Ulcer Diagnostics and Therapy
Ulcer Diagnostics and Therapy
Poor performance caused by gastrointestinal disease in horses tends be focused around stomach ulceration (glandular and/or squamous ulceration). Recent information suggests that up to 50-70% of horses in training and work are affected by gastric ulceration. In some disciplines this can increase to 90% after a 3-day event or multiple days of work. The equine stomach is unique because it evolved based on a feeding regime of little and often (grazing). The acidic stomach environment is buffered by saliva, local bicarbonate secreted from glands in the stomach, and forage. Domestication of the horse has created gaps in grazing (stalls, transport, reduced turnout, competition) and subsequently longer periods of low pH in the stomach. We now know that significant “tips” can help with increasing the pH but there are still some periods we cannot avoid and therefore potential for mild ulceration to develop.
Clinical signs include decreased appetite, weight loss, mild diarrhea, poor coat, behaviour changes, poor performance, riding issues and intermittent colic.
Diagnosis is based on several methods; gastroscopy (a camera used to look at the stomach after a 12-14 fasting period), common clinical signs, or response to treatment. Ulcers are graded from mild to severe (grade 1-4) and which area of the stomach is affected (glandular versus squamous). Therapy takes up to 4-6 weeks in some cases but improvement can be seen as early as 3 days after initiation of treatment.
Therapy is based on management of environment, oral medications and removing any instigating factors. The most commonly prescribed drug for treating ulcers is known as Omeprazole. This drug is given orally, once daily and works by inhibiting the acid production in the stomach. Other medications given include sucralfate (a liquid or tablet medication which coats the ulcers in the stomach and encourages healing), H2-antagonists which aid in supressing the acid production but like sucralfate must be given 2-3 times daily in order to be effective. Other supplements have been recommended with mild improvements but no studies have proven their exact effectiveness. Importantly, alfalfa (Calcium) can be given 1-2 times daily for saliva production (enhances), special feeders which allow slower consumption of hay, reduction of concentrates, increased turnout time, access to water and in some cases antibiotics may be prescribed.
Second to lameness, gastrointestinal issues (GI) are the most common reason for veterinary examinations. Most common GI diseases include:
d) strangulating lesions
These are a few of the common conditions we see in our clinic.
Most cases of colic will be medically managed and do not require surgery. For those cases where surgery is required, we will diagnose and stabilize the horse to maximize survival prior to surgery. Most horses will show signs of being “not quite right” by lying down, pawing, looking at their belly, showing anxious or painful behaviour, striking out, repeatedly going up and down. If any of these signs are seen it is always best to phone and speak to a veterinarian. We routinely treat horses in the field and in the clinic using pain management, fluid therapy (orally and intravenously), repeated blood work and examinations, walking and monitoring, various intravenous therapies and lunging.
Other various GI conditions we see include;
-liver and biliary disease
-choke (esophageal obstruction)
This is a short list of some of the GI disease we would routinely treat and see in our clinic. We routinely utilize ultrasound and a thorough approach when looking at GI cases in order to make the most appropriate decisions about therapy and monitoring.