Stomach Ulcers: Nutritional Factors Treatment And Prevention
STOMACH ULCERS: NUTRITIONAL FACTORS, TREATMENT AND PREVENTIONExcerpt from Horse Nutrition, a My Horse University online course
While gastric ulcers can occur in the esophagus and small intestines, the stomach is the most common site of gastric ulcer formation in the adult horse. Stomach ulcers most often affect the squamous mucosal cells of the lesser curvature of the stomach. Extreme ulceration in the stomach can lead to perforation of the stomach lining, a condition that is almost always fatal. Many forms of stress are linked to stomach ulcer formation as well as certain feeding management practices. Adult horses with stomach ulcers may appear lethargic, have a poor appetite, exhibit mild colic symptoms, have diarrhea, lose weight, exhibit a nervous or grumpy attitude, and show a decline in performance. Often, horses dont exhibit any obvious symptoms but may just be off or are not reaching their full potential.
Stomach ulcers are most common in the squamous mucosa cellsadjacent to the margo plictaus of the stomach in adult horses.
The following are considered possible precursors to stomach ulcers in equine:
Exercise intensity is directly related to gastric ulcer formation.
Stalled horses have a higher frequency of gastriculcers than horses housed on pasture.
Transportation: Transporting horses as little as four hours may also predispose some horses to gastric ulcer formation. Again, the effect of disruptive feeding or the stress of hauling may all be factors.
How Are Gastric Ulcers Treated
There is currently only one pharmaceutical treatment omeprazole approved by the U.S. Food and Drug Administration for gastric ulcers in horses. Omeprazole is available as a paste formulation and has been very effective in preventing and treating gastric ulceration in all types of horses. Although the commercial paste is expensive, it is very effective and requires administration once a day. Due to the cost of this product, some compounding pharmacies prepare and sell paste or liquid omeprazole at cheaper prices. However, several studies have shown that the amount of active omeprazole in those products is lower than the label. In addition, the ability of those products to inhibit gastric acid production and their ability to resolve gastric ulcers has been variable. Horse owners should be wary of claims for products that are not controlled or regulated by the FDA or evaluated in scientific studies. While those products may be less expensive to purchase, they may be more costly in the end due to inefficacy.
A preventative dose of omeprazole is commercially available for use around transport or stressful events. Horses with a history of gastric ulceration may benefit from proactive treatment to decrease the chances of ulcer recurrence. At this dosage, the omeprazole is less costly and may serve as a good investment.
What Should You Feed A Horse With An Ulcer
If your horse has suffered from an ulcer then when it comes to his feed its time to go back to basics and keep it simple. If you keep these points in mind you cant go far wrong:
- Plenty of forage Forage takes longer to chew than concentrates and as a result, produces a lot more saliva which will help to keep the levels of stomach acid under control.
- Little and often Weve all heard it a million times before but feeding horses little and often is crucial for a healthy gut and digestive system, and therefore a happy horse.
- Avoid too many cereals Cereal concentrates dont allow the horse to produce the amount of saliva they need which increases their risk of ulcers. Thats not to say you shouldnt feed concentrates but try to find one that has a higher proportion of digestible fiber
- Include alfalfa Studies have shown that the protein levels in alfalfa make it one of the best sources of fiber when it comes to treating horses with ulcers.
- Dont exercise on an empty stomach You dont need to feed your horse a lot before exercise, a scoopful of chopped fiber is enough. This will ensure his stomach isnt empty and therefore the acid wont be left to slosh around.
- Turn out Turning your horse out as much as possible will not only give him a chance to graze but will also reduce his stress levels. This will help when treating ulcers because itll take away one of the triggers for them.
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Looking Ahead To Greater Impact
Equine Gastric Ulcer Syndrome is a daily challenge for veterinarians, with a horses performance and overall health being challenged by ulcers and their secondary effects. Continued research to better understand EGUS, EGGD in particular, and how to prevent and treat it more effectively is needed, says Dr. Belgrave, hopefully. These ulcers are often recalcitrant to treatments available in todays market and have the greatest negative impact on performance in equine athletes.
As equine veterinary medicine shifts its focus, resources, research and attention on a more predictive, preventive and personalized approach, horses at risk and suffering from diagnosed gastric ulcers will benefit. In the future, we will ideally head toward personalized medicine and a whole-horse approach in order to prevent and then, as needed, treat disease, says Dr. Whitfield. Everythings related. We know that however, we need to further consider the implications of what were doing and how its affecting all aspects of the horse.
Dr. Belgraves sentiment is shared by Dr. Smith, a lifelong horseman in his own right. Its 100 percent about the horses. Im happy to get up every morning, be a part of the team with my clients and see their success in the ring or the arena doing what they and their horses love. When youre included in that circle, its something special, and I dont take my responsibility to keep them healthy and performing for granted.
