What Are The Clinical Signs Of An Ulcer
The clinical signs of EGUS can be hard to identify. Many horses may show no signs or mild signs such as poor performance, a change in attitude or behaviour, weight loss or poor condition. Some horses may experience recurrent colic, especially associated with a specific activity such as feeding.
In many horses that dont show obvious signs, an improvement in behaviour or performance can be seen after treatment. Its important to realize that while many horses do not show signs of pain, gastric ulcers are associated with discomfort and warrant treatment.
The better you know your horse, the more likely you are to notice subtle changes that may indicate the formation of a gastric ulcer.
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.
Diagnostic Tools And Challenges
While there is a long list of behavioral and performance indicators that can point toward the presence of ulcers, equine veterinary medicine relies on a strong set of diagnostic tools, led by gastroscopy, to definitively confirm, then grade ulcers. Dr. Davis is quick to point out that gastroscopy is a necessity when ulcers are suspected to avoid medically treating suspected ulcers when something else entirely could be going on. For every horse that gets prescribed medication for gastric ulcers without ever taking a look inside their stomach, I always ask myself How do we know if that is a correct treatment? How do we know exactly what condition is going on? When do we stop the medication and what medication would we use? Diagnosis is quite literally a guessing game in the absence of gastroscopy. Gastroscopy allows for a thorough evaluation of the stomach, grading and localization of the ulcers, as well as assessment of the proximal small intestine , confirms Dr. Belgrave.
As the gastroscopy continues, Dr. Davis outlines the next steps. Well pass through the pyloric sphincter in the pyloric antrum into the small intestine. Well sometimes take a biopsy of the stomach or the small intestine, and well do that either in the case of a very ill horse or when the stomach looks really inappropriate. This will also happen in a follow up gastroscopy 20 to 35 days following the beginning of treatment.
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The Role Of Inflammation
As Dr. Whitfield mentioned in his findings, inflammation can be a significant contributing factor to equine gastrointestinal disease, including gastric ulcers and Leaky Gut Syndrome. Of course we all live with a certain level of managed inflammation, both horses and humans alike. Its when that inflammation inches above the disease threshold into an unmanaged state that significant clinical issues can arise. Inflammation of the mucosal lining of the stomach is the first stage in the development of gastric ulceration. It is mediated by a variety of acids that come into contact with the mucosa of the stomach. The inflammation subsequently gives rise to erosion, and eventual ulceration of the mucosa, explains Dr. Belgrave.
Prevention is where its at in so many ways. It seems like an obvious thing, but taking care of diet, nutrition, proper conditioning and stress management, its all so important in everything we do as veterinarians, and well continue to see greater results as we forge this new way of thinking and practicing. Canaan Whitfield, DVM, Texas A& M University
Nutritional Management Is An Important Tool To Manage Gastric Ulcers
While the environment of horses cannot always be controlled, nutritional management typically can be and it is one important piece of the puzzle for ulcer care and prevention. By putting the feed management practices described by this article into place, horse owners can better manage their horses’ ulcers and decrease the risk for ulcers developing.
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How Do Gastric Ulcers Develop
Horses differ from humans because they secrete stomach acid continuously, even when not eating. Adult horses secrete 30 litres of gastric acid daily. When horses are unable to access food on a continual basis, such as when grazing, the pH balance of the stomach changes drastically and gastric juices begin to attack the stomach mucosa. Acid produced in the stomach is generally buffered by saliva which contains a high concentration of bicarbonate and mucus.
If access to feed is limited, then consequently the horses saliva production is reduced. As a result the squamous portion of the horses stomach, the most common part to be affected, lacks the buffer bicarbonate and protective mucous coating to protect the stomach lining from acid.
Various feed stuffs produce different amounts of saliva. For example, 1kg of hay takes 3000 chewing movements and produces 4 litres of saliva, versus 1kg of grain, which takes only 1000 chewing movements and produces 2 litres of saliva.
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.
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Mouth Ulcers In Horses
Oral ulcers occur in horses due to a variety of reasons and cause some bad effects on their health. In horses, the most common lesions that will appear are blisters to form in the mouth on the tongue, dental pad, and lips. These ulcers swell and burst, resulting in raw tissue that will cause immense pain, and the infected horse will refuse to drink or eat.
Ulcer Rates Before Training
The researchers assigned each horse a score of 0-4 for squamous ulcers and 0-2 for glandular ulcers , with higher scores being more severe.
