Monday, September 26, 2022

How To Treat Hindgut Ulcers In Horses

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My Treatment And Feeding Program

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

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

1/4 cup ground Flax seeds

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

1 Tablespoon Brewers Yeast ,

Green Tea powder

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

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.

Types Of Ulcers In Horses And How To Take Them Under Control

Unfortunately, ulcers are a common problem in horses. Almost 50 to 90 percent of horses suffer from ulcers in their lifetime. Ulcers are common in all types of horses but are more common in performance horses, with a ratio of over 90 percent in thoroughbred horses and 70 percent in endurance horses.

Being a horse rider or owner, it is important to know the signs of ulcers in horses because they cause extreme discomfort for your horse and rarely heal on their own.

In fact, according to research, only 4-10 percent of ulcers in horses heal without treatment.

All horse owners must know the signs of ulcers in horses, their types, symptoms, treatment, and prevention. If you know this problem better, you will be able to take better care of your horse.

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The Placement Of The Ulcer Indicates The Seriousness Of The Issue

To examine a horse for ulcers, a vet will use an endoscope. The endoscope, 3 meters in length, is inserted into the nostril and passes through the epiglottis and stomach. The camera on the end of the instrument allows the vet to see the digestive tract and locate any ulcers clearly.

Of course, finding the ulcers is just the first step to determining the cause. This is where the big picture has relevance. For example, if ulcers are discovered primarily in just the upper portion of the stomach, this would indicate that the issue is likely a feed management-related issue.

In other words, an adjustment to the diet or the feed schedule and exercise may need to be altered. We will discuss this in greater detail later.

If ulcers are discovered in the lower portion of the stomach, this indicates a more serious condition because the bottom portion of the stomach has a lining designed to protect the stomach wall from the acidic digestive enzymes .

When ulcers are found in the lower stomach, this points to the possible over-use of NSAIDs or non-steroidal anti-inflammatory drugs. The treatment for this condition may vary slightly regarding oral dosing amounts and the duration of treatment.

Because horses cannot speak to us about their health, we must be fully engaged to ensure optimal health.

Treating Gastric Ulcers in Horses

There are several steps you can take to treat your horses ulcers. Most of these should be taken while consulting your vet.

What Are The Clinical Signs Of Gastric Ulcers

Gastric Ulcers in Horses

The majority of horses with gastric ulcers do not show outward clinical signs and can appear completely healthy. Subtle signs may include:

  • Poor appetite
  • Low grade colic
  • Girthiness

More serious cases will show abdominal pain and/or grinding of the teeth. Some horses are found on their backs since this position seems to provide some relief from severe gastric ulceration. Others will walk away from food if they experience discomfort when the food first reaches the stomach.

Clinical signs of ulcers in foals include intermittent colic , frequent recumbency, reduced nursing, diarrhea, poor appetite, a pot-bellied appearance, grinding of teeth, and excess salivation. When a foal exhibits clinical signs, the ulcers are likely to be severe and should be diagnosed and treated immediately.

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Examine The Potential Risk Factors Of Your Horse

The first step to addressing better hindgut health in your horse is to examine current risk factors in their diet, routine and health history.

Think about your horses history in regard to gut health and behavioural changes. A few questions to review include:

  • Is your horses prone to gastric ulcers?
  • Has your horse shown signs of colic or has colicked in the past?
  • Is your horse known to react to dietary changes or be sensitive to changes in diet/routine?
  • Has your horse developed any stereotypic behaviour recently such as weaving, pacing, cribbing, etc.?
  • Is your horse overly stressed?

Reviewing the history of your horses gut health will help your veterinarian diagnose if your horse could be at risk of hindgut acidosis.

The Importance Of A Healthy Hindgut

Extensive research and modern treatments have emphasized equine gastric ulcers in recent years. But in reality, a horses stomach makes up less than 10% of the equine digestive tracts total volume.

The hindgut includes the cecum and colon, the largest structures in the equine gastrointestinal tract. These structures also house a population of beneficial bacteria responsible for digesting fiber, the primary energy source in the equine diet.

Fibrous material in the hindgut provides a water reservoir that promotes hydration, and bacterial fermentation of dietary fiber also produces essential vitamins absorbed by the horse. Although the full capabilities of equine hindgut bacteria are still unclear, the gut microbiota may also impact immune function and behavior.

Poor hindgut health and an unbalanced microbiota can prevent the absorption of vital dietary components necessary for peak health and performance. As a result, horses that struggle with common equine hindgut problems may experience dehydration, reduced appetite, poor hoof condition, impaired immune function, and attitude changes.

