Just a few years ago, gastric ulcers were an obscure topic in the horse world that was occasionally mentioned by veterinarians when addressing an issue with a horse.? But, in a relatively short time, gastric ulcers now come up in daily conversation among veterinarians and owners as a possible cause of several common issues that plague horses.
But, although they?re widely prevalent, there are plenty of things that you can do to manage them if your horse is among the unlucky majority that has them.
HOW THEY OCCUR. Gastric ulcers occur in the stomach.? They?re defined by an erosion of the stomach lining due to prolonged exposure to the incredibly concentrated stomach acid that is continually produced in the stomach.? However, ulcers only occur when there is insufficient blood flow to the stomach wall.
Naturally, acid will continually eat away the stomach lining, but under normal physiologic circumstances, blood flow to the stomach wall helps the body regenerate new stomach lining to replace that which has been eroded.? When the rate at which the stomach lining is worn away exceeds the rate at which the body can regenerate stomach lining, an ulcer will form.
PROBABLE CAUSE. There are several theories to explain why horses get gastric ulcers.? For instance, it is thought that ulcers occur in broodmares because the fetus displaces organs forward causing stomach acid to pool higher in the stomach, thus creating ulceration.
When a horse is given non-steroidal anti-inflammatory medications (NSAIDS such as bute or banamine) for a prolonged period of time, ulcers may occur.? NSAIDS, as one of their mechanisms of action, cause the blood vessels that feed the stomach wall to constrict. When the blood vessels constrict, less oxygen and nutrients to the stomach wall are available to regenerate the stomach lining.
But beyond pregnancy and NSAIDS, the most common documented cause of gastric ulcers is stress.? In order to try to limit stress in your horse, it is important to understand what stress really is, since our common definition differs greatly from the medical meaning of the word.
We as humans rarely experience physiologic stress to the degree that animals do.? Our idea of stress is having bills to pay or a deadline to meet at work.? But true physiologic stress can only best be described as brief moments of intense physiologic changes in the body in response to perceived danger.
Think about it this way: You?re driving on the freeway and suddenly the car in front of you slams on its brakes. Will you stop in time'? Your stomach falls, your heart rate shoots up, and you become suddenly hot, tingly and flushed.? Before your brain can even think about it, you slam on the brakes!? This is a true physiologic stress response.? It comes from a catecholamine response that occurs when your adrenal glands release adrenalin.? See ulcer sidebars.
Some term this a ?fight or flight? response?meaning that the body is quickly gearing up for something big to occur.? One of the many physiologic changes that takes place when this stress response occurs is a dramatic constriction of the blood vessels feeding the stomach.
Whether we like to believe it or not, horses likely experience this type of stress response quite a bit.? The list of situations in which a horse could experience stress can go on and on, but here are some common scenarios associated with catecholamine responses:
- Intense Training
- Stable confinement
- ?Boot Camp? training sessions
- Losing a pasture pal
- Horses with Cushing?s disease
- Moving to a new home
- Changes in barn mates
- Unpredictable feeding times
- Having to live without companionship
- Visits from the veterinarian and/or farrier
- Anything that makes them spook
- Any deviation from ?routine.?
NOT MY HORSE. All of us would like to think that our horses live in a stress-free environment, but the fact of the matter is, the majority of our horses do not.? For this reason, there is a strong likelihood that many of our horses have some degree of gastric ulceration.
Estimates of ulcer prevalence are 25 to 50% in foals and 60 to 90% in adult horses depending on age and performance level!? Broodmares, racehorses, and horses in intense competitive training show the highest ulcer prevalence among adults.? Basically, if you walk a horse up to a veterinarian and ask if it has ulcers, the veterinarian would be betting with the house if he or she responds, ?Yes.?
One important thing to remember about gastric ulcers is that they are not all created equal.? Ulcers are scored on a scale of 0 to 4, with 0 representing a basically normal-looking stomach wall and 4 representing severe ulceration that creates deep abrasions in the stomach wall.? But how do you determine if your horse has gastric ulcers'
TO SCOPE, OR NOT TO SCOPE. As mentioned, the signs of gastric ulcers can vary widely.? And to really bake your noodle, many horses have gastric ulcers and do not show any appreciable signs!? Sometimes, a horse displays signs that are overlooked because ?the horse has always acted that way.?? How many of us have heard those words before'
Just because a horse has always acted a certain way (such as cranky when cinched or inexplicably spooky) does not make the behavior normal.? Quite simply, the horse could have had ulcers for years, if not from birth.? So remember, if you have even the slightest inkling that your horse may have gastric ulcers, you owe it to your horse to find out for sure.
