Choke is an esophageal obstruction caused by poorly chewed food or other material that gets stuck in the throat of horses.
• Unlike choking in humans, the airway is not compromised, therefore choke is not immediately life-threatening in horses
• Left untreated, it may become a medical emergency, so immediate veterinary attention is required if a choke does not resolve itself in under 30 minutes
• Symptoms include greenish, frothy discharge coming out of the nose along with coughing, stretching the neck repeatedly, excess drooling, lack of appetite, and sweating
• Diagnostic tools include physical examination, nasogastric intubation, and endoscopy
• Treatments include sedation and lavage
• In rare cases, general anesthesia is required
• Prognosis is good, although horses who develop aspiration pneumonia or esophageal rupture have a guarded prognosis
Choke is not immediately life-threatening in horses as it is in humans, because the blockage occurs within the esophagus, not the windpipe. A horse with choke can still breathe.
In many cases, choke resolves itself quickly. In cases where choke has been ongoing for more than 30 minutes, immediate veterinary attention is needed to avoid potentially life-threatening consequences.
Choke is very common in horses.
Very young horses, miniature horses, ponies, and older horses are more susceptible to choke. Horses that are sedated are also at risk.
Horses that feed too quickly, do not chew properly, are in competition with other horses for food, are fed dry or fibrous feed or hard food such as carrots, or swallow indigestible items are more likely to experience choke.
Horses that have previously experienced choke are also at greater risk, because esophageal damage caused by choke can leave scar tissue that makes the esophagus smaller in diameter and less flexible.
The severity of choke depends on how long the episode lasts, and what complications occur as a result.
Horses with a prolonged episode of choke often have damage to the inside of the esophagus. This damage can impede the ability to eat even when the choke is resolved. In some cases, the damaged area becomes infected. Horses that have experienced a prolonged episode of choke, especially where the esophagus has been damaged, are likely to experience further episodes of choke as a result of scar tissue.
In some cases, horses with choke develop aspiration pneumonia. This occurs when fluid or solid matter is inhaled into the lungs and causes an infection. The symptoms of aspiration pneumonia typically develop within 3 days of a choke episode. Aspiration pneumonia is a medical emergency requiring immediate veterinary attention.
Choke occurs when something swallowed gets stuck in the esophagus. The esophagus contracts around it, drawing the moisture out of it, making it even harder to pass into the stomach. Any further food or water that is swallowed during the episode gets stuck on top of the blockage.
Choke is caused either by behavior or issues with the feed.
Horse behaviors that cause choke include:
• Lack of proper chewing of food due to poor dental health
• Bolting food or eating too quickly (sometimes related to being in competition with other horses for food)
• Swallowing foreign objects, such as bedding, corn cobs, wood shavings, metal or rope, or other objects
Issues with the feed include:
• Dry feed, such as pellets
• Fibrous feed, such as hay or straw
• Hard feed that does not readily soften, such as apples or carrots
In rare cases, horses that choke repeatedly are diagnosed with a problem affecting normal movement of feed through the esophagus. Possible causes include:
• Masses, cysts, abscesses, or scar tissue in the esophageal wall or around the esophagus that narrow the passageway
• Conditions affecting the movement of the esophagus, such as megaesophagus
The main symptoms of choke include:
• Green or yellow, frothy discharge from the nose that often contains bits of food
• Stretching and contracting the neck or shaking the head
• Repeated attempts to swallow
• Abrupt lack of appetite
• Alarmed, confused expression
• Excessive sweating
• Gagging or retching
• In some cases, a bulge is detectable on the left side of the neck
Horses with symptoms of choke should be monitored closely and prevented from eating or drinking until the condition is resolved. If the horse is still experiencing choke after 30 minutes, immediate veterinary attention is required.
Diagnostic tools include:
• Physical examination
• Nasogastric intubation
• Diagnostic imaging, including X-rays and ultrasound
Note: nasogastric intubation should only be performed by a veterinarian. There is no safe way to intubate a horse at home.
• Sedation to relax the esophagus
• Esophageal lavage (flushing the esophagus with water to loosen the blockage)
In rare cases, the blockage is too severe to remove with lavage and sedation alone. Hospitalization and lavage under general anesthesia are necessary in these cases. Surgical removal of the block may be required in very rare cases.
After the blockage is removed, endoscopy of the esophagus is often recommended to evaluate for any damage. In cases where esophageal damage has occurred, repeated endoscopies are indicated to monitor the healing process and identify any scar tissue formation early.
Following resolution of a choke incident, ongoing care is required for a few days including:
• Giving no feed or forage for approximately 12 hours to allow the esophagus to rest
• Feeding a slurry of pelleted feed that contains a large amount of water for several days after resolution
• Reintroducing drier, more fibrous foods gradually
• Close monitoring for fever and other signs of aspiration pneumonia for three or four days
In many cases, choke clears in under thirty minutes. Other cases require treatment to resolve, and the prognosis is determined by how quickly the veterinarian starts treatment, and how quickly the treatment takes to resolve the choke.
The prognosis for choke is typically good. Horses with damage to the esophagus are more likely to experience future episodes. The prognosis for horses with aspiration pneumonia or a ruptured esophagus is guarded. In some cases, these complications are fatal.
Strategies to prevent choke include:
• Soaking dry food such as pellets, large cubes, and beet pulp in water for at least an hour before feeding
• Avoiding feeding horses that are sedated
• Feeding horses separately to avoid competition
• Feeding many small meals over the day
• Slowing down the eating process with the use of grazing muzzles or by placing large smooth stones in their feed box
• Feeding grain after hay
• Slowing hay consumption by using hay nets
• Tidying the environment of objects a horse may try to ingest
• With repeat chokers, feeding slurried food on an ongoing basis
Choke is a common condition in horses.
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