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Gastric Ulcers

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    Posted: 07 Nov 2013 at 8:04am
As the subject came up recently over a medication given to a Melb. Cup runner on race morning, I thought this info might be handy for any punters interested in furthering their knowledge Smile

Equine Gastric Ulcers: What Horse Professionals Should Know
Submitted by News Editor /EQUImed

In the past 10-15 years, it has become clear how common gastric (stomach) ulcers are in trained horses and in the general horse population. This problem has a huge impact on the horse industry.

Preventing ulcers in horses

The development and more widespread use of the 3-meter endoscope over this time has given veterinarians a tool to visualize the inside of the horse's stomach and definitively diagnose this problem. Excellent recent research helps explain the different ways gastric ulcers are caused, and sheds some light on what we can do to prevent the problem.

Gastric ulcers are very common in the performance horse population. Endoscopic studies of horses in training have shown that up to 90% of horses stabled at race barns have stomach ulcers. At least 60% of horses in other competitive disciplines have ulcers.

The prevalence of ulcers in horses that are not in training is lower, but still far higher than one might expect. Gastric ulcers are also common in young horses, especially those that have other illness.

Clinical signs of ulcers in horses

The classic signs of ulcer disease in the adult horse are poor appetite, decreased performance, attitude and personality changes, poor body condition, rough hair coat, and low-grade or repeated colic episodes. In foals, the classic signs of gastric ulcers are colic, diarrhea, teeth grinding, salivation and poor body condition.

Temperament and pain tolerance can affect whether or not an individual horse shows obvious clinical signs. Some horses with mild lesions show obvious and âclassicâ clinical signs while others with more serious lesions may show very little sign of a problem.

In some cases, horses with gastric ulcers exhibit well-established behavior patterns that are simply considered normal for that horse. Treatment of ulcers in these cases sometimes reveals a previously unknown – and sometimes very pleasant – underlying personality.

Diagnosis of gastric ulcers

The definitive way to diagnose gastric ulcers is with the use of a 3-meter video endoscope. These scopes have been used at veterinary schools for years, but are now more common in private equine veterinary practices.

The procedure goes something like this: The horse is kept off feed for 12 hours prior to the exam. The horse is lightly sedated for the procedure. The scope, a long, narrow tube that has a video camera at its tip, is passed through the nostril and into the stomach. The stomach lining is visualized on a television screen.

Ulcers appear as erosions of varying size and depth in the surface lining. Ulcers are usually found in several typical locations within the stomach. The severity of these lesions is visually recorded, and this recording serves as a baseline for studies performed during and after treatment.

We have had a 3-meter endoscope in our practice since 2001 and have found it to be a great diagnostic tool. It has allowed us to make a definite diagnosis of this common problem and to monitor the effectiveness of treatment. It has also allowed us to diagnose other problems of the stomach and esophagus, such as certain types of cancer.

Other, âsimplerâ methods for determining the existence of gastric ulcers have arisen in the past decade as well. A fecal blood and protein test has proven to be unreliable in adult horses. Urinary sucrose testing may have some predictive value for bleeding into the gastrointestinal tract but requires urine collection and laboratory testing. The standard diagnostic tool remains the 3-meter endoscope.

It is often proposed that rather than going to the $300-$400.00 expense to diagnose ulcers definitively with an endoscope, one should instead simply put horses on medication and see if they respond. One real problem with this idea is that proven ulcer medications are more costly than the testing procedure. Use of unproven medications only further confuses the situation.

Also, endoscopy provides a direct view of the stomach that is the only way to diagnose other possible problems. Things like stomach cancer, outflow obstruction and congenital abnormalities cannot be diagnosed any other way.

Why are ulcers so common?

Understanding how equine gastric ulcers occur gives some insight into how to manage horses to prevent this problem. Horses, unlike humans, secrete stomach acid continuously and independent of a meal. The presence of food in the stomach buffers this acid and so helps protect the lining from damage.

Horses, unlike humans, have an upper portion of the stomach that has an unprotected lining and is vulnerable to damage by acid. The lower portion is the acid-producing part and is more resistant to acid damage.

