Gastric Ulcers: How to Tell if Your Horse Has One, and What to Do if it Does

Gastric Ulcers: How to Tell if Your Horse Has One, and What to Do if it Does

[MUSIC] Okay, good evening everyone. It looks like we can go ahead and get started
with our presentation tonight. I am Amanda Bodle with My Horse University
and I just wanted to get us started off. So welcome to the My Horse University and
eXtension HorseQuest live webcast titled ‘Gastric Ulcers: How to Tell if Your Horse Has One,
and What to do if it Does’. Our presenter tonight is Dr. Jenifer Nadeau. Jenifer is an Associate Professor in Equine
Extension Specialist for the University of Connecticuit where she’s been since 2001. Jenifer grew up riding and working with horses
including a variety breeds and disciplines such as trail, hunter jumper, draft and racehorses. She also rides both English and Western. Her research focuses on equine health while
she also teaches animal nutrition for undergraduate students and works in extension outreach with
adult horse owners and 4-H horse project members. Most of you have already seen that you can
use the text chat to the left of your screen to ask questions and we’ll be trying to answer
those throughout and also compiling them and answering them at the end. Our presentation tonight will be recorded
and uploaded to the My Horse University website by the end of the week if you’d like to review
it at a later date. And at this time, I’ll turn the presentation
over. [Jenifer Nadeau] Hello everyone, please let
me know if I’m go too fast. Sometimes I can talk a little bit fast especially
with this subject because I’ve given a lot of talks on it. So do slow me down. I always tell my students that I’m like a
runaway train and they just have to rein me in. So they go ahead and do that. So tonight we’re going to talk about equine
gastric ulcer syndrome and you’ll also hear it called EGUS (kind of a buzz word and a
short way – we’re always looking for a short way to say things in our world). So basically about sixty to ninety three percent
of performance horses have had this problem which may be why some of you are on tonight. Forty to fifty eight percent of show horses. It’s found in as many as twenty five to fifty
percent of foals. But a study that we did here at UConn, we
did find that only eleven percent of lesson horses had it. So maybe that’s a little reassuring to some
people and we thought that one of the reasons that that study might be a little lower was
that the horses had a lot of turnout on that study and we felt like that might be a reason
that they may have had less ulcers. So toward the end of the presentation we’re
going to talk about some ways to prevent ulcers and that’s definitely going to come up the
management of the horse. It’s a very important way to help to prevent
ulcers. Also, we find that it’s about sixty six percent
in pregnant broodmares and seventy five point nine percent in non-pregnant broodmares. Those are only a couple of studies that have
shown that and they think that diet may have played a role in that that perhaps their diet
not being a lot of forage may have resulted in them having more ulcers because they were
on a fairly high grain diet. And then about thirty seven to fifty three
percent of pleasure horses which are the new thing that we found. So that kind of gives you an idea of how many
horses are likely to affected and whether your horse falls into one of these categories
which may put it at risk. So let’s just talk a little bit about the
stomach anatomy and I just wanted to talk to you about some different regions of the
stomach. And this region here is what we call the non-glandular
region. You’ll also hear it called the squamous epithelium
tissue that this tissue here that lines this region, is called the squamous epithelium. And epithelium is like a lining of a membrane. And then we have here the greater curvature. And we find a lot of ulcers along this greater
curvature region. And this is what we call the margo plicatus,
this dividing line between the non-glandular, or squamous epithelium, and the glandular
region. So the glandular region is the region that
actually secretes, there are no glands present in the stratified squamous region. It has minimal protective mechanisms therefore
and really doesn’t play a functional role in the stomach but it is a place where a lot
of ulcers occur. We can see that this area here, the esophagus
comes into the squamous region. And then here is the margo plicatus, or dividing
line where we do find a lot of ulcers. And this is our glandular region where we
have a lot of hydrochloric acid secretion. And we also have a bicarbonate and mucus layer. Horses are actually continuous acid secretors
so they’re always secreting acid. The squamous region tends to be about five
to seven in the pH so that’s a little bit higher, less acidic, while the glandular region
is usually around two to four. But agin, that can vary quite a bit between
