How Do Ulcers Develop
The horse’s stomach is divided into two distinct areas by a structure called the . The upper portion of the stomach is non-glandular and lined with squamous cells while the lower portion is glandular. The latter produces mucus that coats the stomach lining to help prevent ulcers from the action of the gastric secretions, but the upper portion doesnt. Lesions and ulcers can develop in both portions of the stomach, but the mechanism of development and the predisposing factors are quite different.
The development of ulcers in the squamous portion of the stomach is directly related to intensity of training: the more intense the training of the horse, the more likely the horse is to develop ulcers. These ulcers are extremely common: up to 90 per cent of horses in some disciplines such as racing have ulcers, and even broodmares and pleasure horses can be affected by this condition. Researchers have proposed a new term to describe this problem: ESGUS .
Researchers havent identified the exact mechanism of ulcer development in the upper portion, but the link to training is well established. While training, gastric acid normally contained in the glandular portion of the stomach may splash up to the non-glandular squamous cell portion that does not have the same protective mechanisms as the lower portion to prevent acid injury.
Equine Glandular Gastric Disease
EGGD differs from ESGD, in that it is believed to result from a breakdown of the normal defense mechanisms that protect the mucosa from acidic gastric contents, since this portion of the stomach is normally subjected to near constant exposure to acid. The factors that contribute to breakdown of this protective layer are yet to be clearly demonstrated in the horse, but in humans the bacteria Helicobacter pylori and the use of non-steroidal anti-inflammatory drugs are most common causes of gastric ulcers. To date there remains conflict in the literature as to the role of bacteria in EGGD. While the prolonged use of NSAID medications in horses such as Bute or Banamaine may play a role in causing EGGD, many horses who have not received these medications still suffer from this disease. It is likely that multiple different mechanisms contribute to the development of EGGD in the horse. Reduced access to water has been shown to increase the prevalence of both EGGD and ESGD in horses.
An example of EGGD with multiple distinct superficial erosions of the pyloric region of the stomach and multifocal, diffuse discoloration of the antrum of the stomach.
An Introduction To Gastric Ulcers
Although gastric ulcers and colonic ulcers are similar in the sense that they are both a thinning of the lining of the gastrointestinal tract, they are very different. They occur in different parts of the horses digestive tract, present differently, are diagnosed differently and in some instances, require almost opposite treatments. Gastric ulcers, or stomach ulcers, occur in the horses foregut and are a result of a break or erosion in the lining of the esophagus, stomach or small intestine. Cricket Russillo, DVM, a senior associate at Virginia Equine Imaging in The Plains, Virginia, explains that stomach ulcers typically occur in either the nonglandular region, the upper portion of the stomach, or the glandular regionthe lower portion of the stomach.
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Diagnosis Of Ulcers In Horses
If you suspect your horse has a gastric ulcer, make an appointment with your veterinarian. An ulcer can be serious, and sometimes fatal if medical attention is not given in time. Your medical professional will ask questions pertaining to his health history, look closely at his clinical signs, perform blood work, urinalysis, biochemistry profile, and other laboratory testing in order to rule out any other illnesses and come to a preliminary diagnosis.
Your doctor may perform specific diagnostic testing using enhanced diagnostic equipment. He may use a gastroscope, which is an approximately 2 meters-long endoscope into the stomach of your horse. This is currently the most accurate and definitive diagnostic test used to confirm the presence of a stomach ulcer or ulcers.
This test will confirm the specificities of the ulcers, such as size, severity, and precise location. Typically, ulcers are found in the upper portion of the organ however, ulcers can also be found in the lower section, including the duodenum. The ulcer will be classified between the areas of 0-4, with a 4 having severe lesions. He will communicate with you the extent of the ulcer and let you know the options for treatment.
Signs And Symptoms Of Hindgut Ulcers
Horses experiencing hindgut ulcers can have varying signs and symptoms. Some of these overlap with . It is important to consult with your veterinarian to evaluate which type of ulcer your horse has or whether they have both.
Early signs often include mild, intermittent or recurring colic, lethargy, and/or loss of appetite. As the condition progresses, more symptoms may appear. These symptoms may include:
- Sudden girthiness
- Sensitivity in the flank area
- Difficulty bending, collecting, and extending
- Blood in the manure
A horse experiencing hindgut ulcers may experience acute symptoms or they may experience chronic symptoms.
In acute cases, a horse may have fever, depression, loss of appetite, colic, and/or watery diarrhea. They may also experience free fecal water syndrome . The horse may be dehydrated and have deterioration of the mucous membranes .
Horses experiencing chronic Right Dorsal Colitis may exhibit weight loss, recurring low-grade colic, swelling along the central midline of the belly, and/or loose manure.
Blood work for these horses may show protein loss or low albumin levels . In one study, four horses with symptoms of hindgut ulcers were examined and displayed both of these markers.
Other changes in blood work may include high levels of white blood cells and/or low calcium levels.
