Monday, December 5, 2022

Hind Gut Ulcers In Horses Treatment

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Feed Supplements To Address Ulcers

Equine Ulcer Treatment – Before and After by Mark DePaolo, DVM

In addition to modifying your feeding program, there are a number of digestive supplements on the market, from old home remedies to packaged products labeled for digestive health.

One simple and commonly used method is to add corn or flax seed oil to the feed. This helps to supply Omega 3 fatty acids, which can help with weight management while the hindgut is compromised and may promote healing.

Another dietary product used in caring for the hindgut is Psyllium Mucilloid. This is a natural dietary fiber that works as a bulk laxative. It is used particularly to help remove ingested sand from the colon, which may cause ulcers or lead to sand colic.

Beyond this, the tack store shelves and catalogs are filled with an assortment of products making all kinds of claims for digestive health or ulcer support. But what really works?

Rather than attempt to review all of the different products out there, lets offer some sound, practical advice: be aware that most of these products dont live up to the claims, so read labels carefully, research ingredients and their effects, and discuss options with your veterinarian.

Normal Hind Gut Environment/function

Once you understand the basics of horse nutrition, the anatomy and function of their intestinal tract makes complete sense!

Horses are hind-gut fermenters, where they undergo the same process of mixing and fermenting their food but this process happens after the stomach and small intestine in caecum and the ~3m long large colon. Large/thick bands that run along the walls of the large colon contract to form haustra or houses where intestinal contents are mixed and fermented. Two of the most important functions of mixing ingesta with microbes is the absorption of water/electrolytes and the production of short chain fatty acids which the horse uses for energy.

The combined stresses of training, management, competing and transport can contribute to colonic ulcers and lead to changes in attitude and performance.

Fermentation and absorption is aided by a diverse population of microbes and a folded mucosal layer that is regenerated every week by local stem cells. The wall of the large colon is guarded by a series of different cells that control what is and is not allowed to cross from the intestinal tract into the body. A healthy intestinal wall is impermeable to toxins and disease-causing agents. When the barrier becomes damaged or compromised at any point along the intestinal tract, harmful substances gain access across the intestinal barrier and can cause both local and systemic disease.

Treatment For Equine Glandular Gastric Disease

Treatment of EGGD is not as straightforward as treatment for ESGD. In most cases, omeprazole alone is not sufficient to heal EGGD ulcerations. Other medications utilized along with omeprazole to heal lesions in this region of the stomach include:

  • Misoprostol this is a a synthetic prostaglandin thought to help restore some of the bodys natural defenses against acid by providing additional acid suppression, increased mucosal blood flow and increased bicarbonate secretion.
  • Sucralfate This is a medication that binds to the negatively charged particles in the ulcer bed, buffering acid by increasing bicarbonate secretion, stimulating prostaglandin production, and coating the ulcer bed. In the stomach, sucralfate is converted to a sticky amorphous mass, which is thought to prevent diffusion of acid into the ulcer.

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So Then What Is Hindgut Acidosis

  • Lets dive into the hindgut and see whats going on with respect to acidosis and pH. A horses gut pH is a measure of how acidic the environment is. The measurements are on a scale of 1 to 14, with 7 being neutral, like water. Values closer to 1 are more acidic, values closer to 14 are more basic.
  • The hindgut of a horse usually has a pH of about 6.5 to 7, so fairly neutral. In the hindgut, there are also several types of microbes, each with their own food preferences. In the simplest of terms, theres the group of fiber loving microbes and the sugar-loving microbes.
  • The fiber loving microbes are responsible for fermentation and filling the energy needs of your horse. These guys love the neutral-ish conditions of the balanced hindgut. The other group of microbes LOVE sugars, and eat them up. When these sugar lovers poop, their by-products are acidic and can lower the pH of the hindgut. As the pH becomes more acidic, these sugar-loving microbes thrive! It becomes a vicious cycle.
  • But the fiber loving microbes cant tolerate the lower pH. They will begin to die, and release endotoxins upon their death.
  • So now we have an acidic hindgut, AKA hindgut acidosis, with a bunch of dead microbes and their endotoxins floating around. The acidic nature of the hindgut now will also create openings in the lining of the hindgut. This allows the endotoxins to escape into the bloodstream, where they can create all sorts of problems, including colic and laminitis.