Symptoms Of Ulcers In Horses
The majority of horses with ulcers will not show serious signs. Some horses may appear to be completely healthy but suffer from ulcers. Severe symptoms include teeth grinding and severe colic. You are likely to notice more subtle signs such as:
- Dull or poor coat quality
- Attitude changes
A horse lying down more than usual could be showing signs of ulcers.
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Squamous Gastric Ulcers In Horses
Equine Squamous Gastric Ulcer Syndrome refers to ulcerative lesions specifically affecting the squamous portion of the equine stomach, or roughly, the upper third of the stomach. An ulcer in the squamous region is believed to occur when the mucosal lining becomes damaged, likely by bacteria, parasites or a constant barrage of stomach acid. The squamous region is particularly susceptible to damage as it lacks the protective mechanisms of the glandular region to defend its mucosal lining from gastric acid.
Skippy may very well be suffering from ESGUS, as his current lifestyle and diet fit the typical profile of a horse likely to develop squamous ulcers. These risk factors often include:
- Limited turnout
- Intermittent feeding
Hes also displaying all of the classic symptoms, including loss of appetite, difficulty maintaining weight/weight loss, changes in hair coat, poor behavior, underperformance and wood chewing. If he is suffering from ESGUS, continuing his high-concentrate, low-roughage diet and intensive training schedule could make matters even worse for him.
Types Of Ulcers In Horses
A horse with EGUS can develop ulcers in four main parts of the digestive system:
- Lower part of the esophagus
- Nonglandular region of the stomach
- Glandular region of the stomach
- Upper small intestine
The glandular region of the stomach produces acid but also produces natural defenses such as mucous and bicarbonate to buffer the acid and protect the cells in that region. In contrast, the nonglandular squamous region is not protected by these factors.
Ulcers are most commonly found in the nonglandular region of the stomach.
Ulcers also commonly occur in the lower part of the esophagus. This may be due to acid reflux associated with unnatural feeding practices, like high grain diets, that can lead to decreased pH in the stomach. Reflux of acidic fluids may also occur with gastric compression during intense exercise which might explain why so many racehorses develop ulcers.
Ulcers in the glandular region of the stomach are considered rare by many veterinarians, but some researchers suggest that they may be more common than believed. These types of ulcers have been associated with the overuse of non-steroidal anti-inflammatories such as bute and banamine .
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What Should Not Be Fed Before Exercise
Never feed grain within 4 to 5 hours of a ride or exercise, and that includes any feed that is high in starches or sugar. The starches and sugars in these feeds are absorbed from the small intestine largely as glucose, which triggers the release of insulin from the horses pancreas. Blood glucose and insulin levels following a grain feed generally peak at 2 to 3 hours following a meal and return to normal within 4 to 5 hours. Insulin is a hormone that instructs the horses muscles and organs to store away glucose.
So if there is insulin in a horses blood when exercise starts, the horse isnt able to mobilise glucose stores to burn and fuel the muscles during work . The horses ability to burn fat as an energy source is also reduced when insulin is present. The result of feeding a grain or high starch and sugar feed too close to when the horse is exercised is the horse that will run out of muscle energy supplies and fatigue quickly.
This concept is particularly important for high intensity exercise where a horses glucose supplies are burnt up very quickly. In endurance type activities, large grain meals should not be fed within 4 to 5 hours prior to the start of exercise, however smaller grain meals may be fed during exercise to top up muscle glycogen stores and prolong the time to fatigue.
Adjust Your Horses Eating & Exercise Schedule
Another important step is to adjust the time between meals. This aspect of treatment can pose a real challenge for a lot of equine enthusiasts. Many horse lovers work away from their horses, which makes feeding more frequently than twice a day difficult. Fortunately, today, there are a few feed accessories on the market that make it easier to provide frequent feedings to your horse. This is done by dramatically slowing down how quickly they can consume their feed.
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Vet: Why The Time Of Day You Ride And Feed Is So Important To Preventing And Managing Gastric Ulcers
Recent research shows two distinct gastric syndromes in horses, one affected by intensity of exercise and the other by the amount.
Dr Ben Sykes, associate professor in equine internal medicine at Massey University in New Zealand and a vet for more than 22 years, explains why the time of day you feed and ride are so important to managing ulcers.
Once thought of as a condition that mostly affected racehorses and high-performance horses , vets and researchers are now increasingly seeing equine gastric ulcer syndrome in everyday horses and ponies .
There are two types of gastric ulceration: squamous and glandular, both of which are diagnosed and treated separately.
Cribbing Or Other Stereotypic Behaviors
Stereotypic behaviors, such as cribbing, are repetitive and unnatural behaviors that become increasingly fixed. However, these behaviors only occur in a small percentage horses so this is one of the less common signs of ulcers.
Dietary factors such as a lack of available forage have been strongly associated with oral stereotypies like cribbing. However, foals with ulcers may crib-bite as well.