Surprisingly, the prevalence was high when the horses were first brought in, said Luthersson, noting 71.6% had squamous ulcer scores of 2 or higher, and 47% had glandular ulcer scores of 1 or higher.
Initially, when looking at equine squamous gastric disease , 26% of the horses had Grade 2 ulcers, 40% had Grade 3 ulcers, and 6% had Grade 4 ulcers. When looking at equine glandular gastric disease , 27% had Grade 1 ulcers, and 20% had Grade 2 ulcers.
At the second evaluation, 14% of horses had Grade 2 ESGD ulcers and 11% had Grade 3. None of the horses had Grade 4 ulcers. This was a significant reduction in the squamous ulcers without any medical treatment. When looking at EGGD at the second evaluation, results showed 32% had Grade 1 ulcers and 9% had Grade 2, which Luthersson said was not a significant change.
For ESGD, the team saw no significant differences between horses of varying sexes and ages. However, the farm and region the horses were from did make a difference.
Age, initial BCS, behavior, number of days worked per week, and performance quality appeared to play a role in EGGD prevalence.
Equine Squamous Gastric Ulcer Syndrome :
The other type of ulcer is squamous gastric ulcer syndrome. ESGUS lesions can affect the upper third of the stomach. According to research, ESGUS is more common than EGGUS. The squamous region is more susceptible to damage as it lacks a protective mechanism. Most horses showing the equine gastric ulcer syndrome sign are more prone to ESGUS.
How Can I Diagnose Ulcers In My Horse
There are three ways to further investigate the likelihood that your horse has ulcers. A great first step is to perform a focused acupressure point test to determine if there is sensitivity. Another option is to perform a therapeutic trial with drug therapy and/or digestive support supplementation. The most costly procedure is to have your veterinarian perform an endoscopy.
A simple, non-invasive indicator of possible digestive tract ulceration involves palpating acupuncture points near the horses girth area. These points are closely associated with the digestive tract, and start just behind the withers, run down along the horses barrel and cross the sternum. If the horse reacts with pain or sensitivity, it is very likely that your horse has an ulcer. You may also notice a defensive or reactive response when saddling or brushing this area. Severe acidosis and un-diagnosed ulcers cause often very sensitive withers or chronic sore backs.
A therapeutic trial consists of basing your diagnosis on the results of treatment with a proper drug or effective supplement. For example, if you feed your horse a digestive health supplement for one to two weeks and see improvement in symptoms, you have correctly identified the problem. Natural digestive support supplements are a fantastic way to perform a therapeutic trial, as there are no negative side effects.
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If You Suspect Ulcers In Your Horse
There are primarily three options for diagnosing gastric stomach ulcers in horses, gastric endoscopy, gastroscopy, and noninvasive diagnosis through observing the horses behavior and the response to therapy.
Clearly, the first two options must be performed by a professional, a DVM . The third option, you may be able to diagnose and employ the proper therapy right away if you are astute and can read the signs of your horses distress well.
I am in no way advocating for the average equine owner to forego professional treatment of their horses when their horse needs medical attention. But, throughout the years, I have observed many equine professionals who, through experience, became capable of diagnosing and treating equine gastric ulcers.
The safest plan of action is to let your vet know that you suspect an equine gastric ulcer so they can quickly treat it.
Now let us take a closer look at how a vet will diagnose an ulcer.Diagnosing Horse Ulcers
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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Treatment Of Squamous Ulcers
GastroGard is the only medication on the market in the United States that is FDA approved to treat squamous ulcers in horses. Omeprazole works to reduce the production of stomach acid by inhibiting a proton pump within the stomach that is responsible for secretion of stomach acid. It is not just a buffer for stomach acid. Usually, a 28-day treatment with this medication is prescribed by a veterinarian. This medication can also be given at half dose to aid in the prevention of ulcers. It is important to use GastroGard and not medication intended for human ulcers when treating ulcers in horses because GastroGard has a special coating to ensure that it is not degraded by the time it reaches the small intestine where it is absorbed. While GastroGard is effective, successful treatment and particularly prevention of future ulcers requires nutritional changes as well.
Should I Have My Horse Scoped Or Treat Instead
Its a fair question why put my horse through an 18 hour fasting period and pay to have him scoped for gastric ulcers when I can buy Gastrogard and treat as if he did? Gastroscopy can be a stressful procedure due to the fasting required however, the diagnostic clarity helps dictate length of treatment AND medication used for treatment. First, it helps to understand the anatomy of the horses stomach.