How Are Stomach Ulcers Diagnosed

4 Common Causes of Hindgut Ulcers in Horses [How to Treat ...

Clinical signs and response to treatment can offer circumstantial evidence that your horse has ulcers, but gastroscopy is the only way to confirm the diagnosis of stomach ulcers and to evaluate their severity. There is no correlation between the signs and the severity of ulcers. Some horses exhibit very few signs but have severe ulcerations, whereas others show many signs but have less severe ulcerations.

Stomach scoping involves passing an endoscope through the horses nose all the way to the stomach and the beginning of the small intestine to see the stomach lining. This requires the horse to be fasted, so that the stomach is empty, and lightly sedated to help pass the camera more easily.

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Two Keys To Stopping Equine Hindgut Pathologies: Early Detection And Accurate Diagnosis

When it comes to the gastrointestinal health of our patients, equine veterinarians are highly aware of the widespread nature of gastric ulceration, especially for horses used in competition and professional settings. We also deal with colic as the top cause of medical death in horses, and were called upon regularly to diagnose and treat bacterial imbalances, diarrhea and other GI upsets. Considering those are specifically hindgut issues, horses are hindgut fermenters, and the hindgut makes up the majority of the GI tract, we ought to be concerned.

Should we be giving more attention to the hindgut, and is there a greater role that the hindgut plays in equine GI upset?

Unfortunately, the tools available to diagnose hindgut issues in horses are limited. Heres why you need to be paying more attention to hindgut health, why early detection matters, and the options you have for more accurate GI diagnosis.

Rebecca Mcconnico Dvm Phd Dacvim

Professor of Equine Medicine

Department of Veterinary Clinical Sciences

School of Veterinary Medicine

Louisiana State University

Baton Rouge, LA 70803

Ulcers in the equine colon are common in performance horses and lead to decreased performance, vague clinical signs , changes in blood work and may go undiagnosed for months because horses are usually normal between acute episodes. All ages and breeds of horses are susceptible to ulcers of the colon and current treatment focuses on reducing bulk in the diet, use of gut coating agent and condition agents, mild laxatives, and oils to promote healing.1

Read Also: Ulcerative Colitis Is It Deadly

My Treatment And Feeding Program

The following are the foods and medication I give and why I feed them. You can use whatever want. I do believe the cabbage, oat flour, and pumpkin seeds are easy and are a must. As with all feed changes, you should take one to two weeks to work up to the suggested amounts. All my horses love these foods.

First 2 weeks each day:

Omeprazole Full dose

1 pump of GUTX am & pm

1/4 cup Oat flour

5-10 Tums or 1/4 cup Mylanta in 2 cups of Alfalfa pellets or 1/2 flake of Alfalfa

Several cups of hay pellets before riding

Afterwards: If your horse is doing well, stop the Omeprazole and cut the Sucralfate dose over the next month unless travel or weather warrant it.

Always use at least 1/2 pump am/pm of GutX and Tums/Mylanta/Alfalfa and oat flour.

Feed: Free choice grass hay 24/7

I feel the following are absolutely necessary to heal and maintain the stomach and hind gut:

I mix these with a few cups of hay pellets twice a day in a bucket:

1/4 cup pumpkin seeds

1 Tablespoon Cabbage powder ,

1 oz. Probiotics

1/4 cup ground Flax seeds

In addition, you can use these calming foods for all horses, if you desire:

1 Tablespoon Brewer’s Yeast ,

Green Tea powder

I do not feed any grains. These are hard on the horse’s stomach and extremely difficult to digest.

Equine Gastric Ulcer Drug Treatments

Myth busting Hindgut Ulcers with world expert on equine gut health Associate Professor Dr Ben Sykes

While there is only one FDA-approved drug product available for treating gastric ulcers in horses, there are a number of pharmaceutical remedies commonly used. They all generally fall into three categories:

  • Antisecretory agents shut down acid production in the stomach to allow healing to occur. Drugs in this category include omeprazole, ranitidine and cimetidine. Omeprazole is the active ingredient in Gastrogard®, and is also sold in generic forms, often at a lower price.
  • Neutralizing agents buffer acids and/or coat the stomach lining to protect the stomach and reduce the corrosive effect of acid. Antacids or bismol products are common drugs in this category. The actual effectiveness of antacids and coatings has generally been minimal.
  • Antibiotics treat bacteria in the ulcer bed that can inhibit healing. While not used in every case, antibiotics can be helpful if gastric ulcers are taking longer than normal to heal because the ulcers are inflamed from bacterial infection.