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Equine Gastric Ulcer Syndrome: Potential Causes Treatments Performance Implications And Preventive Measures
At first glance, equine ulcers seem well understood with an established diagnostic process and tried treatment modalities. Beneath the surface, however, it quickly becomes clear that ulcers remain a bit of an enigma, with near endless causes, high recurrence rates and an approach that requires a multifaceted and individualized plan to accomplish a successful outcome.
Ulcers touch an overwhelming percentage of the horse population, making them one of the more prolific struggles faced by both riders and equine veterinarians. According to the American Association of Equine Practitioners , up to 90 percent of racehorses and 60 percent of performance horses are afflicted with gastric ulcers, with non-performance horses and foals impacted as well. The progress happening in the understanding, treatment and perhaps, more importantly the prevention of equine gastric ulcers is incredible. Veterinary medicine is witnessing significant leaps in areas including the impact of NSAIDS, the critical role of diet, the influence of advanced nutrition and the tie between equine gastric ulcers and the horses gut microbiome.
New Way To Prevent Ulcer Recurrence
Research from Louisiana State University suggests that a new supplement may help reduce the recurrence of gastric ulcers among horses that have undergone successful treatment with omeprazole.
Estimated to affect 60 to 90 percent of horses, gastric ulcers are erosions of the stomach lining caused by excessive acid production. Competition, intense training, transport and other stressors increase a horses risk for ulcers, which often lead to weight loss, poor performance, a sour attitude and colic. Diagnosis is usually made through endoscopic0 examination.
A four-week regimen of the omeprazole , which reduces the production of stomach acid, usually resolves gastric ulcers. But afterward some horses experience a recurrence because their acid secretions return to pretreatment levels or even higher, a phenomenon known as rebound acid hypersecretion . Omeprazole treatment leads to a decrease in acid secretion and, as a result, G-cells of the stomach release gastrin—a hormone that stimulates acid secretion—in the blood, explains Frank Andrews, DVM, MS, DACVIM. With drug cessation, leading to acid-related heartburn, acid regurgitation or dyspepsia. All this can lead to recurrence of ulcers in horses.
Based on this research, Andrews advises starting horses on the SmartGut Ultra supplement when they are treated for ulcers, then continuing to feed it once treatment has ended.
This article first appeared in EQUUS issue #450, March 2015.
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I Have Been Told To Give My Horse A Small Feed Before Exercise Is This Safe
Yes providing it is fibre based. The advice is to give a scoop of chopped fibre within 30 minutes prior to exercise. This recommendation is given to make sure that the fibrous mat within the horses stomach is maintained to reduce acid splashing about in the stomach. Acid splash in the squamous or non-glandular lining of the horses stomach is linked to gastric ulceration. Ideally this chopped fibre should include alfalfa as research has shown that alfalfa particularly is a superior buffer to acidity within the digestive tract.
The Critical Influence Of Diet
While grains and concentrates can have a detrimental effect in some cases, forage choices and grazing behavior can both positively and negatively impact a horses propensity for ulcers as well. Pasture turnout is considered to reduce the risk of EGUS as does free access to fibrous feed or frequent forage feeding, notes Dr. Belgrave. While a high-quality, forage- based diet is essential, the type of hay fed can also factor into a horses risk of developing ulcers. There is an increased likelihood of ESGD when straw is the only forage provided, though feeding alfalfa hay has been shown to have a protective effect of the gastric squamous mucosa in adult horses. Dr. Belgrave is a strong advocate for pasture access, and for those times when horses are stalled, he recommends continual and gradual access to good-quality hay while keeping grains and concentrates to a minimum and only feeding them when a sufficient amount of hay is in the stomach to buffer the gastric acid released upon their consumption.
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What Are The Symptoms Of An Ulcer
Every horse is different and will display different symptoms but the common things to look out for are:
- Poor appetite
- Reduction in performance
- Lying down more than normal
Some horses will continue to eat the same amount of food but will change the way they eat. Instead of eating all of their feed in one go, theyll eat a little bit of it then walk away and come back to it later. This is because theyre in pain when they eat but are still hungry.
In more serious cases horses have been known to grind their teeth due to the pain and lie on their backs. Its more common in foals, but its thought that they lie on their backs as that position offers some relief of the pain. If your horse is producing brown gastric fluid then its possible that he may have a bleeding ulcer and veterinarian assistance is crucial.
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What Should You Feed Before Exercise
What you feed before exercise is very important. You should only feed forage before exercising your horse and preferably long stem forage like hay. Hay requires a lot of chewing and will stimulate plenty of saliva production which provides good buffering protection for the stomach. While any forage that forms parts of your horses everyday diet is acceptable, if you are concerned about gastric ulcers in your horses, alfalfa hay has been shown to be helpful when it comes to preventing or resolving ulcers. So if alfalfa hay is available and is fed as part of your horses normal diet, this would make a good choice for a preride or exercise feed.