Recent research has shown that when horses are exercised at a trot or gallop, the pressure in the abdomen (the space around the internal organs) increases. This raises the level of the âacid pool,â which normally lies down low in the more resistant portion of the stomach, to the more sensitive upper part. This favors the formation of ulcers in this area.

There are several different and distinct ulcer “syndromes” in different classes of horses that affect either the upper or lower portion of the stomach, or both. The bacterial cause of ulcers that has been determined to be such an important causative factor in human gastric ulcers has not been found to date in horses.

Nutrition plays an important role in determining the level of acid in the stomach fluid. High grain diets cause more acidity than low grain diets. Alfalfa actually causes a lower acidity than grass hay. One of the most important points is that ulcer syndromes can be unapparent, and the signs are often attributed to other causes.

Treatment options

Horses diagnosed with gastric ulcers can be treated and often make full recoveries. The most effective treatment for gastric ulcers in horses is the prescription drug omeprazole, trade names are Gastrogard® and Ulcergard®. Gastrogard® is intended for the treatment of ulcers and Ulcergard® is intended for the prevention of ulcers and is given at a lower (preventative) dose.

These are specially formulated pastes developed from a drug used to treat human ulcers. They act by directly inhibiting acid production by the acid-producing cells in the stomach. They are highly effective but also very expensive.

Other medications that have historically been used to treat gastric ulcers have been shown not to be as effective, and require multiple doses per day. These medications act by a more indirect route. They include ranitidine (Zantac), cimetidine (Tagamet), and the ulcer coating agent sucralfate (Carafate).

Antacid medications are marketed with great claims for success, but have been shown to only lower acidity in the horse's stomach for short periods of time. That said, they are probably better than doing nothing and the products have become quite popular.

Ulcer prevention

Awareness is the key to prevention. The more you know about gastric ulcers, the better you will be able to manage your horses to avoid them. I regularly suggest the following preventative measures:

Remember that if you do make feeding changes, make them over several days.
Feed only as much high-carbohydrate grain as is necessary for the intensity of training.
Keep high bulk feed (hay or grazing) present for your horses as much as possible. The less time a horse spends standing around with an empty stomach, the better.
Consider the timing of feeding versus training. Do not train your horse on an empty stomach.
Recognize and consider that alfalfa actually lowers stomach acid, and feed it accordingly.
Be on the lookout for subtle signs and be ready to change your management accordingly.
Some research suggests that corn oil may be protective of the stomach lining.
If you are concerned that your horse may have gastric ulcers, discuss it your equine veterinarian. They can help make a definitive diagnosis and help you make the right management decisions.

By: Douglas O. Thal DVM Dipl. ABVP

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Fiddlesticks Quote  Post ReplyReply Direct Link To This Post Posted: 07 Nov 2013 at 12:36pm
So in nature horses are grazers, constantly eating and wandering around etc, hence why they are designed to secrete stomach acid, so taking this on board, if some pharmaceutical was developed that reduced stomach acid and was not harmful or performance enhancing, this might go some way to help reducing the problem across horses generally in work...?


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Post Options Post Options   Thanks (0) Thanks(0)   Quote Gay3 Quote  Post ReplyReply Direct Link To This Post Posted: 07 Nov 2013 at 12:57pm
That's what omeprazole & ranitidine do basically but both have their limitations. The only thing that clears them completely is a course of the former combined with a fibre based diet & relaxed environment which is what the recipients of OTTBs do immediately the horse arrives Smile
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Fiddlesticks Quote  Post ReplyReply Direct Link To This Post Posted: 07 Nov 2013 at 1:16pm
Originally posted by Gay3 Gay3 wrote:

That's what omeprazole & ranitidine do basically but both have their limitations. The only thing that clears them completely is a course of the former combined with a fibre based diet & relaxed environment which is what the recipients of OTTBs do immediately the horse arrives Smile


I'm talking about a drug that inhibits the production of stomach acid, something that works similar to a Monoamine oxidase inhibitor..


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Post Options Post Options   Thanks (0) Thanks(0)   Quote anabel Quote  Post ReplyReply Direct Link To This Post Posted: 07 Nov 2013 at 2:34pm
Omeprazole is a proton pump inhibitor so that does prevent acid formation in the stomach. Not the same mechanism as the MAOs but it is very effective. Just extremely expensive to maintain for horses - hopefully there will be a generic alternative available soon.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Shammy Davis Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 1:15am
JMHO but gastric ulcers are the most significant problem facing the general health and well-being of the competitive horse during training through retirement.
 
