Diagnostics and Treatment

Horses can suffer from 2 main categories of digestive ulcers. Both gastric (stomach) and colonic ulcers can be common in certain populations of horse. A Texas study of approximately 180 horses in a high stress environment showed over 95% of these horses had either gastric or colonic ulcers or both. In this article I would like to discuss some basic information on gastric ulceration, its diagnosis and treatments.

For the past 10 years the prevalence of gastric ulcers in performance horses has been well documented. The incidence of ulcers in racing Thoroughbreds is estimated to be about 90%. In other words, when groups or populations of these horses are screened for ulcers, approximately 9 of every 10 examined do have some level of gastric ulceration. Although it is known that this group of horses is among the most susceptible to gastric ulceration, we also know that horses of any breed can suffer from gastric ulcers, and the incidence is quite high. Feeding of concentrates and high grain diets, combined with stress which can come in many forms, are known to contribute to the development and support of the debilitating condition. The degree of ulceration can range from mild gastric irritation, to erosive and bleeding lesions. These gastric ulcers can lead to poor performance, poor weight gain, anorexia, poor condition, excessive nervousness, poor attitude, and colic

For a definite diagnosis of gastric ulcers, we must look at the stomach through a gastroscope. For the horse this must be a 3 meter length scope. Due to the length of the scope and the high cost of the instrumentation, the gastroscopy is normally performed at an equine hospital, and therefore the horse must be transported to the hospital. Occasionally as an alternative to performing the “scoping”, a horse will be placed on trial therapy to determine if gastric ulcers seem to be the problem. Of course trial therapy is not the preferred method, but on the other hand at times this method can be helpful, and can even be followed up with the gastro-scope. Assuming that the veterinarian performing the gastroscopy discovers ulcers, those ulcers are then graded on the basis of severity.

Upon discovering ulcers, there are a multitude of therapies for the veterinarian to choose from, and most often the prescription is accompanied by recommendations for management changes. The management changes are usually parallel to those recommended by gastroenterologists for humans, change of diet and reduced stress. When it comes to drug therapy, there are three classes of drugs for the veterinarian to choose from. There are proton pump inhibitors, H2 blockers and antacids. The three classes vary in their ability to treat ulcers, with the proton pump inhibitors such as Gastroguard® being the most effective, and the antacids such as calcium carbonate, and aluminum silicate, being the least effective. So, if the proton pump inhibitors are the most effective, why would H2 blockers such as Zantac® or the antacids even be a consideration for therapy? The answer is simple; cost. The cost of these therapies is proportional to their effectiveness, and so many times H2 blockers and antacids are used as part of a treatment protocol or as a prophylactic measure to reduce costs. It is not uncommon for a treatment protocol to include Gastroguard® followed by one or both of the alternative drugs to make a complete program. Once the initial ulcer conditions are cleared up, many horses are maintained on antacid products to help reduce the risk of recurrence of the ulcer conditions.