Sand enteropathy review highlights diagnostic and treatment gaps
Bottom line
Version 1
A new narrative review in Animals argues that sand enteropathy in horses remains an underrecognized, inconsistently diagnosed condition, even as it’s increasingly reported in arid regions and other sandy environments. The review by Lena Karlotta Lousberg and Ann Kristin Barton says clinical signs can range from colic and diarrhea to weight loss, fever, inappetence, and poor performance, which makes diagnosis based on presentation alone difficult. Across the literature, abdominal radiography is still treated as the reference standard for confirming clinically relevant sand accumulation, while common field tools such as fecal sand testing have important limitations. The same author group has also recently studied treatment approaches, including polyethylene glycol plus psyllium, as clinicians continue to look for better-supported medical management options. (merckvetmanual.com)
Why it matters: For equine veterinarians, the review is less about a single breakthrough and more about the gaps that still shape everyday case management. Sand enteropathy can mimic other causes of colic or chronic gastrointestinal disease, and the evidence base around screening, case definition, treatment selection, and prevention remains uneven. That’s important because newer work suggests clinicians are trying to refine what amount of radiographic sand is actually clinically significant, and recurrence appears to be a real concern when sand isn’t fully cleared. In practice, the paper reinforces the need to pair history and exam findings with imaging when possible, and to be cautious about overinterpreting low-specificity screening methods. (beva.onlinelibrary.wiley.com)
What to watch: Expect more work on radiographic thresholds, treatment comparisons, and recurrence risk, especially as recent studies try to separate incidental sand accumulation from clinically meaningful disease. (onlinelibrary.wiley.com)
Key facts
- Condition
- Sand enteropathy in horses
- Main issue
- Underrecognized and inconsistently diagnosed
- Clinical signs
- Colic, diarrhea, weight loss, fever, inappetence, and poor performance
- Diagnostic standard
- Abdominal radiography is the reference standard for clinically relevant sand accumulation
- Field test limitation
- Fecal sand testing has important limitations
- Risk factors
- Sandy turnout, sparse pasture cover, drought conditions, and feeding on the ground
- Treatment
- Polyethylene glycol plus psyllium was studied as a medical management option
- Recurrence
- Recurrence appears to be a concern when sand is not fully cleared
Version 2
A new review in Animals takes stock of what the profession knows, and still doesn’t know, about sand enteropathy in horses, a condition tied to sand accumulation in the gastrointestinal tract that can present as anything from vague poor performance to acute colic. The paper’s central message is straightforward: awareness is rising, but the clinical evidence base is still patchy, particularly around diagnosis, treatment choice, and prevention. (beva.onlinelibrary.wiley.com)
That uncertainty matters because sand enteropathy isn’t confined to one narrow presentation or one geography. Prior literature has described cases worldwide, including in the United States, Europe, the Middle East, and Australia, with risk linked to sandy turnout, sparse pasture cover, drought conditions, and feeding on the ground. Merck’s veterinary reference notes that horses may present with diarrhea, weight loss, or colic, and that treatment often requires weeks rather than days, especially if the horse remains exposed to the source of sand. (beva.onlinelibrary.wiley.com)
The review’s diagnostic emphasis lines up with the broader literature: radiography remains the most accepted way to confirm and monitor large-colon sand accumulation, even though older studies have also cautioned that no single imaging score is perfect in every setting. Recent research is now trying to sharpen that picture. A 2024 report proposed a bodyweight-adjusted formula, 9 mm of sand depth per 100 kg, to help distinguish clinically significant findings from incidental accumulation on abdominal radiographs. A 2025 Australian Veterinary Journal paper similarly suggested that horses without active signs but with sand areas greater than 21 cm² per 100 kg may still be at risk of developing sand enteropathy. (pmc.ncbi.nlm.nih.gov)
On treatment, the literature remains active but not settled. Standard medical management has long centered on psyllium, often alongside laxatives or fluids, and Merck notes that 3 to 4 weeks of therapy may be needed to remove most of the sand burden. The Lousberg group’s related Animals study evaluated polyethylene glycol combined with psyllium against established regimens, reflecting interest in whether human-medicine laxatives might improve clearance. At the same time, other recent reports continue to examine psyllium with magnesium sulphate or paraffin oil, suggesting that clinicians are still working within a fairly heterogeneous evidence base rather than a single agreed protocol. (merckvetmanual.com)
Industry and expert-facing references broadly support the review’s caution. A 2022 clinical review in Equine Veterinary Education concluded that evidence does not support the fecal glove sedimentation test as a reliable screening tool under field conditions because of limited sensitivity and specificity. Merck likewise frames diagnosis as a combination of environmental history, fecal sand, auscultation findings, and, when available, abdominal radiographs, underscoring that simpler stall-side clues can help, but usually shouldn’t stand alone. (beva.onlinelibrary.wiley.com)
Why it matters: For veterinary professionals, the review is a reminder that sand enteropathy sits at the intersection of ambulatory medicine, hospital imaging, nutrition, and case prevention. Horses may cycle through recurrent mild colic, chronic diarrhea, or poor performance before a definitive diagnosis is made, and recent Australian data suggest recurrence after medical management is common when sand clearance is incomplete. That raises practical questions for veterinarians about when to image, how aggressively to monitor response, which medical regimen to choose, and how to counsel pet parents and barn managers on environmental mitigation. (onlinelibrary.wiley.com)
The bigger takeaway is that the field is moving from simply asking whether sand is present to asking whether the amount present is clinically meaningful, how best to clear it, and how to prevent repeat cases. That’s a more useful framework for practice, but it also highlights how much of the evidence is still emerging. For clinicians, the safest read is that radiography remains central when available, prevention still depends heavily on management changes, and treatment decisions should be made with an eye toward follow-up rather than one-time intervention. (onlinelibrary.wiley.com)
What to watch: The next wave of evidence will likely focus on prospective treatment comparisons, better radiographic cutoffs for clinically important sand burdens, and recurrence outcomes after discharge, all areas where the current literature is still thin. (onlinelibrary.wiley.com)