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What Is Equine Gastric Ulcer Syndrome
In order to treat Skippy effectively, its important to understand the overall scope of the problem. First, a gastric ulcer isnt a disease. It simply refers to a lesion or lesions, which, like gastritis, are also part of a syndrome, or a collection of conditions such as the ones Skippy is currently displaying. All of these symptoms can be lumped together under one parent term used to describe ulcers caused by a more specific underlying disease: Equine Gastric Ulcer Syndrome.
Most horse people are familiar with the concept of gastric ulcers. Many trainers and barn managers keep a tube of omeprazole on hand at all times to suppress the production of gastric acid in a horse they suspect may have gastric ulcers. And sometimes, it helps. But its crucial to know what type of ulcer youre dealing with in order to treat it effectively.
Gooseberry Ulcer Guard For Stomach Balance
Gooseberry is a manufacturer of different kinds of horse supplements. They focus on specific diseases, like laminitis, and stomach ulcers. Ulcer Guard, in particular, is good for alleviating the symptoms that horses usually experience when they have ulcers. It basically protects the stomach lining from the gastric acids.
Besides protecting against ulcer, this product also promotes a fuller coat, a healthier weight gain, and hood development. It addresses all the issues that ulcer might have caused in the horse. It is also great for preventing ulcers from ever developing in the first place. And, since ulcer is a very common condition in horses, Gooseberry is one of the equestrians best friends.
As you might expect from a product called Gooseberry, it tastes remarkably well. The supplement was designed to be well tolerated by horses, as that improves the chances of their recovery. You can administer it orally, or mix it with their feed or water. The product is so concentrated that it can be mixed up to make 11 Gallons.
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Key Times To Use Omeprazole For Horses With Ulcers
Managing the ulcer-prone horse can be tricky due to the fact that once a horse has developed ulcers, they are now at higher risk of recurring incidences of ulceration.
Franklin explains that UlcerGard, which contains a lower dose of omeprazole than GastroGard, is commonly used to maintain ulcer-prone horses. However, it can be expensive to give on a long-term basis, so instead, Franklin often recommends that UlcerGard be given to performance horses, as needed.
For example, if someone is hauling their horse to a big show where they plan to be for a week or so, Franklin will often recommend that the horse be given UlcerGard before they leave and stay on it while at the show.
You can do the same thing whenever your horse is in intensive training, says Franklin. The idea is that youre going to treat them with GastroGard and then, because you havent been able to take the horse out of that high-risk environment, you need to maintain them on UlcerGard so that the ulcers dont come back.
But he also notes that the coming back is the main problem that he and other veterinarians tend to see.
We can treat this condition–it may take four to eight weeks–but we can treat it. The problem is that horse owners and managers often make no management changes to prevent ulcers from returning. Thats where the right supplements can be beneficial–they are a relatively easy tool for the horse owner to implement while also greatly impacting horse health.
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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Understanding Ulcer Medication For Horses
When it comes to treating Equine Gastric Ulcer Syndrome, several good options exist, but the specific type of drug/medication and length of treatment your veterinarian prescribes will likely depend on the exact location in the stomach, as well as the severity of ulceration.
Latsons business partner, equine internal medicine veterinary specialist, Dr. Robert Franklin, explains that the horses stomach is divided into two halves: the top, which is called non-glandular and the bottom, referred to as glandular.
The non-glandular region is typically the area affected by ulceration, says Franklin. This region typically responds well to treatment.
GastroGard and UlcerGard, which both contain the active ingredient omeprazole, are the two main drugs veterinarians tend to use for non-glandular ulcers.
They work about 80% of the time in a 4-week treatment period, notes Franklin.
However, Franklin goes on to explain that a glandular ulcer does not heal nearly as easily and doesn’t always respond to the typical treatments, so veterinarians often have to rely on a different strategy when treating these types of ulcers.
Weve used sucralfate in combination with omeprazole to manage glandular ulcers. Some more recent studies have shown that another drug called misoprostol is likely the best treatment for this type.
Preventing Gastric Ulcers In Horses
As always with health and wellness, prevention is the best medicine. We stress horses digestive systems simply by owning them and removing them from their natural environment. Then we further compound the difficulties by riding, traveling, and competing. Thus its critical, especially for the performance horse, to take as many measures as possible to encourage better digestive health.
We stress horses digestive systems simply by owning them and removing them from their natural environment. Then we further compound the difficulties by riding, traveling, and competing
The most beneficial changes to your feed and management program may include:
- Providing as much turnout as possible with other horses
- Offering forage continuously around the clock
- Feeding alfalfa, which is shown to help buffer stomach acids
- Reducing grain-based feed intake
- Providing fats as a source of energy/calories
- Feeding multiple small meals throughout the day
- Mixing chaff with grain meals to increase chewing and slow intake
- Using hay nets or slow feeders to increase chewing and slow intake
- Feeding beet pulp, a complex carbohydrate metabolized in the hindgut, for higher caloric needs
In addition to these, and especially when its not possible to implement them all, digestive supplements can also play a role in supporting your horses gut health. Certain digestive supplements can help:
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Gastric Ulcers In Horses: Search For Biomarkers Treatments Continues
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Are you considering having your horses stomach scoped again? Is there any other way to verify the presence of gastric ulcers? Right now, there isnt, but researchers are working on noninvasive ways to diagnose and monitor horses with equine gastric ulcer syndrome .