Unfortunately, confirming the diagnosis of gastric ulcers can be just as much a pain in the gut as the ulcers themselves.? No matter which way you go, diagnosis can be expensive and sometimes time consuming.
The gold standard for gastric ulcer diagnosis is gastroscopy. This procedure must be completed by a veterinarian and, in order for it to be done properly, the horse must be held off of feed for 12 to 24 hours prior.? During scoping, the horse is sedated and a nine-foot long tube with a camera on the end of it is inserted into the stomach through the nasal passage. This procedure usually costs between $300 and $500.? Although you can get an instant answer yay or nay, most horse owners still cringe at the thought of this saga.? Therefore, some have chosen alternate methods of diagnosis.
Although not as thorough as scoping, many horse owners have ?backed into? the diagnosis of gastric ulcers by prophylactically administering medication to their horse and then looking for a response.? While this sounds like a strange way of making a diagnosis, it's really quite amazing how horses can ?tell? owners that they are on the right track with treatment.? Usually, the behaviors that caused the owner and the veterinarian to raise an eyebrow about gastric ulcers in the first place will lessen or disappear when the treatment starts to work.
If a horse owner decides to opt for experimental use of anti-ulcer medication, the next step is determining which treatment to use.? There are several options, and it is? wise to ask your veterinarian which medication, or combination of medications, he or she thinks would be right for your horse.? Not to worry though, they won?t hurt your horse if you use them and your horse doesn't have ulcers.
By far and away, the gold standard for treating gastric ulcers is Gastrogard (Merial).? Gastrogard is omeprazole in a paste form, which is administered once daily.? It acts to shut off the proton pumps in the stomach that create stomach acid.? Study after study has shown that one tube of Gastrogard per day for 28 days will reduce ulcer scores. The downside'? One tube of Gastrogard will set you back $33 to $50.
Many veterinarians recommend trying the medication for 10 to 14 days because the majority of horses will show some response by then.? Other veterinarians try to use ? of a tube per day while some will combine Gastrogard with other medications.? This article isn?t intended to tell you how to treat your horse for gastric ulcers. That's up to you and your veterinarian.? Frankly, each case is different so no one single approach will work on every horse.
However, the charts on page 5 may help you decide if certain medications can work better for them than others based on cost, the number of times per day they must be given and how much should be administered.? The first chart is pharmaceutical medications to be used per your veterinarian, and the second table shows several over-the-counter options we like. See ulcer products chart.
A RECURRING NIGHTMARE. If you know someone who suffers from heartburn or indigestion, you rarely hear them speak of it in the past tense.? Gastric ulcers in horses are no different. They should not be thought of as a one-time occurrence, but as an ongoing condition that will need to be treated to varying degrees depending on their severity.? By now, you would likely agree that preventing them is far better than treating them.
Here are some popular management strategies to minimize the formation of gastric ulcers in horses:
- Feed small, frequent meals to help keep stomach acid concentration low.
- Add beet pulp and alfalfa to the diet because they are high in protein and pectin.? Both have been shown to buffer stomach acid.
- Increase hay portion of diet since bulk feeds can neutralize stomach acids.
- Decrease concentrates such as grain because grain is acidic and less bulky foods enable stomach acid to concentrate.
- House your horse with pals or at least make sure that he can see other horses.? This will decrease psychological stress.
- Turn your horse out as much as possible since horses in confined housing is a prevalent findings in ulcer horses.
- When trailering or showing, consider use of an ulcer preventative since these activities are strongly linked to ulcers.
- If NSAIDS must be used, do so with gastroprotectants and use as little as possible.? Consider using firocoxib, a NSAID that has been developed to minimize alterations in gastric blood flow.
BOTTOM LINE. Although the task of managing gastric ulcers in your horse can be daunting, the benefits? are priceless. If you have even the slightest suspicion that your horse may be affected by gastric ulcers, consult your veterinarian ASAP.
Article by Contributing Veterinary Editor Grant Miller, DVM.