The Best Choice for Treating Equine Gastric Ulcers

The equine gastric disease affects all disciplines and breeds of horses.

Equine Glandular Gastric Diseases (EGGD) and Equine Squamous Gastric Diseases (ESGD) are now recognized as separate diseases. Previously, they were known as Equine Gastric Ulcer Syndrome (EGUS).

Both EGGD and ESGD occur in the stomach of the horse. The symptoms, risk factors, management, and treatments of these two diseases are similar.

What are the treatment options for equine gastric ulcers?

Squamous or glandular ulcer disease cannot be treated according to a "standard protocol." Each lesion is unique, just as each horse is.

Horse ulcer treatment for ESGD:

For both squamous and glandular disease, acid suppression is the cornerstone of therapy.

The effectiveness of omeprazole in treating squamous disease is excellent. Omeprazole is from the family of proton pump inhibitors (PPI’s) that blocks secretion of acid. Omeprazole as a solo treatment for squamous ulcers will reduce and neutralize acid in the horse’s stomach, which enables improved healing of existing ulcer damage.

Treatment of squamous stomach ulcers in horses lesions requires a treatment plan of 28 days.

Horse ulcer treatment for EGGD:

Glandular disease treatment is not always so simple. These ulcers take much longer to heal. It's know a treatment plan of 56 days is required. Omeprazole alone will not heal glandular ulcers. Omeprazole and sucralfate is the best plan. As omeprazole is effective for 24 hours, it is required only one time per day. Sucralfate works for up to 6- 8 hours only. A minimum of 2 doses per day is required. Often horse owners don't have the time to treat every 8 hours, so let's be practical and give in the morning and evening.

Now for the tricky bits!

Sucralfate is most effective when given on an empty stomach. That’s right, a horse's stomach should never be empty. Adding a slow feeder with 1-2 biscuits of lucerne to stabled horses overnight will help suppress appetite in the morning. Due to natural suppression, horses eat less overnight, and this method simply forbids the horse from eating in the morning before the medication is administered, making it easier for it to be absorbed.

Don’t stress the need for a horse to be starved for the medication to work!

Next, give sucralfate at least 30 minutes apart from other medication and supplements. Ideally 1-2 hours is best, but let's be practical. Sucralfate can be given with water or a small handful of chaff.

The risk factors for EGGD are very different to ESGD

A follow-up gastroscopy is best to evaluate the success of the treatment. Management changes are essential to preventing the recurrence of both disorders.

· Given that nutrition and exercise have a key role in ESGD, management techniques to help avoid the condition include:

• Avoid stress through travel and allow interactions with other horses
• Increase turnout, ideally with other horses
• Increase the amount of roughage they consume.
• Feed palatable, high-quality forage in the morning, such as lucerne chaff.
• Make sure to feed at least every 6 hours.
• Reduce your intake of grains and starches.
• Constant access to clean quality water.
• 30 minutes before exercising, feed chaff or forage.

· Exercise frequency and behavioural stress both contribute significantly to the development of EGGD, and the following strategies can be used to help prevent recurrence:

• Reduce the amount of physical stress.
• Give them at least two to three full rest days each week.
• Limit participation in competitions and strenuous exercise.
• Make sure they eat some roughage to keep the stomach's blood flow intact.
• Reduce management alterations
• Reduce the number of handler and rider changes.
• Higher risk amongst Warmbloods

Essential takeaways

• Keep in mind that the stomach ulcers in horses can be affected by two different diseases: squamous disease and glandular disease.
• All horse populations are very susceptible to gastric disease, and the clinical signs can differ.
• Gastroscopic examination is the only way to diagnose gastric disease.
• Omeprazole is helpful in treating squamous disease; sucralfate and omeprazole are both required for glandular disease.
• To prevent and treat both diseases, management changes are essential.
• Feed 2-3L of roughage before working out to reduce "acid splash" and keep the blood flow to the stomach flowing.

Ongoing maintenance with Sucralfate

Sucralfate creates a barrier of defence over the digestive system of the horse. Both the occurrence of ulcers and their healing is facilitated by it.

There are relatively few (if any) negative effects from treating horses "as needed" with sucralfate because very little of it is absorbed by the animal.

Long term treatment of sucralfate v omeprazole is recommended. Sucralfate can be given as an ongoing maintenance daily or 24 hours, pre, during and post a known trigger such as travel or isolation.

The best choice to treat horse ulcers

A 56-day bundle of omeprazole and sucralfate is available from Abler. The best medicine and easy administration make this the best choice for horses suffering from ulcers.