In the USA, some racehorse trainers are giving omeprazole as a prophylactic measure, which I think is extremely  sensibile.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Gay3 Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 8:31am
The trouble is, their digestive system has evolved to need acid.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote JoH Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 9:12am
FWIW (ie it seems to work for me)

For horses that don't have half day (or more) access to green pick / ad lib hay I make sure they get a biscuit of hay at least 30 mins before ie. not at the same time as, their hard feed ration and if they are on an am / pm feed regime that they get one (hay) biscuit some time between those feeds.  





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Post Options Post Options   Thanks (0) Thanks(0)   Quote Gay3 Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 9:47am
I think many do Jo, especially the non racing ppl & it does work well. Many in the industry also give ad lib hay which is certainly a big help but there'll always be the hypey ones best suited to a quiet, less stressful environment.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Fiddlesticks Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 10:31am
Originally posted by Gay3 Gay3 wrote:

I think many do Jo, especially the non racing ppl & it does work well. Many in the industry also give ad lib hay which is certainly a big help but there'll always be the hypey ones best suited to a quiet, less stressful environment.


I wonder if there is any data to support one way or the other if these ulcers are less prominent here or Overseas..( training methods ), my first boss I worked for ( Kiwi trainer ) was very big on hay after work, in fact we used to get this purple stuff that was almost wet, had a sweet smell, he told me the Queen used it for her horses, came in a white vacuum sealed bags...it was very sweet and fruity to smell...
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Munga Rangi Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 12:37pm
Originally posted by Fiddlesticks Fiddlesticks wrote:

Originally posted by Gay3 Gay3 wrote:

I think many do Jo, especially the non racing ppl & it does work well. Many in the industry also give ad lib hay which is certainly a big help but there'll always be the hypey ones best suited to a quiet, less stressful environment.


I wonder if there is any data to support one way or the other if these ulcers are less prominent here or Overseas..( training methods ), my first boss I worked for ( Kiwi trainer ) was very big on hay after work, in fact we used to get this purple stuff that was almost wet, had a sweet smell, he told me the Queen used it for her horses, came in a white vacuum sealed bags...it was very sweet and fruity to smell...
 True guys,
   Just to add to the above, when my late father was training, we always grew our own greenfeed. We have never had a large property, but we are able to irrigate about an acre and this kept all the gallopers in various seasonal greenfeed all year round.The horses in work also went out into their 30mx 30m grassed yards every day after their exercise. The horses absolutely loved this, even the biggest 'picky' pain in the butt when first arrived, would eventually scoff every morsel. My father always said that the best recipe for success was to keep as close to nature as possible. Old fashioned I know, but when you have seen the once 'highest priced yearling in Australasia' - who suffered terribly with ulcers, weaving in his stable, with the door open, unsure of what to do...makes you realize that a lot of these problems are man made. Smile
Caveat emptor
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Fiddlesticks Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 12:53pm
Originally posted by Munga Rangi Munga Rangi wrote:

Originally posted by Fiddlesticks Fiddlesticks wrote:

Originally posted by Gay3 Gay3 wrote:

I think many do Jo, especially the non racing ppl & it does work well. Many in the industry also give ad lib hay which is certainly a big help but there'll always be the hypey ones best suited to a quiet, less stressful environment.


I wonder if there is any data to support one way or the other if these ulcers are less prominent here or Overseas..( training methods ), my first boss I worked for ( Kiwi trainer ) was very big on hay after work, in fact we used to get this purple stuff that was almost wet, had a sweet smell, he told me the Queen used it for her horses, came in a white vacuum sealed bags...it was very sweet and fruity to smell...
 True guys,
   Just to add to the above, when my late father was training, we always grew our own greenfeed. We have never had a large property, but we are able to irrigate about an acre and this kept all the gallopers in various seasonal greenfeed all year round.The horses in work also went out into their 30mx 30m grassed yards every day after their exercise. The horses absolutely loved this, even the biggest 'picky' pain in the butt when first arrived, would eventually scoff every morsel. My father always said that the best recipe for success was to keep as close to nature as possible. Old fashioned I know, but when you have seen the once 'highest priced yearling in Australasia' - who suffered terribly with ulcers, weaving in his stable, with the door open, unsure of what to do...makes you realize that a lot of these problems are man made. Smile


That's a very sad part of racing I feel...it's such an empty feeling to see unhappy animals being made to stand in tiny hot boxes day in and day out, then only come out to work hard for a short period of time before being boxed again...very unnatural...


