What are Gastric Ulcers​? 

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Gastric ulcers are a very painful condition of the horse’s stomach that often goes undiagnosed. Ulcers can cause behavioral issues such as teeth grinding and resentfulness during tacking up as well as decrease a horse’s athletic ability and performance.  Some horses have trouble maintaining their weight because of ulcers or may colic frequently, especially right after eating.  Ulcers can affect 80-100% of thoroughbred racehorses and around 50% of sport and pleasure horses.

 

Where do Gastric Ulcers Form?

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A horse’s stomach is split into two parts: the non-glandular, squamous part of the stomach and the glandular stomach that produces stomach acid.  The dividing line between these parts is called the margo plicatus and is a very common site for gastric ulcers since acid produced by the glandular stomach splashes up on the unprotected squamous stomach lining.  Ulcers can also form in the glandular part of the stomach, especially at the very bottom of the stomach right before the small intestine begins (known as the pyloric sphincter). 

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Diagnosing Gastric Ulcers

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The best way to diagnose ulcers is by using a 3m (9 foot) video endoscope passed through the horse’s nostril and esophagus and into the stomach.  This allows a veterinarian to visualize and assess the severity, number and location of ulcers in the stomach and to formulate the best treatment plan.  Horses must be fasted overnight prior to being scoped to ensure the entire stomach lining can be assessed.  They are sedated heavily and their nostrils are numbed so they are not so irritated by the scope being in their nose while the procedure is performed.

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Treating Ulcers

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       Ulcers that occur in the squamous part of a horse’s stomach are treated similarly to human peptic ulcers with proton pump inhibitors or H2 receptor antagonists such as omeprazole and ranitidine respectively.  Omeprazole is by far the best treatment for ulcers, but because of the horse’s unique digestive system this medication must be specially buffered or coated in order to be absorbed and effective.  Currently, Gastrogard® or Ulcergard® are the only omeprazole products recommended by CBE veterinarians.  Omeprazole is administered once a day on an empty stomach to be the most effective and often horses need to be treated every day for 3-4 weeks to completely resolve squamous ulcers.

     Ulcers occurring in the glandular stomach or by the pylorus are often very painful and require different treatments and can take much longer to resolve.  These ulcers are treated with omeprazole and sucralfate (Carafate®) which coats the ulcers and helps enhance the normal protective measures of the stomach. Sucralfate is administered as pills 2-4 times a day and must be given separately from all other medications to prevent drug interactions.  Often glandular ulcers need to be treated for 2 months or more before they are resolved! 

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Prevention

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Ulcer treatment is very involved and can be expensive, but the results speak for themselves when horses are healthier, happier and perform better.  Preventing ulcers from happening is the best thing owners can do for this particular disease.  Management changes such as increase pasture turnout with friends, free choice or frequent hay meals (4-6) throughout the day,  sufficient volume of hay (15-20lbs a day), low starch grains  and providing free access to water at all times are considered important first steps.  Additionally, adding corn oil to the diet can also be helpful.  Omeprazole (Ulcergard®) is also very useful as a preventative and can be given at a lower dose anytime the horse experiences increased stress (travelling, new turnout buddies, shows or increases in training intensity).

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     If you are frustrated with chronic issues with your horses or just feel he’s not quite right, ulcers could be a contributing factor.  Chat with one of our veterinarians at your next appointment or give us a call at the office (706-769-4749) to discuss whether or not a gastroscopy to diagnose ulcers in your horse might be indicated.

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Sources: Sykes, B., Heweston, M., Hepburn, R., Luthersson, N., & Tamzali, Y. (2015). Europena College of Equine Internal Medicine Consensus Statement - Equine Gastric Ulcer Syndrome in Adult Horses. Journal of Veterinary Internal Medicine , 1288-1299.