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What Are The Symptoms

The clinical signs are variable between horses with some patients displaying no symptoms at all. The signs are as follows but are vague and can be inconsistent

  • Variable appetite
  • Resistance to leg aids or grooming
  • Stereotypies such as cribbing

The most important consideration is any change in behaviour whether it be appetite, manner, eating behaviour or poor performance.

What Are Horse Ulcers

Horse gastric ulcers are sores that form in the lining of the stomach. Ninety percent of all horses will develop ulcers at some point in their life. Horses have four types of ulcers. Squamous ulcers occur in the upper part of the stomach, close to the esophagus, and are referred to as Equine Gastric Ulcer Syndrome. Glandular ulcers are found in the lower part of the stomach and are referred to as Equine Glandular Gastric Disease. Pyloric ulcers are found in the opening of the stomach to the small intestines.

But why are ulcers so prevalent in horses?

Compared to other large animals, the horses stomach is on the smaller side. In fact, because of the size of their stomach, experts recommend horses should eat smaller meals more often.

A horses stomach acts like two stomachs in one. The upper portion of the stomach is called the squamous. It does not produce any digestive acids and therefore does not have a protective lining. It is particularly vulnerable to ulcers. The lower portion of the stomach is known as the glandular. It produces digestive acid twenty-four seven and, as a result, has a protective lining.

Squamous ulcers occur during a horses movement when acid splashes up onto the upper portion of the stomach where there is no protective lining and causes irritation. In some cases, it produces an ulcer. Even though movement can result in ulcers developing, they are preventable.

Figure 2 The Equine Stomach with permission from Jean Abernethy

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Diagnosis Of Gastric Ulcers

Gastric ulcers can be difficult to diagnose in horses because of subtle, inconsistent signs. Indirect, non-invasive tests such as measuring sucrose permeability have been proposed but are currently unreliable.

Gastroscopy which visually inspects all areas of the stomach and proximal intestine is the only reliable method to definitively identify ulcers.

Gastroscopy also provides information about the severity and number of lesions to further inform treatment.

However, severity and clinical signs dont always match. In some cases, horses with minor lesions may show more clinical signs than horses with severe lesions or vise versa.

Gastroscopy is also not accessible to all horse owners due to the high cost. Given the very high prevalence of ulcers in performance horses and even pleasure horses, it may be prudent to assume that your horse is at risk of ulcers and to take steps to mitigate the risk in the future.

Hindgut Ulcers Fact Or Fake News

Hindgut Ulcers, Fact or Fake News?

As we continue to become more aware of horse gut health, the topic of hindgut ulcers is frequently raised. The horses stomach can develop ulcers, so does this mean their colon can as well?

First, lets take a look at what the hindgut is and what it does

The horses hindgut comprises the caecum, large colon, small colon and rectum. The hindgut is the powerhouse of the horses digestive system and consists of 63% of the total tract. It houses trillions of microbes that produce enzymes to breakdown plant fibre. A by-product of microbial fermentation of fibre is the production of volatile fatty acids . VFAs provide the horse with a source of energy. In fact, approximately 70% of the horses energy supply comes from VFAs!

The beneficial microbes in the horses hindgut are in a very delicate balance and sensitive to changes in their environment. The pH of the hindgut typically rests around 6.5 7, which provides ideal conditions for fibre-fermenting microbes. pH is a numerical scale that tells us how acidic or alkaline a substance is. It ranges from 0 to 14, with 0 being highly acidic and 14 being highly alkaline. A pH of 7 is considered to be neutral.

Fermentation of fibre is a very slow process. Feed can take between 48 and 65 hours to travel from the end of the small intestine to the rectum, where it is expelled as manure. On the other hand, fermentation of starch and sugar is a rapid process. Problems start to occur if starch and sugar reaches the hindgut.