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Post Options Post Options   Thanks (1) Thanks(1)   Quote JoH Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 1:38pm
I think many do Jo, especially the non racing ppl & it does work well. Many in the industry also give ad lib hay which is certainly a big help but there'll always be the hypey ones best suited to a quiet, less stressful environment.

Even in full work my endurance horses were trained out of the paddock so 24 hour pick was always available.  I fully understand that this would not be available (or even suitable) for many/most TB's in work but one of the plusses with the  (TB) trainer I'm happy to drive 2.5 hrs out of Melb to use is that the horses aren't stabled 24/7, that they are in day yards with a WI/WO plus they get a grass paddock turnout each day and don't live at the track - much as Munga described.
Again, I'm aware city trainers would be hard pushed to do this but as most of my horses will be coming home once their racing days are done I do what I can to ensure they come home as physically (and mentally) sound as possible.



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Post Options Post Options   Thanks (0) Thanks(0)   Quote Gay3 Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 1:56pm
Apparently in the old days, the Flemington trainers had daily deliveries of milk thistles from the multitude of market gardeners& imagine other city tracks did also.
Whilst I too feel sorry for the Aussie horses who only get out of their boxes for an hr max per day, at least they get to spell in paddocks. Imagine life for Hong Kong long termers who get the 'luxury' of a box to spell in Disapprove
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Mr Prospector Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 1:58pm
I am using an Omeprazole based product when I feel its needed and never realised that it fully stopped the production of stomach acids . I will definitely have to have a close look at its used now .
Has anyone ever linked insisted worming problems with Ulcers ? Some of the wormers on the market do very little now and I've often wondered what long term issues would be caused by insisted worms .
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Post Options Post Options   Thanks (0) Thanks(0)   Quote JoH Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 2:17pm
Not sure if there is a connection between worming pastesand ulcers but moxidectin as active ingredient is the best (and IMO the only) way to get rid of encyctsed worms.

Suggested reading:  Dr Anne Nyland's book on worms and worming for Horses and donkeys




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Post Options Post Options   Thanks (1) Thanks(1)   Quote Shammy Davis Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 2:27pm
Originally posted by Gay3 Gay3 wrote:

The trouble is, their digestive system has evolved to need acid.
Prophylactic measures are about 1/4 of the normal dose.  How many racehorses stalled at the track do you see with out a full hay bag almost 24/7?  Theorectically, the production of saliva (via consumption of fiber through hay or similar forage) neutralizes the access production of stomach acids, but it is not working at the track or other competitive discipline stables and the reason is the stressful and confined conditions allocated to the competitive horse.  Further, anything that prevents the ulceration of the stomach and GI tract extends the healthy life of the horse.  As long as horses are confined 23 hours a day in stalls we are going to continue to see a rise in gastric ulcers.
 
 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Gay3 Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 2:29pm
I'll 2nd that & it's only $5 as an ebook in many downloadable forms:
http://smashwords.com/books/view/114972

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Originally posted by JoH JoH wrote:

Not sure if there is a connection between worming pastesand ulcers but moxidectin as active ingredient is the best (and IMO the only) way to get rid of encyctsed worms.

Suggested reading:  Dr Anne Nyland's book on worms and worming for Horses and donkeys





I was suggesting a high population of encysted worms due the lack of Moxidectin in some pastes may be a problem for horses . Our vet was expressing his concern over the lack of effectiveness of some pastes these days .
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There are specifically only two wormers capable of clearing an encysted worm burden. Equest which is Moxidectin & Praziquantel combined. The other is Panacur or the generic Fenbendazole (1/2 the price).
Equest is used 2 wks apart x 3 = 3 tubes
Panacur is a 5 day course to be repeated..................I'd have to look it up.
They are the only two despite claims from other companies Wink  & I doubt the relevance of worms to gastric ulcers but you never know Smile


