Understanding Equine Ulcers and Gastric Health

Understanding Equine Ulcers and Gastric Health

Lydia F. Gray, DVM, MAMedical Director/Staff Veterinarian

Jessica NormandDirector of Supplement Marketing

May 3, 2011

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Understanding Equine Ulcers and Gastric Health

What are gastric ulcers? Risk factors Signs Diagnosis Treatment and

prevention

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Some statistics . . .

It has been well-documented that as many as 90% of racehorses and nearly 60% of active show horses have gastric ulcers.

Simulated conditions representing activities typical in the recreational use of horses were determined to cause gastric ulcers in as little as five days.

McClure SR, Carithers DS, Gross SJ, Murray MJ.

Gastric ulcer development in horses in a simulated show or training environment. J Am Vet Med Assoc. 2005 Sep;227(5):775-777.

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What are Gastric Ulcers?

Gastric = stomach Ulcer = erosion Equine Gastric Ulcer Syndrome (EGUS)Ulcers can also occur in the colon but we will not be discussing

these as the history, signs, diagnosis and treatment are all different

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A horse in his natural state…

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Grazing 20+ hours per day

Risk Factors for Gastric Ulcers

Diet

Infrequent hay feeding High grain diet

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“Feeding horses more than five pounds of grain every five to six hours can cause gastric ulcers.”

~Frank M. Andrews, DVM, Univ. of Tennessee


Limited turnout

Stall confinement Lack of grazing time Lack of socializing time

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Intense exercise

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Stress

Training/competition Transportation Schedule changes Injury or illness

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Excessive use of NSAIDS

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Signs of Gastric Ulcers

Physical Mild, recurring colic Weight loss Poor appetite Dull hair coat

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Behavioral

Poor attitude Irritability Resistance Dullness

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Poor performance Lead swapping Reluctance to bend/collect Hitting jumps Slower times Lack of energy

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None (silent, subclinical)

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Diagnosis of Gastric Ulcers

History Signs Endoscopy Response to

treatment

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Reproduced from Andrews F, Bernard W, Byars D, Cohen N, Divers T, MacAllister C, et al. Recommendations for the diagnosis and treatment of equine gastric ulcer syndrome (EGUS). Equine Vet Educ 1999; 1 (2): 122-134.

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Treatment and Prevention of Gastric Ulcers

Goal is to create a permissive environment in the stomach for tissue healing, which requires a

combined approach:

1.Pharmacologic agents2.Natural agents3.Dietary changes4.Management changes

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1.Pharmacologic agents

Proton pump inhibitors (FDA-approved) GastroGard® (Rx) UlcerGard ®(OTC)Both contain the active ingredient omeprazole

Histamine type 2 receptor antagonists Cimetidine Ranitidine

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2. Natural agents

Antacids: calcium, magnesium and aluminum Amino acids: glutamine, threonine, glycine, collagen Herbs: licorice, marshmallow root, slippery elm, aloe vera,

adaptogens Others: pectin, lecithin, silica, gamma oryzanol, kaolin

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2. Natural Agents

Antacids (calcium, magnesium and aluminum)

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Clark CK, Merritt AM, Burrow JA, Steible CK. Effect of aluminum hydroxide/magnesium hydroxide antacid and bismuth subsalicylate on gastric pH in horses. J Am Vet Med Assoc. 1996 May 15;208(10):1687-1691.

Murray MJ, Grodinsky C. The effects of famotidine, ranitidine and magnesium hydroxide/aluminum hydroxide on gastric fluid pH in adult horses. Equine Vet J Supple. 1992 Feb;(11):52-55.

2. Natural Agents

Amino acids (glutamine, threonine, glycine, collagen)

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Zhong Z, Wheeler MD, Li X, et al. L-Glycine: a novel anti-inflammatory, immunomodulatory, and cytoprotective agent. Curr Opin Clin Nutri Metab Care. 2003 Mar;6(2):229-240.

Noe JE. L-Glutamine use in the treatment and prevention of mucositis and cachexia: a naturopathic perspective. IntegrCancer Ther. 2009 Dec;8(4)): 409-415.

2. Natural Agents

Herbs (licorice, marshmallow root, slippery elm, aloe vera, adaptogens)

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Aly AM, Al-Alousi L, Salem HA. Licorice: a possible anti-inflammatory and anti-ulcer drug. AAPS PharmSci Tech, 2—5 Sep 20;6(1):E74-82.

Lee EB, Kim OJ, Kang SS, Jeong C. Araloside A, an anti-ulcer constituent from the root bark of Aralia elata. Biol Pharm Bull. 2005 Mar;28(3):523-526.

2. Natural Agents

Others (pectin, lecithin, silica, gamma oryzanol, kaolin)

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Ferrucci F, Zucca E, Croci C, et al. Treatment of gastric ulceration in 10 Standardbred Racehorses with a pectin-lecithin complex. Vet Rec. 2003 May 31;152(22):679-681.

Venner M, Lauffs S, Deegen E. Treatment of gastric lesions in horses with pectin-lecithin complex. Equine Vet J Suppl. 1999 Apr;(29):91-96.


3. Dietary changes

Provide constant access to good-quality hay Or, provide hay frequently throughout the day Offer alfalfa hay, if possible Limit the amount of grain Or feed grain in small, more frequent meals

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4. Management changes

Give “down time” from competition, travel Provide pasture turn out, with “buddy” if possible Keep a regular schedule Reduce stress

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Questions

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Your Questions:1. Should you feed supplements to "prevent" ulcers? If so, what would

you recommend?

2. Does one dose a day of Gastrogard act as a preventative for ulcers?

3. Someone has told me that Ulcergard can actually cause ulcers when the medicine is discontinued – is this true?

4. How do you help reduce causes of ulcers when you are in a boarding situation?

5. I heard music playing in a barn can cause ulcers in horses-is this true?

6. How do probiotics factor in prevention/symptom management of ulcers?

7. Bute and ulcers... should you give ulcer preventive along with meds?

8. Is grinding of my horse’s teeth a symptom of ulcer pain?

9. Can ulcers be caused by bacteria as in humans - H. pylori and is there a treatment for same?

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Your Questions:10. I have read many articles that alfalfa hay is a great way to naturally

buffer the acid in the stomach. How much do you recommend giving a day and how often?

11. Does sweet feed really cause ulcers?

12. Are there natural alternatives to treat ulcers?

13. My horse was fighting pneumonia and taking alot of meds. While adding Ulcergard in the morning, I also added Zantac at night to prevent colic or ulcers. The Ulcergard is very costly, but I was very nervous about his stomach and had to do something. Your thoughts?

14. What do wild roaming mustangs do to support their gastric health?

15. Does it make sense to go to the expense of scoping (particularly if you have to travel a long distance to get this done) for definitive diagnosis?

16. Can you discuss ranitidine and sucralfate, as well as compounded omeprazole?

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Understanding Equine Ulcers and Gastric Health