Many performance horses have gastric ulcers, which are defects in the surface of the stomach lining that occur in either the glandular or nonglandular regions. Thought to be due primarily to management factorsstress due to training or competition, social isolation, diets high in concentrates or low in foragesgastric ulcers often cause poor performance, decreased appetite, and weight loss.
After diagnosing and grading ulcers via gastroscopy, veterinarians typically recommend treatments geared to decreasing the acidity of the stomach. Treatment plans for EGUS typically include diet modifications, management changes, and medications such as omeprazole, sucralfate, and ranitidine. Nutritional supplements designed to control the pH within the stomach could also be included.
Because gastroscopies play a key role in ulcer management, repeated procedures are a necessary evil as horses may be resistant to treatment or the ulcers may return rapidly following cessation of pharmaceutical treatments like omeprazole.
While horse owners wait for this research to advance, Whitehouse suggested using diagnostics and treatments, including gastrointestinal buffers, currently recommended by veterinarians.
Feeding Plan For Ulcer Recovery
Grain should be avoided for horses with or prone to gastric ulceration. Carbohydrates are fermented to some extent within the stomach, disrupting the microbiome and releasing lactic acid and VFAs.
Instead, horses with ulcers should be fed a forage-first diet that supports gut health and prolongs feeding time. Consider the following strategies:
- Provide continuous access to forage and avoid intermittent feeding or long periods of time between meals. The prevalence of ulcers in horses fed twice daily is 75% compared to 58% for horses fed three times daily.
- Feed alfalfa prior to exercising this legume hay has high calcium content and can help to buffer stomach acid.
- Feed oil as an energy source instead of grain-based concentrates.
- Feed Visceral+ to reduce the likelihood of ulcers recurring after treatment. Visceral+ is formulated with natural ingredients that support gastric barrier function.
- Give your horse constant access to fresh water. Horses that do not have contact access to water are 2.5 times more likely to develop ulcers.
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Dietary Nucleotides Improve Efficiency Of Cell Growth And Repair
In general, DNA is synthesized through complicated de novo pathways. These pathways create fresh nucleotides from scratch rather than using existing material. However, in the presence of dietary nucleotides, the body can down-regulate DNA synthesis. And instead, it uses an enzyme named HGPRT to scavenge the intact nucleotides improving the efficiency of cell repair and conserving energy.
In addition to ongoing maintenance, cell division is critical for repairing damaged tissue, including ulcers. This is why in times of stress, dietary nucleotides have proven to be beneficial.
How Do Ulcers Form In Horses
The horses stomach is constantly producing acid to help with digestion. This acid is kept in check by a thick layer of mucus that coats the stomach lining. When this mucus layer is disrupted, the acid can eat away at the stomach lining, causing an ulcer. Ulcers can also form in the small intestine, where they are known as enteroliths. Enteroliths are caused by a build-up of minerals and other materials in the intestine, which can form into hard masses. These masses can eventually erode through the intestinal wall, causing an ulcer.
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What Dose Of Omeprazole Should My Horse Have
Omeprazole is typically administered to horses in 37% GastroGard paste form at a dose of 4 mg per kilogram bodyweight per day.
For a standard adult horse of 500 kg , this is 2000 mg of Omeprazole per day which is roughly equivalent to one syringe of GastroGard paste per day.
Lower doses of 1.6 mg per kilogram bodyweight per day have been shown effective at reducing gastric acid production and ulceration severity. However, this dosage is not as consistent at promoting ulceration healing compared to the 4 mg dose.
For squamous ulcers, omeprazole is typically administered for 28 days to enable full healing. Research shows that 86% of horses ulcers are healed within 28 days.
For glandular ulcers, omeprazole is typically administered for longer periods. It may also be administered alongside antimicrobials and gastroprotective supplements, such as sucralfate.
Is Gastroscopy Essential
Gastroscopy remains the only method of definitively diagnosing gastric disease. It is also the only way to distinguish between squamous and glandular disease. This distinction is important as the treatment regimens for the two conditions varies, as does the emphasis on specific management changes to prevent recurrence.
While gastroscopy remains best practice, there may be situations where this is not available or feasible. In this situation, the veterinarian may decide that a treatment trial is warranted to help establish a diagnosis. Prior to attempting a treatment trial, consideration should be given as to whether ESGD or EGGD is more likely in the individual horse, with the treatment trial adapted accordingly. It is important to keep in mind that not all horses with gastric disease will respond to a treatment trial. If gastric disease is still considered likely, then gastroscopy should be performed to confirm the diagnosis.
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