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Post Options Post Options   Thanks (1) Thanks(1)   Quote Fiddlesticks Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 4:11pm
Originally posted by Gay3 Gay3 wrote:

Apparently in the old days, the Flemington trainers had daily deliveries of milk thistles from the multitude of market gardeners& imagine other city tracks did also.
Whilst I too feel sorry for the Aussie horses who only get out of their boxes for an hr max per day, at least they get to spell in paddocks. Imagine life for Hong Kong long termers who get the 'luxury' of a box to spell in Disapprove


It is this that very reason..( and some others ) that I simply cannot continue to take an interest in their product. For quite sometime when they came on line here I would follow the HK & Singapore stuff, but as you say, the way horses have to lead their lives up there, well I just can't support that type of industry with my punting $. I really cannot see anything good coming out of the extended Chinese product that will soon be coming on line either..




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Post Options Post Options   Thanks (0) Thanks(0)   Quote Mr Prospector Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 5:47pm
Originally posted by Gay3 Gay3 wrote:

There are specifically only two wormers capable of clearing an encysted worm burden. Equest which is Moxidectin & Praziquantel combined. The other is Panacur or the generic Fenbendazole (1/2 the price).
Equest is used 2 wks apart x 3 = 3 tubes
Panacur is a 5 day course to be repeated..................I'd have to look it up.
They are the only two despite claims from other companies Wink  & I doubt the relevance of worms to gastric ulcers but you never know Smile





I didn't want to hijack the thread but there is already some resistance reported to Moxidectin due to overmedication and shorter effectiveness to some strongyles I believe .
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Gay3 Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 5:55pm
Moxi plus Prazi is the difference between all the other Moxis & there's reported resistance to everything available so we can only go with the best we've got & not worm indiscriminately e.g every 6wks for the sake of it, given 20% of the herd carry 80% of the parasites Smile
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Post Options Post Options   Thanks (0) Thanks(0)   Quote anabel Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 10:17pm
I think Omeprazole blocks around 90% of acid production. I have a feeling it can also cause a rebound overproduction of acid once discontinued, although I can't remember where I read that so can't reference it. For this reason, I am nervous about using it long-term.

