Recurrent colic: evidence-based approach to management

Recurrent colic, defined as repeated episodes of abdominal pain of varying frequencies and durations, interspersed with periods of clinical normality, is a relatively common presenting complaint in equine practice, the investigation of which can be frustrating, time-consuming and often unrewarding. This is largely due to the extensive variety of conditions which may result in such a presentation and the limitations of commonly used noninvasive diagnostic modalities. Furthermore, the potential for functional alterations in intestinal function to present with recurrent episodes of abdominal pain also limits the opportunity to identify an underlying physical cause.
However, a limited number of studies on this subject have provided interesting and important data which may help to determine the most appropriate investigative approach, predict the degree of diagnostic accuracy and estimate the likely prognosis. Careful consideration of signalment and history of the case is important, as a variety of risk factors have been associated with the recurrence of abdominal pain, including breed, increasing age, dental disorders, stable vices, certain feeding, housing and grazing practices and most notably previous abdominal surgery [1,2]. Furthermore, consideration of the frequency, duration and severity of colic episodes can be valuable with respect to directing the route of investigation [3]. Generally, invasive procedures are more indicated in cases with frequent episodes of severe colic compared with infrequent episodes of mild colic.
The investigation of such cases should include a thorough clinical examination, with the likelihood of identifying the cause and/ or the source of abdominal discomfort being significantly greater if this is performed during a colic episode. Furthermore, concerted efforts should be made to identify additional, although less obvious, presenting signs which may determine the most appropriate direction of the diagnostic investigation. These include subtle weight loss, ventral oedema, cutaneous lesions and/or oral dysphagia. […]