Gastric Ulcers

Imagine you are in your fifth week of showing at the Winter Equestrian Festival in Palm Beach. For a majority of the five weeks your gelding has been standing in his stall on the showgrounds.Imagine you are in your fifth week of showing at the Winter Equestrian Festival in Palm Beach. For a majority of the five weeks your gelding has been standing in his stall on the showgrounds.

Story originally posted by: Michelle GstattenbauerHorseCity.com Free-Lance Correspondent

Imagine you are in your fifth week of showing at the Winter Equestrian Festival in Palm Beach. For a majority of the five weeks your gelding has been standing in his stall on the showgrounds. One day you notice that his chestnut coat looks dull and that he seems to have lost a few pounds, despite constant care. You also discover he is leaving a handful of grain in his bucket, which is very unusual.

The first three weeks you were very successful, collecting blue ribbons consistently, but the last two weeks your gelding has been unusually cranky and your performances did not collect ribbons. What do these signs tell you? You may think your show horse is simply a little sour from unending weeks in the ring. But you may want to reconsider your diagnosis.

All of these symptoms could be the signs of a bigger problem called Equine Gastric Ulcer Syndrome (EGUS). It is a disease often overlooked because of its ambiguous symptoms, but don’t take that to mean it is not harmful. EGUS is a widespread condition that effects 93% of racehorses, almost 60% of all other performance horses and up to 57% of foals. In foals the disease can often be fatal.

Dr. Michael J. Murray of the Marion duPont Scott Equine Medical Center (The Scott Center is part of the Virginia-Maryland Regional College of Veterinary Medicine) points out, "Symptoms of ulcers are often not apparent because our patients can’t talk to tell us they are uncomfortable."

According to Dr. James Orsini of New Bolton Veterinary Hospital, "(EGUS) is basically a disease associated with damage to the lining of the stomach, the esophagus, and the small intestine. We believe a lot of it is caused by hydrochloric acid and pepsin (digestive protein). Where normally the stomach is coated with a white coating, instead there are pits or ulcers."

EGUS is very similar to the ulcers that afflict humans in that the stomach acid eats through the protective lining causing painful lesions. The methods used in treating the ulcers are also similar to what a doctor would do for a patient.
In adult horses the ulcers form in the upper part of the stomach, a sensitive area that is less able to protect itself from ulcers. About 80% of all ulcers happen in that region while the remaining 20% are found in the lower part of the stomach.

Although there are many similarities between equine and human ulcers one of the biggest differences is how often the acid is produced. Unlike humans who produce acid periodically throughout the day, horses produce acid 24 hours a day. The stomach is constantly being bombarded. This is an important function in a grazing animal that needs to break down the grass that is ingested around the clock.

In a foal who is unable to graze, nursing is the means by which gastric acidity is decreased. Gastric acidity is high in foals as young as two days old and nursing keeps food moving through the stomach and doesn’t allow acid to sit.

Another defensive factor that keeps things balanced is bicarbonate. This is able to counter balance the high acidity, but when factors are out of balance an ulcer can still develop.

SYMPTOMS & DIAGNOSIS
As with any disease there are a warning signs that should trigger concern. In foals one of the most obvious signs is when a foal lies on its back. The foals will roll to their back because it relieves pressure from the ulcer.
Orsini explains, "Foals have the greatest potential life-threatening problems because the ulcers can actually perforate or erode through the stomach. Most of those foals will die eventually." Dr. Orsini recounted a foal who had coliced. He discovered that the ulcers actually caused a blockage and the stomach couldn’t empty.

Other signs typical in foals with EGUS can include poor appetite, diarrhea and heavy salivation. Remember that some or all of these signs may become detectable when dealing with EGUS.

Unfortunately in adults the symptoms are less overt or unusual which makes self-diagnosis difficult. EGUS can cause poor appetite, weight loss, attitude change and a decrease in performance. As in foals the ulcers can also lead to obstructions or blockages causing mild to moderate colic, but is not as common in adults.

All of these symptoms are generally linked because each one can attribute to the other. As Dr. Orsini explained simply, "If you don’t feel well you don’t perform well."

One of the biggest questions is how ulcers can be diagnosed. Unfortunately the only reliable way is gastroscopy, a definitive diagnostic tool that not every veterinarian has available to them. Gastroscopy requires the use of a 9.8-foot long endoscope that is inserted during a painless outpatient procedure. Using the endoscope a vet can study the stomach lining and make a definitive diagnosis.

A second way to diagnose the problem is through a response technique. Because a horse will respond within 24-48 hours to medication, a reaction to the medication can confirm a suspicion.