horses. Some horses are more acid secretors than others. Gastric juice itself is usually a pH of about
one to two. And in the stomach there are liquid contents
and these decrease in volume by half about every thirty minutes. And solids decrease about every one point
five hours by half. This is again the pyloric region, still part
of the glandular region, and then it goes out to the duodenum or the small intestine. Also in the stomach we found some bacteria
to be present which includes the lactobacillus bacteria, streptococcus, E. coli, and helicobacter. Helicobacter has been implicated in ulcers
in humans, so we have found that. Okay, let’s just talk a little bit about the
types of ulcers that can occur in your horse. The first type that we have is called primary
squamous ulceration. And this occurs with increased acid exposure
usually due to an alteration in the pH gradient. There is a content stratification in the stomach
so we’ll have different layers like the grain layer on top, then the hay layer, and so on
and so forth. And as I said, acid is continuously secreted
so if we don’t have a lot of meals going on, like infrequent meals or a long delay between
meals, more acid will be exposed because the stomach will empty and then it will be exposed
to a lower pH. And this is the way that primary squamous
ulceration usually occurs. With primary glandular ulceration, acid exposure
will occur due to a failure of the mucosal defenses. So usually the – we talked about how the glandular
layer will secrete mucus as one of the things, and bicarbonate which are kind of protective. But in this case, those mucosal defenses fail. And then the horse ends up being exposed to
this acid so it does not act as a buffer and the horses are exposed to the acid. The other type of ulcer we have that can occur
in hroses is secondary squamous ulceration which is usually due to a pyloric disease. So there’s some problem with that pyloric
area which we saw. This results in delayed gastric emptying. So the stomach will not empty and this will
increase the residual gastric fluid volume so the fluid that is present in the stomach
will then build up and we will get dorsal movement of the acid. Someone asked for us to define ulcer and I’m
going to show you on the very next slide what an ulcer is. So if you look on this slide you can see this
is a nice clean stomach. The epithelium is intact and we have no signs
of hyperemia or hypercaretosis. So this is what a nice clean stomach looks
like. On this layer, we can see that we have these
little tiny ulcers here. We have the – actually here’s an area with
hyperemia – or hypercaretosis, I didn’t show you a clean stomach. This one is a clean stomach right here is
zero. And here the epithelium is intact but we do
have this little area of hyperemia or hypercaretosis. This one we have some pictures of small single
multifocal regions. So you see these little guys right here all
get – I’ll get my my green pointer out again – this is an example of a lesion or an ulcer. So you’ll hear lesion and ulcer kind of used
interchangably by people. Okay, then when we look at this region, that
was a Grade 2 ulcer. Back here we have a Grade 1, these are both
Grade 2, so you can have more than one example of that. And then with Grade 3 we have large, single,
or multifocal lesions. See how many lesions we have showing up here? And these – or we have extensive superficial
lesions in this case. So these are all ulcers that we see here. And then with a Grade 4 from the – this grading
system comes from the Equine Gastric Ulcer Syndrome Council. My major advisor, Dr. Frank Andrews who’s
now at Louisiana State University with others, helped to develop this system. And we can look here and we see a Grade 4
ulcer, you see these extensive lesions and we have deep ulceration. You can see how it’s going deep in tissues
here, see that? Okay. So those are our squamous ulcers. Now let’s go on and look at our glandular
ulcers to see what the difference is between an ulcer in the squamous region and an ulcer
in the glandular region. So here we see this epithelium , the mucosa
is intact (this is a glandular mucosa so it’s going to have a different appearance, more
of a red appearance because it does secrete so it does have a reddish appearance). But again, we have areas of what we call hyperemia
so you can see that here. Okay now when we look at this, you can see
small single or multifocal lesions. So that’s a Grade 2. And then when we look at Grade 3 we have some
large single or multifocal lesions or some extensive superficial lesions like we see
here. And then going to Grade 4, we have extensive
lesions with areas of apparent deep ulceration or mucosal pathology. So something wrong with that mucosa, some
pathologic disease going on. So we see that with these. And again, this system too, this is all part
of the EGUS, Equine Gastric Ulcer Syndrome Council, they’ve actually developed a council
of veterinarians that came together for this particular system. Okay, now we’re going to talk about the causes
