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Hindgut Ulcers In Horses Treatment

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Feeding The Hindgut Ulcer Horse

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

by Tigger Montague·April 8, 2014

Hindgut ulcer development and hindgut acidosis have become almost as prevalent as gastric ulcers in horses.Causes behind colonic ulcers include the use of NSAIDs , acidity of the hindgut being altered , stress , and long term daily use of omeprazole.

BioStars True Balance EQ

Adaptogenic herbs are also beneficial to reducing stress. These include Ginseng, ashwaganda, and holy basil, which have shown to reduce cortisol. Ashwaganda is available in BioStars Equilibrium, and holy basil is available in BioStars True Balance. Ginseng is available in Auburn Labs APF Formula. Yeast probiotics are not recommended if a horse has an active hindgut ulcer or acidosis.Whether youre dealing with a hindgut ulcer horse or not, keeping human stress in check is also important in reducing stress in horses. Horses can read us like books, and some will start stressing because their owner is stressing, or the groom is stressing, or the trainer is stressing, or the barn manager is stressing. Its always a good idea to keep the barn a drama-free zone.

Prescribe Omeprazole To Treat Ulcers

The main treatment for gastric ulcers is Omeprazole. Omeprazole is an acid reducer. Because the equine stomach produces acid around the clock, Omeprazole has significant benefits. In a serious case of gastric ulcers, Omeprazole is usually administered for at least thirty days.

Now here is where things get tricky. It is important to consult a veterinarian. If your horse is on a thirty-day regimen of Omeprazole, you do not want to stop administering the drug cold turkey.

Why is this a problem?

When the treatment with Omeprazole is stopped suddenly without tapering the dose off, it can result in the horses stomach going into overdrive, producing acid. This results in a much worse reoccurring case of gastric ulcers, not the desired outcome!

Secondly, extended use of Omeprazole can result in your horse suffering dramatic weight loss and loss of body condition. This occurs due to a lack of digestive acids to begin the digestive process so the horse can absorb the needed nutrients from his feed.

As you can see, there is a delicate balance here that needs to be achieved, and if you lack the necessary experience to strike that balance, you need to consult a vet.

What You Can Do To Help Your Horse Acidosis And Ulcers

Your vet and equine nutritionist can absolutely help you design a program to help your horse.

  • Depending on the overall state of your horses hindgut, medications may be prescribed. Omeprazole for gastric ulcers does nothing for hindgut ulcers, sucralfate is used instead.
  • There may be supplements and diet changes to consider as well. For some horses, the ability to tolerate long stem forage is decreased and new forage options needs to be considered. For other horses, the amount of long-stem forage needs to be increased. There are also hindgut supplement programs to consider, and well as using a hindgut buffer supplement. I recommend doing research here into the best ones, there are many supplements based on marketing with zero science to back them up. I use a KER hindgut buffer, its been studied with proven results. Probiotics and probiotics may help also.

Haynets and slow feeders are important.

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Clinical Signs And Diagnosis

Clinical signs of gastric ulcers can include changes in attitude, poor appetite, colic, decreased performance, decline in body condition, weight loss and lack of energy.To diagnose stomach ulcers, veterinarians use an endoscope. In order to perform the procedure, referred to as a gastroscopy, the horse must have fasted for 12 hours, with an exception given to water. Using a fiberoptic camera, the veterinarian inserts the endoscope through the horses nostril, into the back of the throat, until the horse swallows it. Then the camera is directed down the esophagus until it reaches the stomach. According to Russillo, it is vital that all areas of the stomach be looked at for any indication of ulcers, inflammation or other irritation. A complete evaluation is crucial since horses can have ulcers in multiple areas of the stomach.In the case of a stomach ulcer, there is a grading scale from 0 to 4 0 indicates a healthy, non-irritated stomach, whereas 4 indicates the stomach is suffering from severe ulcers and ulcerations. The maximum grade essentially, indicates a complete loss of the epithelium. Grade 4 ulcers are large, coalescing and full thickness , often with associated hemorrhage. This is called Equine Gastric Ulcer Syndrome .

Diagnosing Ulcers In Horses

How to Keep Your Horses Stomach Healthy and Ulcer

If you suspect your horse is suffering from an ulcer you need to speak to your veterinarian about it but the only definitive way of diagnosing an ulcer is a gastroscopy . This is where an endoscope is placed down the horses throat, through their esophagus, stomach, and into the opening of their intestine. If its suspected that the ulcer is in the lower region of the stomach then the endoscope may be placed through the rectum, along the intestine, and into the stomach. Both of these methods are usually done under sedation so that the horse is calm and not stressed at all.