I am still experimenting with the best way to manage ulcers with our racehorses. At this stage they are receiving a treatment dose of Omeprazole followed by the maintenance dose, but will probably cease that and swap to supplements such as Gastrocoat & changed feeding practices once ulcers have healed. There seems to be no conclusive timeframe or recommended program for this though.
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Best way to wean off omeprazole is to very gradually reduce the dose over a couple of months. Expect some discomfort for a couple of days after reducing the dose. Based on experience in people!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote anabel Quote  Post ReplyReply Direct Link To This Post Posted: 08 Nov 2013 at 11:06pm
Thanks songline, glad to hear of your own experiences with it.
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In human studies, flax seed oil (linseed) has proven to have a protective effect on the colon and reduce bile acids.
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Ulcers ... For Life?
There’s no cure-all for equine gastric ulcer syndrome, but proper management and prevention methods can help your horse remain ulcer-free
Janice L. HoLLand, PHd, PaS
What could the following three situations all have in common? 1. You return home from a horse show after a disappointing weekend. Your elite performance horse, usual- ly high in the ribbons, did not place well. He occasionally looks at his sides and appears uncomfortable.
2. You have a young, excitable filly that was recently weaned. A normally robust and outgoing foal, she is now standing in her stall, uninterested in either interacting with humans or eating her grain.
3. Your mature gelding that lives on lush pasture recently went through a mild bout of laminitis. He’s always been a stoic fellow and rarely shows when he’s in pain. Now, his hair coat is dull, and he seems to be “depressed.”
What might be surprising to some is that while these clinical signs could point to a number of problems, all three of these horses could be diagnosed with the same condition: equine gastric ulcer syndrome.
history and signs
Equine gastric ulcer syndrome includes not only ulcers found within the stomach (usually in the esophageal region, or upper portion), but also ulcers found at the duodenal part of the small intestine, which is the portion closest to the stom- ach. Ulcers occur when the pH of these gastrointestinal tract areas becomes too acidic, and cells of the lining are damaged. The primary acid of digestion in the stomach, hydrochloric acid, is produced and released continuously into the stomach of the horse. Horses produce almost 1.5 liters/hour of this acid because they have evolved as continuous eaters, or grazers.
Ulcers can occur in horses of all disciplines and management situations,although horses in higher stress environments do appear to be more susceptible, according to veterinarians and researchers. A variety of studies have been conducted on gastric ulcer incidence in horses competing or training in different disciplines; some of these results are shown in the chart on the following page.
A definitive diagnosis can only be made by a veterinarian who performs gastroscopy on the horse. This involves placing an endoscope (a tubular optical instrument) into the stomach of the sedated horse to view the stomach lining. However, there are some signs that a horse owner or farm manager can watch for that might be in- dicative of a horse experiencing ulceration. Some of these, on their own, might not indicate a problem, but owners should be concerned when they observe more than one at a time.
Foals suffering from gastric ulcers, for instance, might show poor appetite (anorexia), bruxism (teeth grinding), exces- sive salivation, diarrhea, and lying on their back (to relieve some of the pain). Mature horses might show some of the same signs, such as anorexia, but they might also ex- hibit weight loss/poor body condition, a dull or rough hair coat, an attitude or behavior change (especially toward train- ing), poor performance, a tendency to lie down, and mild, chronic, or intermittent colic (Buchanan and Andrews, .NUTRITION Causative Factors
There are a variety of factors that can predispose a horse to ulcers. Some can be managed, while others, such as genetic predisposition, are more difficult or impossible to control. The three most commonly mentioned causes of gastric ulcers are summarized below.
The feeding regimen, including type of feed offered and how often, is one of the most common factors related to ulcer inci- dence (Reese and Andrews, 2009). Horses that are fed only a few meals a day, with grain or concentrate feeds that are high in soluble carbohydrates and comprise a large percentage of their diet, are most susceptible. Since the stomach empties fairly quickly after a meal, usually within 30-60 minutes, the cells lining the stomach can be exposed to the acids that are secreted for several hours before the next meal. So, horses that graze continuously or that are fed free choice hay tend to have a lower ulcer incidence. Feeding grains such as corn, barley, oats, and wheat products might also contribute to a higher ul- cer incidence, related to increased levels of a hormone called gastrin that stimulates stomach acid production.
Training and exercise might also contribute to an increased incidence of gastric ulcers. Horses involved in strenuous exercise have a higher incidence of gastric lesions, as shown in the table below, and intense exercise might cause a serum gastrin increase similar to that observed in horses consuming high-grain diets.
Decreased blood flow to the stomach during exercise, as well as increased abdominal pressure, might also be a cause (Orsini et al., 2009). Studies have shown that external pressure on the stomach during exercise forces the liquid contents of the lower portion of the stomach up- ward, exposing the sensitive mucosa of the gastric wall to the stomach acids and inducing ulcerous lesions. Another train- ing factor that might contribute to ulcers is increasing the physical demands on the horse too rapidly. This might lead to an increased physiologic stress level, which can in turn increase acid production, and decreased mucosal blood flow, which can delay gastric emptying.
