depressed, had an elevated heart rate (80 bpm), normal gut sounds and a normal temperature.

Given the history, bute toxicity was the likely diagnosis. Even in a full size 1000 pound horse, a dose over 4 grams a day can cause severe gastric ulceration. The pony was initially treated with probiotics and calcium bentonite clay. Since grass was the only thing he would eat, he was taken out to walk and graze a few times a day. At this time, no blood work or other diagnostics were performed.

After 48 hours, the pony was eating a little hay and starting to feel more normal. After a week of the treatment, he was back to eating normally and had a much improved attitude.

In mid November, the owner noticed that he had some edema around his sheath area. Upon examination, it was found that the edema had spread ventrally along his midline as well. At this time, his attitude and appetite were fairly normal and nothing else on the physical exam was remarkable. Blood work revealed anemia, decreased total protein, decreased bilirubin and increased creatine kinase.

The lab values in conjunction with the history of bute overdose and ventral edema led to the diagnosis of protein losing enteropathy (PLE). PLE is a condition in which there is increased permeability in the gut so proteins can 'leak' out, creating a decrease in oncotic pressure in the blood that causes movement of fluid into the tissue spaces, hence the edema.

On November 19, 2006, he was started on GastroPLUS, which is specifically formulated to aid in the healing of gastric and intestinal mucosa. His weight was estimated at 400 lbs so he was given a dose of 32 cc (6cc per 100 lbs) twice a day for two weeks. Within 14 days, the ventral edema was resolving. Treatment was decreased to once a day at this time and continued for another two weeks.

Follow up blood work done in December of 2006 revealed completely normal red blood cell and hemoglobin values (resolution of anemia), normal protein levels in the blood and normal bilirubin values. The pony continues to do very well.