title: Idiopathic focal eosinophilic enteritis (IFEE), an emerging cause of abdominal pain in horses: the effect of age, time and geographical location on risk.
abstract: BACKGROUND
  Idiopathic focal eosinophilic enteritis (IFEE) is an emerging cause of abdominal pain (colic) in horses that frequently requires surgical intervention to prevent death. The epidemiology of IFEE is poorly understood and it is difficult to diagnose pre-operatively. The aetiology of this condition and methods of possible prevention are currently unknown. The aims of this study were to investigate temporal and spatial heterogeneity in IFEE risk and to ascertain the effect of horse age on risk.
  
  
  RESULTS
  A retrospective, nested case-control study was undertaken using data from 85 IFEE cases and 848 randomly selected controls admitted to a UK equine hospital for exploratory laparotomy to investigate the cause of colic over a 10-year period. Generalised additive models (GAMs) were used to quantify temporal and age effects on the odds of IFEE and to provide mapped estimates of 'residual' risk over the study region. The relative risk of IFEE increased over the study period (p = 0.001) and a seasonal pattern was evident (p<0.01) with greatest risk of IFEE being identified between the months of July and November. IFEE risk decreased with increasing age (p<0.001) with younger (0-5 years old) horses being at greatest risk. The mapped surface estimate exhibited significantly atypical sub-regions (p<0.001) with increased IFEE risk in horses residing in the North-West of the study region.
  
  
  CONCLUSIONS
  IFEE was found to exhibit both spatial and temporal variation in risk and is more likely to occur in younger horses. This information may help to identify horses at increased risk of IFEE, provide clues about the aetiology of this condition and to identify areas that require further research.
authors.affiliation: Institute of Infection and Global Health/School of Veterinary Science, University of Liverpool, Leahurst Campus, Neston, United Kingdom.
authors.forename: Debra C
authors.initials: DC
authors.lastname: Archer
authors.affiliation: Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Costain
authors.affiliation: Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom.
authors.forename: Chris
authors.initials: C
authors.lastname: Sherlock
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology* / Q000601:surgery / Q000662:veterinary*; D000818:Animals; D016022:Case-Control Studies; D004751:Enteritis / Q000453:epidemiology* / Q000601:surgery / Q000662:veterinary*; D004802:Eosinophilia / Q000453:epidemiology* / Q000601:surgery / Q000662:veterinary*; D005756:Gastritis / Q000453:epidemiology* / Q000601:surgery / Q000662:veterinary*; D005843:Geography; D006736:Horses; D007813:Laparotomy; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D013997:Time Factors