Thursday, April 18, 2024

Treating Hindgut Ulcers In Horses

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Treatment For Equine Glandular Gastric Disease

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

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.

Can Ulcers In Horses Cause Diarrhea

Chronic Diarrhea

They can also develop diarrhea with certain illnesses such as salmonellosis or coronavirus. However, chronic diarrhea may be a symptom of ulcers. Researchers arent sure exactly why this occurs, but it has been reported widely enough that it is accepted as one of the clinical signs of ulcers in horses.

Reduce Your Horses Stress Level

Stress is a major contributor to the development of ulcers in both humans and horses.

Why? Stress elevates circulating levels of cortisol and other thyroid hormones. Short-term elevation in cortisol is not a health concern and can be a good thing.

However, ongoing stress causes chronically elevated cortisol levels which can .

Prostaglandins are involved in mucous production in the gut.

In rats, high cortisol levels were not directly associated with ulcers. But the low prostaglandin levels that occurred in conjunction with high cortisol resulted in ulcers.

In horses, there is significant evidence that stressors including high-intensity exercise, traveling, and environmental changes are associated with higher incidence of ulcers.

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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.

Prescribe Omeprazole To Treat Ulcers

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

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.

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Minimize The Use Of Nsaids

Non-steroidal anti-inflammatory drugs are administered to horses to reduce pain and treat certain conditions.

Phenylbutazone is a common NSAID used for pain management in skeletal muscles. Firocoxib is more commonly used to reduce pain associated with osteoarthritis or bone injuries.

NSAID use may be necessary at times. When advised and monitored by a veterinarian, NSAIDs can benefit your horse.

However, outside of these circumstances, the use of NSAIDs should be limited.

NSAID use has been directly associated with increased ulcers in the digestive tract of horses. These ulcers occur in the squamous and glandular regions of the stomach, as well as the hindgut.

By inhibiting prostaglandin synthesis, NSAIDs reduce mucous production. They may also lower gastric pH levels below the normal pH of 2.

In healthy adult horses, administering phenylbutazone negatively impacted the mucosal barrier of the gastrointestinal tract. This increased ulcers and reduced overall digestive health.

Reduce The Risk For Equine Colonic Ulcers

Because the way we care and feed for horses varies greatly from their life in the wild, domesticated horses are prone to digestive imbalance that can lead to colonic ulcers. Understanding and awareness of colonic ulcers is not as prevalent as that for gastric ulcers however, we believe that equine ulcers can be stopped before they start by making changes to the horses diet.

  • Reduce concentrates and increase forage in the diet
  • Feed smaller meals more frequently throughout the day

All of this will help ensure that carbohydrates are digested in the foregut where they belong. This keeps starches out of the hindgut so that the pH remains balanced and its acidity low.

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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.

What Causes Ulcers In Horses

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

Before you can successfully treat an ulcer its important to understand what caused it in the first place, knowing what can cause ulcers will also help you to reduce your horses chances, if not eradicate them completely. A recent study showed that 93% of all racehorses suffered from ulcers, while 63% of performance horses were likely to have an ulcer at some point in their life, reducing to just 35% for domestic horses. While these numbers may seem shocking at first it does give us an indication of what a possible cause might be. Most race and performance horses spend a lot of time stabled with little or no forage and a very controlled diet which is why their risk of suffering from ulcers is so high.

Knowing that a horses diet can change their susceptibility is only part of the matter, to fully recognize why its such a big factor you need to understand how a horses digestive system works. Unlike humans, who only produce stomach acid when eating , horses are continually producing acid which is why they spend so long eating and grazing. As a horse grazes the forage slowly moves through his digestive tract and stomach, this process actually reduces the amount of acid thats produced which is why grazing is vitally important for a horses wellbeing. The saliva thats produced while chewing will also act as a barrier, protecting the sensitive stomach lining against acid.

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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.

Feed Fibre Before Exercise

One of the age-old golden rules of feeding horses is not to exercise on a full stomach, however, this only applies to concentrate feeds and it is actually highly recommended to allow your horse some hay or chaff immediately before exercise. Having fibre present in the stomach will help to prevent the gastric acid splashing up into the non-glandular portion of the stomach, where ulcers are most common.

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Recovery Of Ulcers In Horses

Once treatment is begun, ulcers tend to begin healing however, it may take time. Depending on the type of treatment and the severity of the ulcer, your horse may take anywhere from a week to over a month to heal. Since ulcers tend to recur, it is important to have your horse get checked by your veterinarian a few days after the treatment is complete.

If you choose to give supplements or probiotics to your horse, be sure to consult with your veterinarian and he may give you professional advice on what would benefit your horse. Your medical professional will also reiterate the importance of altering his eating habits and stall time.

Your veterinarian will give you specific instructions on the medication dosage and administration, and will communicate to you any side effects to watch for. It will be important to monitor your horses symptoms and behavior during treatment and after. If you have any questions or concerns about how your horse is recovering from a gastric ulcer, contact your veterinarian. He may want to see him again during his treatment period to check on his recovery.

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The Importance Of The Horses Hindgut

Does Your Horse Have Ulcers?

Its important to understand what the horses hindgut is and how it functions. The hindgut includes the cecum and colon and is an essential part of the overall digestive system.

Horses are hindgut fermenters which means that the hindgut is necessary to process digestible energy from the food that a horse consumes. When this function is impaired, it can have wide-ranging impacts on the health and well-being of your horse.

When feed moves through the horses digestive system, the stomach and small intestine produce enzymes that start to break down the feed. Simple sugars and amino acids are mostly absorbed in the small intestine.

But fibre makes up a huge portion of the horses diet and it does not get digested in the small intestine. Horses cannot break down fibre without the help of microbes in the hindgut.

Bacteria, yeast and other microorganisms digest fibre through a process known as fibre fermentation. This process provides the horse with energy, volatile fatty acids, vitamins, minerals, and amino acids necessary for good health.

These nutrients are then assimilated through the intestinal wall for utilization in the horses body. A healthy intestinal wall provides a protective barrier that allows nutrients to be absorbed, but doesnt allow toxins and microbes to enter the body.

If this barrier becomes damaged by ulcers or compromised by leaky gut syndrome, harmful substances can cross into the bloodstream, which can lead to infection and disease.

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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.

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.

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How Can Gastric Ulcers Be Prevented

The following management techniques may assist in preventing ulcers:

  • Feed horses frequently or on a free choice basis . This helps to buffer the acid in the stomach and stimulate saliva production, natures best antacid.
  • Reduce the amount of grain and concentrates and/or add alfalfa hay to the diet. Discuss any feed changes with your veterinarian so that medical conditions may be considered.
  • Avoid or decrease the use of antiinflammatory drugs. If anti-inflammatory drugs must be given, use newer, safer ones such as firocoxib, if appropriate and under veterinary recommendations.
  • Limit stressful situations such as intense training and frequent transporting.
  • If horses must be stalled, allow them to see and socialize with other horses as well as have access to forage.

Equine Gastric Ulcer Drug Treatments

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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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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
  • Chewing wood

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.

Equine Colonic Ulcer Syndrome

Whereas equine gastric ulcers are found in the stomach, colonic ulcers are lesions that occur in the hindgut . A horse is a hindgut fermenter, meaning it ferments forage in its colon to create Volatile Fatty Acids , which produce the majority of a horses energy. Because the hindgut is where most of the horses digestive process takes place, it is vital to overall equine health.

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