While a gastroscopy is the only completely reliable way of diagnosing an ulcer your veterinarian will be able to assess your horse to see the likelihood of his symptoms being the result of an ulcer. He can also perform a number of tests to help with his diagnosis.

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Prevention Of Colonic Ulceration

Administer NSAIDs at appropriate doses and for no longer than necessary. Advise clients of the risks of over-administration.

Ensure horses are fed an appropriate diet that constitutes primarily roughage, such as grass, hay and chaff. Carbohydrate-rich supplements such as grain should only be added to the diet as necessary to fulfill energy requirements. Consider beet pulp and Omega-3 rich oils as alternative energy sources to grain.

References

Andrews, F.A. et al. Colonic Ulcers: a pain in the hindgut!

Barton, M. Understanding Abdominal Ultrasonography in Horses. Which Way Is Up. Compendium: Continuing Education for Veterinarians., .

Jones, S.L. et al. Right Dorsal Colitis. In: Current Therapy in Equine Medicine, ed. N.E. Robinson and K.A. Sprayberry. Elsevier pp. 430-432.

Pellegrini, F.L. Results of a large-scale necroscopic study of equine colonic ulcers. Journal of Equine Veterinary Science 25:113-117.

How To Manage Signs Of Ulcers In Horses

Equine gastric ulcers are thought of as a man-made disease. Horses in the wild or living out at pasture rarely suffer from this painful disorder. Therefore, it is vital to make changes to how the horse is cared for in order to alleviate the symptoms of this condition.

The aim of treating horses with EGUS is to look after them in the most natural way possible. Horses evolved to graze continuously for most of the day, so they should be allowed access to hay or grass at all times. High grain diets should be avoided, as these will make your horses stomach ulcers worse.

If your horse is struggling to gain weight, then adding a high-calorie oil such as corn oil to the diet can help. Veterinarians also advise increasing the amount of alfalfa in the diet, too as much as 50%. Giving a small feed of alfalfa 30 minutes before exercise can help to reduce the amount of acid splashing onto the delicate stomach lining.

Stress is a major cause of stomach ulcers in horses. Ways to reduce stress for your horse include making sure he has equine company, giving him time to relax and play in the field each day, and providing toys and treats to reduce boredom.

Certain medications, such as anti-inflammatory painkillers, must be avoided in horses with EGUS. Some feed supplements, especially those designed for horses with stomach ulcers, can help reduce the symptoms of this painful condition.

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But First Some Anatomy Of Your Horses Digestive System

  • Lets briefly go over your horses digestive system, from rooter to tooter. It all starts at the mouth and continues through the pharynx, where the respiratory system and digestive system meet.
  • Then, the esophagus and stomach. Incidentally, this is usually where gastric ulcers are found. The foregut is comprised of the stomach and the small intestine. Most of your horses nutrient absorption happens in the foregut.
  • Next is the hindgut, which has many parts. The cecum, the large colon, the small colon, and the rectum make up the hindgut. This is where water is reabsorbed, microbes do their fermenting action, and manure is made and passed.

Listening to your horses guts sounds give you an idea of whats going on inside know the normals!

Gastric Ulcers In Horses

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

Gastric ulcers are one of the common ulcers in horses and can seriously affect your horses health. Stomach ulcers in horses are also known as equine gastric ulcer syndrome. But it is very difficult to diagnose this type of ulcer, and only a veterinarian can help you with the diagnosis. Gastric ulcers are defined according to the different regions of the stomachs

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Diet And Feeding Schedule

Your horses feeding program is essential to maintaining good gut health. The diet is directly linked to what microorganisms are present within the digestive tract .

When thinking about your horses diet regimen a few important aspects to ensure are:

  • Any changes to the diet are done gradually to allow the microbial populations in the digestive tract to adapt
  • Horses should maintain eating throughout the day to ensure the digestion process is occurring at all times
  • Constant free access to fresh clean water
  • Maintain a feeding schedule
  • Allow for herd environments to reduce stress
  • Minimize environmental stress

You can submit your horses diet for a by our university-trained equine nutritionists. They can recommended a feeding program to help minimize the risk of hindgut acidosis in your horse and ensure optimal digestive function.

Can An Ulcer Heal On Its Own

In the vast majority of cases, an ulcer wont heal on its own and your horse will need some sort of intervention, either medicinal or natural. That said a very small percentage of horses will recovery completely on their own without any sort of treatment. While a small number of horses will recover on their own its better to presume they wont rather than presume they will.

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What Is A Hindgut Ulcer

An ulcer can be defined as a thinning of the lining of the gastrointestinal tract. Ulcers can occur in the foregut and are also referred to as gastric ulcers. However, ulcers can also occur in the hindgut, specifically in the colon, and are therefore referred to as colonic ulcers.