Stall confinement in performance horses could be a contributing factor as well, but ulcers might be more related to a horse’s feeding schedule than confinement alone. A study conducted in New Zealand (Bell et al., 2007) found that racehorses that spent part of the day on pasture hadthe same incidence of ulcers (89%) as stall- confined racehorses.
Some medications are also recognized as causing ulceration. According to a 2009 study by Videla and Andrews, the most common medications implicated are non-steroidal anti-inflammatory drugs (NSAIDs), which can impair mu- cosal blood flow and compromise the mucus bicarbonate barrier of the stomach, a layer which generally protects the stom- ach lining from the acid. The most common NSAIDs used in horses are phenylbutazone (Bute) and flunixin meglumine (Bana- mine). The potential to cause ulceration is why these medications often are given for a few days and then discontinued.
Treatment
There are a variety of medications that can be given to treat ulcers. Some are available at the local feed store or in supply catalogs, while others are only available through a veterinarian.
Histamine antagonists (H2 blockers), such as cimetidine and ranitidine, block hydrochloric acid secretion. Proton pump inhibitors (PPIs) such as omeprazole (Gas- trogard) also prevent hydrochloric acid secretion and are longer acting than the H2 blockers. Anthony Bliksl*ger, DVM, PhD, Dipl. ACVS, professor of equine surgery and gastroenterology in North Carolina State University’s Department of Clini- cal Sciences, recommends omeprazole as the best therapy for ulcers in horses. PPIs are very efficient at increasing the pH (decreasing the acid level) in the stomach but he says that it takes about three days for these to have the maximal effect of blocking the acid pump. Many veterinar- ians will recommend giving one of the H2 blockers concurrently with the PPI for the first few days because, although they do not decrease acid to the same extent, they will act more rapidly and can block secretion until the PPI takes full effect.
Veterinarians sometimes recommend antacids, which contain magnesium hydroxide or aluminum hydroxide. According to a study by CK Clark et al., these treat- ments can cause rapid increase in pH and might eliminate some clinical signs quickly. However, most of these medications only provide relief for a few hours.
Protectants such as sucralfate might be useful in combination with other therapies. These medications form a gel within the stomach that coats and binds to the surface of the ulcers and promotes healing. Bliksl*ger believes sucralfate can be a use- ful “third line” of treatment in combina- tion with PPIs and H2 blockers, depending on the severity of the ulcers.
Foods that are high in amino acids L- glutamine and L-threonine, such as green cabbage, might also aid in gastric ulcer treatment and prevention, suggest someresearchers. These amino acids help repair and nourish the cells lining the stomach and intestines (Hagen et al., 2009).
Changing the Diet
Diet modification also is recommended for horses that are predisposed to gastric ulcers. Diets that are higher in forage content and lower in grain should promote the appropriate pH within the stomach and small intestine. In addition, having small amounts of feed present in the stomach for most hours of the day, mimicking the natural feeding tendencies of the horse, can help buffer the acid. According to Bliksl*ger, forage in the diet also essen- tially traps the acid in the lower portion of the stomach, thus protecting the upper regions that are more prone to ulceration.
Horses that require more calories than can be provided by forage alone (e.g., competition horses) might need a diet with higher fat content. As well as decreasing the acidity in the stomach, some oils, such as oat oil and rice bran oil, contain polar lipids, which are watersoluble fats that help transport nutrients into the bloodstream and support a healthy gut lining (Frank et al., 2005). Due to its high calcium content, alfalfa might provide an effect similar to antacids (Lybbert et al., 2007).Prevention
Ideally horses would be kept in a management situation where ulcers are not even a remote possibility, because ulcers are essentially a management disease. However, the reality is that even horses maintained under the most idyllic condi- tions can develop ulcers. For example, in a 2007 study (TheHorse.com/9950) researchers evaluated ulcer incidence in 62 Thoroughbred broodmares that were kept on pasture. More than 70% of the mares, both pregnant and open (not in foal), had ulcers, and no one factor was isolated as causing the problem.
Some of the suggestions given to treat horses with ulcers can also be used to prevent ulcers from recurring, or even occur- ring in the first place. According to Bliksl*ger, the best thing a manager can do to prevent ulcers is to provide maximal pasture turnout and develop/offer a forage- based diet. He also recommends dividing the horse’s diet into multiple small meals throughout the day. For horses that must be confined to stalls for large portions of the day, Bliksl*ger advises using the newer hay nets available that have smaller holes. The horses cannot eat all the hay at one time and will essentially “graze” all day while trying to get the hay out ofthe nets. He also recommends decreas- ing the stress of training or competition (e.g., providing a horse with ample time to adapt to a new environment and sched- uling rest or downtime between periods of heavy training). If this is not possible, then your horse might require some of the medications mentioned in the treatment section.
Take-home Message
Some horses are more predisposed to getting gastric ulcers, due to manage- ment, performance, or temperament. Nonetheless, horses can be managed, even in less-than-ideal conditions, to lessen the incidence. With proper medical treatment and removal of predisposing factors, ul- cers can be healed, and horses can remain ulcer-free. However, ulcers will reoccur if diet, exercise, and management changes are not incorporated. As with all disorders, consult a veterinarian or equine nutrition- ist about syndromes that might be caused by diet or management.
TheHorse: Your Guide to Equine Health Care | TheHorse.com
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