The equine stomach is made up of squamous and glandular mucosa. Glandular mucosa is in the lower half and is resistant to damage from acid produced in the stomach. The squamous portion of the stomach is the most commonly affected area, especially at the junction referred to as margo plicatus. Excess acid production is worsened by stress due to showing, traveling, sickness, or physical pain. Often times there are stressors that we dont acknowledge easily, such as an aggressive pasture mate or discomfort that is not visible to us. It is reported that 60-90% of showing horses have evidence of gastric ulceration, mostly seen in the squamous portion of the stomach. The pylorus is where feed exits the stomach and can be a site of ulceration as well. Efforts to heal pyloric ulcers are more involved.
So why scope? The best way to explain this is through examples:
If you have specific questions about your horse, please dont hesitate to reach out to us to see if a gastroscopy would be indicated!
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Treatment For Ulcers In Horses
Equine ulcer treatment should target removal of predisposing factors as well as reducing acid production in the stomach. Horses should be allowed free-choice access to grass or hay, have more turnout time where they can socialize with other horses, and eat more frequent, smaller meals as opposed to two larger feedings. Decreasing grain and replacing it with high-fat feed or more high-quality hay is also helpful.
Medication to decrease acid production may be necessary for horses showing clinical signs or when predisposing factors cannot be removed, such as with horses in race training or those with intense showing schedules. The only FDA approved drug to treat gastric ulcers is omeprazole and this must be prescribed by your veterinarian.
Problems In The Equine Hindgut
Horses are biologically designed to continuously consume small amounts of food, such as pasture grass, throughout the day.
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You might have noticed that youve been hearing the phrase hindgut health in conversations about horses more so now than ever before. What does hindgut health mean in the context of your horse and what does it mean for you as his owner?
In this article, we break down the basics with help from experts Frank Andrews, DVM, LVMA equine committee professor and director of the Equine Health Studies Program at Louisiana State University in Baton Rouge, Louisiana, and Christina Russillo, DVM, a senior associate at Virginia Equine Imaging in The Plains, Virginia. Remember, in addition to the information provided in this article, always be sure to consult your veterinarian about what is best for your horse as an individual.
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Perfect Company Gastroease Eq
This is the first product on this list thats available in powdered form. The rest have been either liquid or paste. However, dont think that its any less effective because its a powder. GastroEase EQ was developed by the Perfect products, the same people that manufacture hoof repair and joint support supplements.
Perfect products bring their experience to the field in creating this product. It is specifically designed to treat ulcer and keep it at bay. With a daily maintenance dosage, it supports the animals GI Tract from the inside out. It is recommended for show and travel horses that are often subjected to a great deal of stress.
The product works at the tissue level, and it interacts with the horses natural flora. It also provides probiotics and prebiotics for extra GI Tract support. At the beginning of the treatment, you should give your horse 1 scoop twice daily as a loading dose. This will suppress all the ulcer symptoms. Subsequently, you can reduce to 1 scoop a day as a maintenance dose.
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How To Naturally Keep Horses From Getting Ulcers
AVOID CONTINUAL FEEDING
When you feed your horse seldom, the time between meals is extended and the stomach is left empty. The likelihood of developing ulcers rises as a result.
Horses can graze for up to 18 hours a day in the wild. Since their stomachs are virtually never empty, ulcers cannot form.
It is crucial to feed your horse frequently during the day because of this.
The stomachs protected glandular region is kept acid-free by the continual presence of food there. Additionally, it supplies saliva and nutrition to the squamous region to counteract the areas acidic pH.
In fact, fasting is utilized as a model to create ulcers in research since intermittent feeding is such a significant risk factor for equine ulcers. In other words, ulcers will unavoidably form if your horse goes too long without food.
Quarter horses fed 20 meals throughout the day exhibited a lower occurrence of ulcers after 30 days when compared to horses fed two meals per day.
Some horse owners worry about giving easy-keepers and overweight animals regular access to forages.
The use of slow-feed hay nets can assist your horses stomach to stay fuller for longer without consuming too many calories by extending the time spent feeding.
GIVE CONSTANT ACCESS TO WATER
In addition to other components of equine wellbeing, hydration is crucial for digestive health. Ulcer risk is increased by sporadic water consumption.
Limit your intake of grains.
FETCH A QUALITY HAY
Reduce the use of NSAIDs.
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