Does Hand Walking Help the Gut?

Hello, Summairans!

Do clinical studies always correlate to clinical experience and insight? Not always…

The first summary challenges a long-held clinical belief. What is your take?

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Hand walking and GI Motility

Hand walking is a common practice in equine postoperative care, especially after colic surgery, with the belief that it reduces the risk of postoperative ileus (POI) by enhancing gastrointestinal motility. It is also used preoperatively to decrease ingesta fill within the digestive tract. While human studies have shown that early mobility after surgery can reduce POI and shorten hospital stays, the effect of hand walking on gastrointestinal motility in horses had not been objectively evaluated. 

This study aimed to assess the effects of hand walking exercise on myoelectrical activity in the cecum and left ventral colon (LVC) of healthy, fasted horses confined to box stalls. Using multichannel electrointestinography (EIG), researchers measured intestinal myoelectrical rhythms and compared these findings with intestinal contractions identified through transabdominal ultrasonography and auscultation of borborygmi. The hypothesis was that hand walking would increase intestinal myoelectrical activity, ultrasonographic contractions, and borborygmi compared to stall rest alone. 

The results did not support the hypothesis. Hand walking did not increase gastrointestinal motility as measured by EIG dominant frequency (DF), dominant power (DP), or total power (TP) distribution in the cecum and LVC. There were no significant differences between hand-walked horses and sedentary horses regarding intestinal myoelectrical activity. Additionally, the EIG DP did not correlate with intestinal contractions observed via ultrasonography or with borborygmi, although a correlation was found between ultrasonographic evidence of contractility and auscultation findings. 

The lack of effect of hand walking on intestinal motility aligns with findings in human studies, which have also questioned the benefit of early ambulation on gastrointestinal function post-surgery. This suggests that the widespread belief in equine practice—that hand walking improves gastrointestinal motility and reduces POI risk—may not be supported by objective evidence. 

The study acknowledges several limitations, including a small sample size and the use of healthy, fasted horses rather than those with gastrointestinal disease or postoperative conditions. Observers were not blinded during assessments, but the correlation between their observations strengthens the data. The study also notes that a single episode of hand walking might not be sufficient to elicit changes in gastrointestinal motility; longer periods or studies involving horses with naturally occurring gastrointestinal disease might yield different results. 

In conclusion, this study does not provide evidence to support the mechanistic role of hand walking in improving motility patterns of the cecum and LVC in normal horses undergoing fasting and stall rest. While auscultated borborygmi correlated with ultrasonographic contractions, there was no correlation with EIG DP as a measure of global contractility. Further research, particularly in clinical cases and using additional methods to monitor motility and transit time, is needed to determine whether hand walking has any beneficial effects on equine gastrointestinal motility. 

Munsterman, A. S., Rogers-Tirado, J. M., & Kottwitz, J. (2024). Electrointestinography, ultrasonographic contractility, and borborygmi of the cecum and colon are not altered by a single episode of hand walking exercise in healthy horses. Journal of the American Veterinary Medical Association https://doi.org/10.2460/javma.24.07.0486 

Bottom line — Not in this case…

Long-Term Efficacy of Cytopoint

Lokivetmab, a caninised monoclonal antibody targeting interleukin-31 (IL-31), is recognized for its effectiveness in treating pruritus associated with canine atopic dermatitis (cAD). This study evaluated the long-term efficacy and safety of lokivetmab in 150 dogs with cAD under field conditions, defining long-term use as at least three consecutive injections. Medical records were reviewed, and follow-ups with owners or veterinarians were conducted when necessary. Treatment success was determined by a decrease of at least 2 points in the pruritus Visual Analog Scale (PVAS) score or achieving a PVAS score of 2 or less after treatment. Logistic regression analyzed factors that might influence outcomes, including the type of cAD (food-induced versus environmental), age at initial administration, disease chronicity, dosage, and presence of secondary infections. 

The results indicated that lokivetmab significantly reduced PVAS scores with long-term use (p < 0.01), achieving a success rate of 77% (53 out of 69 dogs). The likelihood of treatment failure decreased with longer treatment duration, and none of the investigated factors significantly influenced the treatment outcome. Adverse events were reported in 8% of the dogs (12 out of 150), primarily involving gastrointestinal signs or lethargy. 

In conclusion, lokivetmab appears to be an effective and safe long-term anti-pruritic therapy for dogs with cAD, demonstrating significant reduction in pruritus with minimal adverse effects. 

 Kasper B, Zablotski Y, Mueller RS. Long-term use of lokivetmab in dogs with atopic dermatitis. Vet Dermatol. 2024; 35: 683–693. https://doi.org/10.1111/vde.13286 

Bottom line — Effective and Safe.

New Modality for Treating Infections?

Cold atmospheric plasma (CAP) is an emerging therapeutic tool used to treat various skin diseases in humans and animals. A study was conducted to evaluate the effect of CAP in the treatment of canine acute otitis externa (AOE). Four client-owned golden retriever dogs with bilateral AOE participated in the study. After cleaning with a commercial ear cleanser, the right ears (designated as the STANDARD group) were treated with an antibiotic, antifungal, and corticosteroid combination. The left ears (CAP group) received CAP treatments every three days for a total of four sessions. Cytological scores and otitis index scores (OTIS3) were recorded for each ear on Day 0, Day 10, and Day 15. Owners and investigators provided overall assessments at Day 10 and Day 15. 

The results showed that both the CAP group and the STANDARD group experienced decreases in OTIS3 and cytological scores over the study period. The overall assessments ranged from moderate to excellent in both groups, indicating that CAP was well-tolerated and effective in reducing clinical signs and cytological scores in dogs with AOE. The therapeutic effect of CAP was similar to that of the commercial topical anti-inflammatory and antimicrobial ear treatment used in the STANDARD group. However, the study concluded that larger controlled studies are needed to further evaluate the therapeutic potential of CAP in otitis externa. 

CAP is a non-pharmacological method used to treat skin infections and wounds and has been shown to be effective against antibiotic-resistant bacterial, viral, and fungal pathogens. Cold plasma works by damaging the bacterial cell membrane, intracellular proteins, and DNA. The particles in the plasma create an electrostatic field that breaks chemical bonds in the bacterial cell wall, causing lesions and openings in the membranes. This allows toxic plasma compounds to enter the bacterial cell, intensifying the destructive process. 

Bakır A, Nett-Mettler CS, Ulutas B. Therapeutic efficacy of cold atmospheric plasma in four golden retrievers with acute otitis externa. Vet Dermatol. 2024; 35: 745–749. https://doi.org/10.1111/vde.13287 

Bottom line — Interesting pilot study.

Just putting things in perspective …