What's your horse's ulcer risk?

A horse coping with gastric ulcers may not always show outward signs of discomfort, but you can calculate his risk by taking a closer look at how he is managed.
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A horse coping with gastric ulcers may not always show outward signs of discomfort, but you can calculate his risk by taking a closer look at how he is managed.

As an astute horse owner, you are no doubt aware of the risk of equine gastric ulcer syndrome. Studies show that up to 90 percent of certain equine populations have gastric lesions caused when digestive acids damage the lining of the stomach.
Ulcers can cause a horse to lose weight, colic intermittently and develop a grumpy or fussy attitude. However, some horses with ulcers soldier on, showing no significant signs of discomfort.
Which gives rise to a more specific concern: Could your horse, the one you work hard to care for each day, have gastric ulcers? The only way to know for sure would be an endoscopic examination, which would be unnecessarily intrusive if the horse isn’t showing any outward signs of trouble. But you can also estimate his risk---the likelihood he has ulcers or will develop them---by considering some specific questions about his management. With honest answers you can make informed decisions regarding any diagnostic or treatment efforts your horse may need.

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The following five-question survey will help you determine an individual horse’s ulcer risk and explain how that risk is influenced by various lifestyle and management factors. Answer each question, then tally up your final score.

1. How many meals is your horse’s concentrate ration divided into per day?
a. 1 (5 points)
b. 2 (2 points)
c. 3 or more (1 point)

The less time a horse spends with an empty stomach, the better. His gut is designed to continually digest food and is constantly secreting acid into his stomach. In the absence of food, that acid accumulates with nothing to act upon but the stomach lining. Dividing a horse’s ration, particularly the concentrate portion, into several small meals a day will go a long way toward reducing his ulcer risk---and can help prevent other digestion-related problems, such as colic, or even laminitis.

2. How much of the day does your horse spend grazing or eating hay?
a. less than 50 percent (5 points)
b. more than 50 percent (2 points)
c. more than 75 percent (1 point)

A forage-based diet is an excellent deterrent against gastric ulcers. Not only does the continual intake of food help protect his stomach from acids, but chewing itself is also beneficial. Chewing hay and other forage stimulates about twice as much saliva production as does eating grain. And saliva acts as a natural buffer against stomach acid. Ideally, a horse would have access to hay or pasture at all times. This, however, can lead to wasted hay and/or overweight horses. A good solution is the use of slow-feeders for hay, which extends the amount of a time it takes for a horse to consume his forage ration while reducing waste. 

3. How many days in a row has your horse been given a nonsteroidal anti-inflammatory drug (NSAID) in the past three months?
a. more than 10 days (5 points)
b. 10 days or less (2 points)
c. none (1 point)

NSAIDs, such as phenylbutazone, play an important role in keeping active and aging horses comfortable, but they need to be used with caution. As they work to block the action of a specific inflammatory prostaglandin called COX-2, NSAIDs also inhibit the action of a prostaglandin called COX-1 that protects the lining of the stomach. The risk of ulcer formation varies with each horse and situation, but long-term use of NSAIDs is a common trigger. The latest generation of NSAIDs selectively block only COX-2, without acting on the protective function of COX-1. Conventional NSAIDs can be beneficial, even long-term, but you’ll want to watch the horse closely for signs of ulcer pain. Your veterinarian can also perform blood tests looking for changes in protein levels that might indicate gastrointestinal damage as a result of NSAID use.

4. Over the past three months, which of the following apply to your horse? (Mark all that apply.)
a. spent at least one night away from home at a show, clinic or other event (1 point)
b. took a trailer ride (1 point)
c. attended a competitive event or clinic at an unfamiliar location (1 point)
d. sustained an injury or developed an illness that required a veterinary visit or stall rest for more than a day (1 point)
e. adapted to significant changes in the herd population or dynamics, such as the arrival of a new horse or departure of an old friend (1 point)

Stress, whether physical or mental, is a well-known risk factor for the formation of gastric ulcers in horses. For that reason, it has become common to put horses on ulcer-preventive medication when they are hospitalized.
Along with illness or injury, even seemingly minor changes in routine and surroundings can increase a horse’s stress levels. In fact, simply riding in a trailer can increase ulcer risk: Researchers cite regular transport as one of the primary causes of the higher ulcer incidence seen among even seasoned competition horses who seem outwardly unfazed by travel. That doesn’t mean, of course, that you need to scratch competition and travel from your horse’s schedule; only that it’s wise to consider how these activities may affect his digestive health. You can adjust your management routine and/or start preventive medication to offset ulcer risks during the “busy” season.

5. How many days per week is your horse in intense, high-speed work?
a. three or more (He’s an eventer or regular competitor in speed events.) (5 points)
b. once or twice (You gallop for conditioning, but not as a routine part of training.) (2 points)
c. none (Besides an occasional short gallop for fun, you keep things slow.) (1 point)

The intense training required for sports such as racing, show jumping and eventing has long been associated with higher ulcer risk. Of course, the transport and circumscribed lifestyles of elite equine athletes are contributing factors. But even leaving these elements aside, a horse who regularly works at high speeds would still be more prone to ulcers than one whose work is less intense. That’s because galloping causes compression of the internal organs that forces acid into the upper, un-protected area of the stomach. This pressure is pronounced when the horse hasn’t eaten for several hours prior to the speed work. A brief gallop on your weekend trail rides isn’t going to appreciably increase his risk, but regular conditioning work at high speeds will.

Tally your horse’s score

0 to 5: Your horse is currently at a low risk of ulcer formation and should remain so unless he has a significant change in environment, management or health. Don’t become complacent, however: It’s wise to reassess your horse’s risk periodically based on any changes in his lifestyle.

6 to 15: Your horse’s risk of developing ulcers is moderate and there are probably a few adjustments you can make in his management right now to lower it. Consider changes to his diet, if possible, to increase his forage intake and ensure his stomach is never empty. Be judicious with your use of NSAIDs and explore alternatives if your horse needs long-term pain management. And if your horse ever appears unthrifty, fussy or otherwise “off,” he may have ulcers, and you’ll want to work with your veterinarian to rule them out.

16 to 25: Your horse’s ulcer risk is high. If he’s not showing signs of trouble, he may be stoically coping with an aching gut right now. Call your veterinarian for a consultation and possible diagnostic work.

Reading the latest studies on equine ulcers, it may seem like there isn’t a horse in the world who isn’t at risk. And in some respects, that’s true. We tend to feed, house and use horses for our convenience, which doesn’t always square with a healthy equine lifestyle.
But compromise is possible: By regularly assessing your horse’s ulcer risk and taking steps to protect his stomach when that risk is elevated, you can keep him comfortable while enjoying your partnership.

This article first appeared in EQUUS issue #464, May 2016. 

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