TREATMENT & PREVENTION
According to Orsini the treatment should begin by eliminating clinical signs. For example, if the horse has coliced, the blockage of the intestine should be eliminated before focusing on ulcer treatment.
In the past, horses have benefited from the same treatments for ulcers that are used on people. Antacids can give relief, but because of the constant acid production in horses the antacid must be used every two hours to buffer the acid Ð a very inconvenient solution.
Cimetidine (Tagamet), ranitidine (Zantac) and amotidine (Pepcid), are histamine type-2 receptor antagonists (H2 blockers) that essentially block the secretion of stomach acid. In so doing, these drugs permit healing of ulcers. Unfortunately these antisecretory agents must be given three to four times a day.

According to Orsini the best treatment for EGUS is an acid pump inhibitor called Omeprazole. Omeprazole was the first acid pump inhibitor to be approved for use in humans, and is now the first and only acid pump inhibitor approved for the treatment of stomach ulcers in horses. The drug was approved this year under the brand name GastroGard and is effective as well as convenient. Horses need treatment only once a day, and GastroGard comes in a paste form, like worming medication, so it is easy to administer. The drug has been proven to have a very wide safety margin in adults as well as foals. Even when given 10 times the recommended dose there were still no side effects.

The high prevalence of ulcers in performance horses is a result of factors such as the way they are fed and managed as well as the intensity of training. Management modification is a big step in preventing the reoccurrence of EGUS. In order to modify the daily routine, one must realize there is not just one cause of ulcers. Stress management, as in humans, is a big factor in controlling EGUS. Things that can be stressful include transport, training changes and socialization such as changing barns or who they are turned out with.

Feeding management is also important to consider. A key factor is that horses at pasture have a lower incidence of ulcers. This is because grazing allows grass or hay to buffer the stomach lining. Intermittent feeding can be a problem as can pulling food (such as hay) from horses before competitions. It is during these periods of fasting with nothing in the stomach that acid has the opportunity to damage tissue.

According to a study done by Dr. Murray stall confinement alone appears to be big factor in the development of gastric ulcers in horses. This goes back to the altered eating behavior found in stall-bound horses, compared with those turned out to pasture.

Dr. Orsini agreed, emphasizing that standing in one place is not healthy saying. "Give them a suite instead of a room," said Dr. Orsini. In the case of injury, if stall rest is necessary be sure the stall is big enough for them to move around comfortably.

Being aware of what can cause ulcers is the first step to prevention. The second is recognizing subtle changes in your horse’s personality and overall health. Remember that your horse can’t always tell you what’s wrong and sometimes the signs aren’t always easy to read. But EGUS does not have to effect your horse. With proper management and use of the medication available you can have a healthy happy partner.

SIDE BAR LIST
Risks that may result in Gastric Ulcers:
ill horse
chronic lameness
stall confinement
intermittent feeding
long distance transport
barn changes resulting in re-socialization
Bute and other NSAIDS (nonsteroidal anti inflammatory drugs)

Signs of Gastric Ulcers In Adults:
– Weight loss
– Crankiness or change of attitude
– Loss of appetite
– Recurrent colic
– Poor coat
– Poor body condition
– Poor performance
In Foals:
Ð Grinding of teeth
Ð Lying on their back
Ð Heavy salivation
Ð Diarrhea
Ð Colic
Ð Intermittent nursing
Ð Decreased appetite
Ð Weakness

SIDEBAR
Eric Hasbrouck and Miss Fio
A perfect example of how ulcers can effect a performance horse is Eric Hasbrouck’s grand prix jumper Miss Fio. During the winter of 1999 his 11-year-old Argentinean Thoroughbred became ill and was placed on antibiotics for three months. Once the mare was no longer sick Hasbrouck returned her to regular work. Despite being over the initial illness Hasbrouck noticed that Miss Fio wasn’t jumping well, struggling over four-foot fences. According to Hasbrouck she was so bloated she looked pregnant and was cribbing more than usual.

He said, "She had no scope. She basically couldn’t jump she was so miserable." Miss Fio was checked over by numerous vets but no one could diagnose the problem. Hasbrouck admitted, "When you have a horse that can jump the biggest grand prix classes in the world easily and to struggle over four feet there has to be a reason. We have the best vets in the world and we couldn’t find it."
Finally after numerous blood tests Miss Fio was checked for ulcers and in Early August the problem was diagnosed Ð gastric ulcers. The mare was given Omeprazole and only three weeks later at her second show back in the ring Miss Fio and Hasbrouck won the $50,000 Autumn Classic Grand Prix Hasbrouck.
Hasbrouck said that night after his victory gallop, "Winning is great, but the fact that she’s healthy again is more important."