Andrews defines a hindgut ulcer as a depression of the lining of the colon. Hindgut ulcers are difficult to diagnose and often require an ultrasound. The severity of the condition is determined by the thickness of the colons outer wall.

Colonic ulcers are extremely difficult to truly diagnose because it is impossible to thoroughly examine the colon without surgery. Surgical diagnosis of colon ulcers is the true gold standard, because the surgeon can either visualize the ulcer or perform a biopsy that can be examined microscopically to determine the degree of ulceration, Russillo says. While surgery isnt typically recommended to diagnose ulcers, its more indicative of just how hard it is to really understand to what degree a horse is affected, she explains. Hence, we utilize the combination of clinical signs, ultrasound and blood work.

What Are The Symptoms Of Ulcers In Horses

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

The symptoms of ulcers in horses can be quite subtle, and often they will not be diagnoses until the sores are quite severe. It is important that any changes in your horses behavior are investigated, to help diagnose this painful condition. Early diagnosis and treatment will help to quickly reduce the severity of the symptoms.

Symptoms of EGUS in horses include:

  • Reduced appetite
  • Biting when being saddled up
  • Teeth grinding

If you spot any of these symptoms in your horse or pony, speak to your veterinarian. The best way to diagnose stomach ulcers is with a gastroscopy. This is where a camera is passed into the horses stomach to look for ulcers.

Alternatively, your veterinarian may prescribe treatment for EGUS without a gastroscopy, choosing instead to assess the clinical signs. If the horse responds well to treatment then it is likely that stomach ulcers were the cause of the problem.

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Treatment For Colonic Ulceration

Current research indicates that diet plays a significant role in the health of the equine intestinal tract. Many performance horses are fed diets that are high in grain and low in roughage. This feeding practice may lead to abnormal patterns of fermentation in the large bowel and to alterations of the intestinal microbiota. Readjusting feeding regimes to better mimic more natural feeding habits may go a long way to preventing colonic ulcer formation, and may also help treat low-grade ulceration. This is an area in which more research is required.

Horses with moderate-to-severe colonic ulceration may benefit from the following treatments :

  • Discontinue NSAID medicationIf pain medication is required, consider alternatives such as opioids , lidocaine/lignocaine infusions or epidural anaesthesia.
  • Minimize stress
  • in order to give the colon time to heal.
  • Feed frequent small meals at regular intervals .
  • Use a pelleted complete feed that is alfalfa based and contains at least 30% dietary fiber.
  • Allow short periods of grazing fresh grass this is also good for stress minimization.
  • Corn oil, 1 cup given 1-2 times daily. Corn oil helps increase the caloric intake without adding bulk to the diet. Other Omega-3-rich oils can also be used.
  • Water. Encourage regular water intake to maintain hydrated intestinal contents.
  • In the rare, extreme cases, when abdominal pain from colonic ulceration is severe and uncontrollable, a bypass surgery has been reported that alleviates discomfort.

    What Is The Best Ulcer Treatment For Horses

    The most common and effective treatment for stomach ulcers in horses is a drug called omeprazole. Your veterinarian may also refer to this drug as AbPrazole®. This medication is very expensive, but in most cases, it will completely cure this painful condition.

    Omeprazole comes in paste form and is given once per day. It works by reducing the high levels of acid in the stomach, giving the ulcers chance to heal. It is normal to repeat the gastroscopy examination after one month of treatment, to check that the ulcers are healing.

    Once the omeprazole has begun to take effect, the clinical symptoms of EGUS should start to subside. This can take some time, however, it is vital to persist with the medication until your horse starts to show some improvement.

    If your horse does not respond to treatment or if the symptoms are very bad your veterinarian may recommend other medications. The other main medication used in the treatment of EGUS is sucralfate. This medication coats the ulcers in a protective layer, helping them to heal.

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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.

    Treatment For Equine Glandular Gastric Disease

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    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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    Learning Strategies For The Dressage Rider Problems In The Equine Hindgut

    A USDF certified instructor shares three methods to help your riding progress more efficiently. Plus, two veterinarians explain problems in the equine hindgut.

    USDF certified instructor Eliza Sydnor Romm says that your mental strategies towards learning are important in your ability to progress as a rider. Plus, Frank Andrews, DVM, and Christina Cricket Russillo, DVM, break down the basics of equine hindgut health.

    In this issue:

    • Romms three strategies to speed up your progress: adopting the beginners mind, distinguishing between excuses versus reasons and focusing on reality versus the story.
    • Andrews and Rusillo define hindgut health and discuss ulcers, the clinical signs, diagnosis and treatment.

    This Dressage Today Extra is brought to you by

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