Equine Gastric Ulcer Syndrome (EGUS) is common in horses - Horses involved in training or racing are at a higher risk of developing EGUS, with upwards of 90% of performance horses having gastric ulcers. Studies have shown that 2 out of 3 performance horses have Equine Gastric Ulcer Syndrome, and gastric ulcers can negatively affect your horse’s health and performance1. Diagnosis is based on history, clinical signs, endoscopic examination and response to treatment. Gastroscopy is the only definitive method for diagnosis of gastric ulcers in horses. All ages and breeds of horses are susceptible to gastric ulcers, and current treatments focus on blocking the gastric acid secretion and raising stomach pH. There are many treatments, but a comprehensive treatment plan should include correcting the underlying cause, environmental management, dietary manipulation and pharmacologic intervention.
Clinical Signs and Risk Factors:
Clinical signs vary from horse to horse, but are more commonly seen as: acute or recurrent colic, poor body condition, on and off feed, poor performance/training, attitude changes, stretching often to urinate, inadequate energy, and diarrhea.
There are several risk factors as well that can cause EGUS including: Stress Transportation High Grain Diet Stall confinement Intermittent feeding Intense exercise Racing NSAID use Management changesGastric Bacteria (H. pylori) By minimizing risk factors and identifying clinical signs early, a treatment plan can be implemented and individualized.
Anatomy and Physiology of the Stomach:
The equine stomach is made up of non-glandular or squamous (the upper portion) and glandular (lower) portions. The majority (about 80%) of ulcers are found in the non-glandular region of the stomach. The glandular portion is responsible for secreting mucus, hydrochloric acid and pepsinogen which help break down proteins in food to aid in digestion. The region in between the glandular and non-glandular portion is called the cuticular ridge, or more commonly the margo plicatus. The non-glandular portion is predisposed to acid injury because it lacks the protective and buffering capacity provided by the mucus rich portion of the gastric region. The glandular region has more protective mechanisms to decrease the likelihood of ulcers.
GASTROSCOPY:
Currently, the gold standard for diagnostics of ulcers is by gastroscopy. Gastroscopy is a procedure used to view the inside of a horse's stomach. The procedure uses a 10-foot (3 meter) long endoscope/camera passed into the stomach via the horse's nose. Gastroscopy is the ONLY way to accurately diagnose stomach ulcers in horses.
OTHER DIAGNOSTIC TOOLS:
There are a handful of other indicators that can help your veterinarian determine if gastric ulcers are present in your horse. One is the Diagnostic Acupuncture Point Exam (DAPE). During the DAPE, if a horse is sensitive to an ulcer point near the cinch line, there is an increased likelihood that your horse has ulcers. Only trained veterinary acupuncturists will be able to perform this test correctly.
Another way to help identify ulcers is the SUCCEED Equine Fecal Blood Test Kit. The SUCCEED test is a non-invasive diagnostic tool that uses antibodies to detect occult blood components in your horse's manure. This test allows your veterinarian to accurately detect inflammation in your horses stomach and hind gut, and can help monitor your horse's ongoing digestive wellness. Although a DAPE exam and SUCCEED test kit can help in the diagnostic work up for gastric ulcers, the only way to determine the severity and grade of gastric ulcers is a gastroscopy.
On Farm Gastroscopy Preparation Protocol:
If a gastroscopy is recommended, there are a few steps that you need to follow in order to have your horse adequately prepared. Because a camera is going into the horse's stomach, the horse's stomach must be empty, it is critical to the success of the procedure!
Withhold feed (including hay, grass, grain and treats) for 14 hours prior to exam.
Withhold water for 4 hours prior.
Remove all bedding/straw from stall if your horse is prone to eating it. If necessary, muzzle your horse during the time period.
No grazing, nibbles or treats!
Gastroscopy is typically scheduled for first thing in the morning due to the fasting requirements.
Management and Treatment Options:
Depending on the severity and grade of the gastric ulcers, your veterinarian will determine the necessary treatment. The goals for ulcer treatment in horses are to relieve pain, eliminate clinical signs, promote healing, prevent secondary complications and prevent recurrence. The mainstay of treatment of EGUS is increasing the stomach pH and suppressing gastric acid secretion. Because of a high recurrence rate, effective acid control should be followed by altered management strategies and/or long-term treatment to prevent ulcer recurrence. Therapy Includes:
Prescription Medications
Omeprazole (Gastrogard); only FDA approved drug for EGUS in horses; blocks gastric acid secretion
Sucralfate/Bismuth - bind to stomach ulcers to promote healing
Antacids - neutralize stomach pH
Cimetidine/Ranitidine - decrease acid secretion
Misoprostol- increases stomach pH and inhibits gastric secretion
Bethanechol- increases gastric emptying
Alternative Therapies
Acupuncture
Herbals
Food Therapy
Supplements - Platinum Outlast
Dietary Management
Slow feeders or pasture grazing
Feeding good quality grass or alfalfa hay
Decreasing grain meals
Prevention:
Gastrogard™ given at a quarter dose once daily (called Ulcergard™ — available over the counter) is effective at preventing the formation of gastric ulcers. This is often recommended around times of stress or NSAID administration in horses at risk for EGUS. Corn oil added to the feed has also been shown to help increase gastric pH (i.e., decrease the amount of acid), although some horses can become “hot” with corn oil supplementation. It has been shown that supplements containing pectin and lecithin can help prevent EGUS, and mineral-rich calcified marine algae helps prevent squamous ulceration.
Most importantly, prevention of EGUS involves recognition of situations that may predispose a horse to gastric ulceration. Horses on high doses of NSAIDs or long-term treatment with NSAIDs are at higher risk for EGUS. Horses in training or who are fed high concentrate meals without access to roughage are at an increased risk. Performance horses are not the only horses at risk for EGUS, as severe ulceration has been diagnosed in recreational and retired horses in seemingly calm environments. It is important to keep EGUS in mind if a horse is being exposed to potential stresses, particularly those horses that have had EGUS in the past.
1. Mitchell RD. Prevalence of gastric ulcers in hunter/jumper and dressage horses evaluated for poor performance. Association for Equine Sports Medicine, September 2001