FAQ – Gastric Ulcers

Dr Bob Rogers, Dr Benjamin Sykes, Dr Karie Vander Werf

Equine Gastric Ulcer Syndrome and the Endurance Horses

By Bob Rogers DVM

Main points

1. Ulcers are common in endurance horses. (87%)

2. The only way to diagnose ulcers is by gastroscopy.

3. There are three types of ulcers in adult horses depending on the location. Squamous ulcers are in the top part of the stomach, (non-protected), glandular ulcers are in the bottom part, (protected). Ulcers also occur in the colon. Each type or location has a different cause, requires different diagnostic procedures and different treatments with different prognosis.

4. Ulcers are caused by

  • Blood supply being shunted away from the GI tract when exerting
  • Stress reduces stomach protective mechanisms, prostaglandins
  • Acid being squeezed up on to the non-glandular, squamous part of the stomach when cantering.

5. Symptoms of ulcers range from poor hair coat all the way up to colic and even death. Ulcers cause colic by slowing gastric motility.

6. Treatment includes omeprazole (in the form of Gastrogard/Ulcergard), sucralfate, misoprostol, in varying combinations. See the consensus statement for more information.

7. Ulcers are not permanently cured. As soon as the horse goes back into training or riding the ulcers will return. Aggressive management is necessary for control and prolonged remission. Management as well as “at the ride measures” are discussed.

Ultimate ulcer prevention requires training to achieve “emotional fitness“.

For Nutritional Management for prevention of ulcers

Little evidence exists for the role of diet in EGGD (equine glandular gastric disease) and as such the following recommendations are based primarily on risk factors identified for ESGD (equine squamous gastric disease).

Although scientific evidence is lacking the following recommendations are made:

1. Although the role of twice daily feeding has been disproved, continuous access to good quality grass pasture is considered ideal if for no other reason it reduces stress and increases salivation. Free choice, slow feed hay bags or balls or at least frequent feedings (4–6 meals/day) of hay is a second option.

2. Overweight horses should be on a diet. Fat produces an inflammatory called Adipokine.

3. Horses should be fed grain and concentrates as sparingly as possible. Low starch feeds are recommended. Feeding of sweet feed should be avoided as a large quantity of Volatile Fatty Acids will be produced.

4. Water should be provided continuously.

5. Electrolyte pastes should be buffered, mixed in feed or given in lower doses in water, or Aloe Vera juice.

6. Alfalfa should be provided as 25% of the forage.

Prevention at the ride

1. Omeprazole at the preventative dose starting two days before trailering. It is legal, although not 100% effective.

2. Outlast or Neighlox during the ride.

3. Free access to hay, with 25% as Alfalfa

4. Fed ½ of the grain at breakfast and ½ at the first break to minimize splashing of acid onto the squamous area. Don’t ride on an empty stomach.

5. Less electrolytes more often and mixed with feed and water. I prefer Perform and Win as it is buffered, lower in electrolyte concentration and is more palatable for the horse.

6. Allowing the horse to eat grass during the ride stimulates salivation. Saliva neutralizes stomach acid.

7. Aloe Vera, bentonite clay (are a small help), and especially corn oil. One oz of corn oil twice daily stimulates blood flow to the stomach, increases gastric mucus production, increase gastric bicarb, increases protective prostaglandins in the stomach.

8. Don’t let the horse lie down for two hours after the ride.

9. Hydration, Hydration, Hydration.

10. AVOID STRESS! Develop an emotionally fit horse.

Bob Rogers DVM

Consensus Statement: European College of Equine Internal Medicine Consensus Statement—Equine Gastric Ulcer Syndrome in Adult Horses: https://onlinelibrary.wiley.com/doi/full/10.1111/jvim.13578

Recommendations for the treatment of Equine Glandular Gastric Ulcers (EGGD):

Fasting to improve efficacy of omeprazole:
Gastric Ulcers: Omeprazole More Effective in Fasted Horses – The Horse

– What’s new in gastric ulcers: https://youtu.be/MEd_5jZSIqw
– EGUS Prevention and Treatment: https://youtu.be/UAFDdQvgOj4
– Everything you need to know about omeprazole: https://youtu.be/20ao-gtovN8

Free masterclass on gastric ulcers: https://feedxl.com/prevent-gastric-ulcers-masterclass/?fbclid=IwAR2HJeWxpmgURk72tyGZeFa8Kz0eE2TzL8pK9u2IYBinrBaPNctPigoqJ-c

For lots more info on gastric ulcer research, join this group: https://www.facebook.com/equineulcerresearch/ moderated by Dr Benjamin Sykes.

Copyright: Dr Bob Rogers, Dr Benjamin Sykes, Dr Karie Vander Werf, and Horse Vet Corner 2020

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