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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

Diagnosis Of Horse Ulcers

Myth busting Hindgut Ulcers with world-leading expert on equine gut health A/Prof Dr Ben Sykes

Veterinarians can provide an official diagnosis of a gastric ulcer through a gastric endoscopy or gastroscopy. In some cases, a vet may determine that an ulcer treatment plan is the best option without doing an endoscopy based on the horses symptoms and behavior.

Testing for ulcers, through an endo- or gastroscopy, requires a 12-hour fasting period. Horses are also unable to have water for four hours beforehand. The procedure itself takes around 10 to 20 minutes and is low-risk.

If your horses ulcer symptoms are severe, such as colic or teeth grinding, your veterinarian will most likely make an emergency call to provide immediate treatment until they can perform an endoscopy.

Endoscopies involve a few steps:

  • A fast-acting tranquilizer is given to relax and sedate your horse.
  • An endoscope is guided through your horses nostril and esophagus, then into their stomach.
  • A light and camera show you and your veterinarian any potential ulcers and their severity.

Its important to note that ulcers on the bottom of your horses stomach are harder to see during an endoscopy, which is why other methods for diagnosing gastric and colonic ulcers exist.

These testing methods include:

Talk to your vet about which test option is best for your horse. Depending on your horses medical history, such as a history of ulcers, your veterinarian may opt to use a less invasive test.

Causes of Horse Ulcers

Treatment for Horse Ulcers

Medicine for EGGUS includes:

Preventative Care for Horse Ulcers

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Riding A Horse With Ulcers

A horse can be ridden while recovering from and receiving treatment for gastric ulcers. An exception to this would be that if your horse has been suffering from the illness for an extended period before diagnosis and is suffering considerably from bad health. If your horse is physically weakened, then riding is not recommended.Ride with less intensity.

It is important to note that stress can intensify the effects of stomach ulcers and inhibit their healing. Therefore, how you ride your horse while treating stomach ulcers is an important factor in their healing.

In other words, You should alter the intensity of your riding during the thirty-day treatment cycle. If you are preparing your horse for competition or working through foundational training, it is recommended to adjust your training program to eliminate as much stress from your riding sessions as possible. You should consider postponing your training during treatment and focus on just enough riding and movement to maintain conditioning.

Keep in my mind a healthy horse will always perform better. So, slowing down to allow your horse to heal from gastric ulcers may speed up your efforts later, once your horse is back to 100%.

Prevalence Of Hindgut Acidosis

A 2006 study of Australian racing thoroughbreds analyzed the rates of hindgut acidosis among horses on high-starch diets.

The researchers surveyed 72 trainers who had a total of approximately 690 horses in training. Among this group, horses were fed an average of 7.3 kg of grain concentrates per day, with 82% of trainers giving their horses grain at least twice a day.

The researchers obtained fecal samples from the horses to determine gut pH levels and the presence of indigestible starches.

Fecal analysis showed that approximately 27% of the horses had a pH level lower than 6.2 in the hindgut. This is a sign of starch fermentation in the hindgut and is indicative of acidosis.

The researchers further pointed out that corn was a major contributor to the incidence of excessive acidity in the hindgut. They hypothesize that this is because of its poor pre-caecal starch digestibility.

Given these findings, the researchers caution against feeding practices that can contribute to hindgut starch fermentation, such as feeding large quantities of grain with poor digestibility in the small intestine.

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Colonic Ulceration In Horses

Ulceration of the large colon of horses is a syndrome that is not yet completely understood by veterinary researchers. Right Dorsal Colitis secondary to NSAID administration is the most recognized form of colonic ulceration. RDC, in its most clinically obvious form, manifests as a syndrome of weight loss, diarrhea, colic, peripheral edema and profound hypoproteinemia. Researchers believe that colonic ulceration may also occur in the absence of NSAID administration, and that the ulcers may form in any of the four quadrants of the large intestine. Available research on colonic ulceration is scarce, largely due to the difficulty of visualizing the colonic mucosa in a live horse. Some conclusions may be drawn based on what we do know about RDC and related research on equine gastrointestinal health and management.

Performance horses that are fed diets low in roughage and high in grain are thought to be at risk of colonic ulceration. New research is currently underway at the University of Glasgow to gain a better understanding of this disease.

Equine Squamous Gastric Ulcer Syndrome :

Hindgut Ulcers

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.

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Diagnosing Hind Gut Ulcersin Horses

If your horse has a weak hind end thatâs unrelated to physical injury, and if the horse has a long history of stomach ulcers, then there is a likelihood that a hind gut ulcer has caused the problem. Nutrient Buffer® H/G is designed to do for the hind gut what the original Nutrient Buffer® liquid does for the stomach. The two products combined are a complete buffering system for the equine digestive tract.

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.

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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.

Equine Gastric Ulcer Drug Treatments

Equine Ulcer Diagnosis by Mark DePaolo, DVM

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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