Treatment

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Common Diagnostic Options And Their Limitations

The current common diagnostic modalities for GI health are limited and do not provide an accurate and timely diagnosis that supports effective treatment before the condition turns serious.

  • Scoping While scoping is an adequate approach as far as showing a clear picture of the stomach, it is limited to showing the stomach only, a mere 10 percent of the horses GI tract. In addition, scoping requires fasting and sedation, which is costly, invasive, and highly stressful for the horse.
  • Ultrasounds Ultrasounds are another diagnostic option, allowing you to confirm wall thickness and fluid content. It only shows limited visuals, though, so you are not able to capture the full GI tract. And it also requires sedation and fasting.
  • Rectal Palpation Rectal palpation is a relatively easy option, yet the actual benefit is limited for diagnostic purposes as you can only reach so far and it is strictly based on tactile feel.
  • Symptomatology Diagnosing primarily on observation may be a common method for detecting GI issues, but it does not provide enough information for a confident conclusion and may arise too late.

What Are The Different Types Of Stomach Ulcers

Your horses stomach is divided into two distinct regions: the non-glandular region, or squamous mucosa region, which covers approximately one-third of the equine stomach and the glandular region, which covers the remaining two-thirds of the stomach and contains glands that secrete hydrochloric acid, pepsin, bicarbonate, and mucus to aid in digestion.

Horses’s stomach

Equine stomach ulcers can develop in both regions of the stomach, but the disease process, risk factors, and treatment response for glandular ulcers is different from those for squamous ulcers. The only way to determine the location of a stomach ulcer is by stomach scoping. To confirm diagnosis, it is therefore critical to perform gastroscopy to identify the location of the stomach ulcer and treat it accordingly.

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Keeping The Hindgut Bacteria Healthy

Based on what causes the hindgut bacteria to get out of kilter, here are the things to do to keep them in balance:

1. Feed lots of fibre! This is absolutely critical. Keeping your horses hindgut full of fibre from low sugar pasture, hay and/or chaff means that the fibre fermenting bacteria always have lots of their favourite food to eat.

2. Limit grazing to the wee early hours of the morning. Pasture plants make their own sugars and starch during the day using a process called photosynthesis . So over the course of a day, sugar and starch levels will increase. Then the plant will burn some of the sugar and starch up overnight to stay alive. This means, sugar and starch levels are lowest in the very early hours of the morning. If your pastures have a tendency to accumulate starch and sugars and these are causing issues for your horse, grazing very early in the morning will give access to the lowest sugar and starch pasture and reduce the negative impact pasture has on hindgut bacterial populations.

3. Feed additional calories as fibre based, low starch feeds where possible. These feeds use high-energy or super-fibres like lupins hulls and beet pulp. These fibres are fermented in the hindgut by the fibre fermenting bacteria and completely avoid any risk that starch may be delivered to the hindgut. Oils are also a useful source of additional calories should you need them.

Causes Of Bacterial Imbalances

Gastric Ulcers in Horses

These undesirable shifts in bacteria when starch and sugars are delivered to the hindgut can occur when:

1. Raw grains are fed! Grains like corn, wheat and barley contain a lot of starch . BUT when fed uncooked, ¾ of the starch will travel undigested through the small intestine and get dumped in the hindgut where it will be gleefully fermented by the starch and sugar fermenting bacteria.

2. Pastures accumulate fructans many of our modern day improved pastures have been purposefully bred to accumulate large amounts of fermentable sugars, including fructan. When horses graze these pastures it a lot of this water soluble carbohydrate ends up in the hindgut where again it will be fermented rapidly by the starch and sugar fermenting bacteria.

3. Starchy grain based feeds are fed in large meals Even if you select a feed with starch that has been cooked and is digestible, you still need to be really careful about how you feed it. A horse only has a very small stomach. If you feed more than the stomach can hold, your horse loses its ability to release that feed slowly into the small intestine for it to be digested and absorbed fully before it reaches the hindgut. If you feed too much at once, you physically force feed too quickly through the small intestine and it will end up being delivered, starch and all into the hindgut where again, it will be fermented by the undesirable starch and sugar fermenting bacteria.

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