of ulceration. The first one we have is diet, especially
the presence of hydrochloric acid which we know helps to lower pH, and volatile fatty
acids. So basically what happens in this case is
that we get a permeability to hydrogen ions. So a lot of times this will happen. For example, if a horse is fed a high starch
meal, we might get a decrease in gastric pH, so that’s one thing that we could see. So I myself have done a lot of studies in
this area. Basically what we found is that carbohydrates
are fermented by the microflora in the gastrointestinal tract. Volatile fatty acids are produced and these
are normally weak acids. They include acids like acetic acid, butyric
acid, propionic acid, and valyric acid. But at a low pH there’s a decrease in the
mucosal barrier function in that non-glandular region of the stomach. And these VFA’s are – have low, have a lipid
solubility, they’re lipid soluble or can penetrate that membrane at a pH less than four. So the VFAs can actually penetrate the cells
in the non-glandular gastric mucosa and that acidifies the cell contents. It inhibits ion transport which is the normal
thing that would occur in the cell and it does cause cellular swelling. So some other researchers, Andrews et. al.,
have found that squamous mucosal cells are susceptible to this VFA injury in a pH dose
and time dependent manor. In other words, they have increased injury
with a lower pH. The higher the dose of the volatile fatty
acid, the greater the damage. And the longer the tissue is exposed, the
greater the damage. Then we have bile acids and the backflow of
duodenal contents is a normal occurrence in horses. They always get kind of like an acid reflux,
as we would call it. And we think some research suggests that refluxed
bile salts may cause gastric ulceration through an increase in non-glandular mucosal cell
permeability to hydrogen ions. But basically that means that the non-glandular
mucosa is able to take up hydrogen ions when this bile reflux occurs. There are some researchers that feel that
this is questionable because they feel that bile salts that are less acidic duodenal reflux
is occuring. So they feel like that would be non-ulcerogenic. So that is a – bile acids are a place where
people can’t really agree on what’s going on with. Bacterial contamination including helicobacter
pylori, as we said in humans – that can, that has definitely been found to be a causitive
agent of ulcers but we really have no conclusive evidence of this in the horse. Although there was a study in which there
was a necropsy, so that’s kind of like an autopsy in humans. We call it necropsy when it’s on animals. Twenty Thoroughbreds were examined for the
presence of heliobacter DNA to see if they had helicobacter present in their stomach
and two out of seven horses with ulcers, four out of five horses that had an inflammation
of the stomach, and five out of six horses with both actually had helicobacter DNA present. So that’s kind of interesting. There was one out of two horses that had normal
mucosa that also had helicobacter DNA present and no one else has really found evidence
of helicobacter being a problem in horses. And people do want to study that more although
there aren’t any studies going on that I know of as of right now. And other bacteria have been implicated in
preventing ulcer healing in the presence of ulcers like E. coli which happened in rats
and impaired healing, and lactobacillus in another species. But again, we don’t really know too much about
exactly how that may be occurring. And then when we look at non-steroidal anti-inflammatory
drugs, you hear about those inducing ulcers in the horse. And this occurs primarily in the glandular
mucosa. Here we’re thinking of things like phenylbutazone
and flunixin meglumine which you may known as Banamine. And really they feel that the way that this
works is it may be due to the effect of prostaglandin inhibition. So these drugs are inhibiting prostaglandin
from being released. So that results in reducing mucosal blood
flow so there’s no blood flow going to the mucosa so therefore there’s decreased mucous
production and increased hydrochloric acid secretion. So normally adequate blood flow would remove
hydrogen ions that would diffuse through the mucosal layer that covers the glandular mucosa
but in this case, that blood flow is not occurring so that may lead to a hypoxia-induced lack
of oxygen cellular acidosis. So the cells turn acidic, they release oxygen-free
radicals, phospholipase, and proteases and these may damage the cell membrane and that
will lead to necrosis or death of the cells. And that results in an ulcer. Another thing that they’ve found as being
a problem in horses is intense exercise in horses. They feel that this causes gastric compression
and acid contents are then moved into the proximal squamous-lined region of the stomach
that we saw and with exercise, and this is called ‘acid-splashing’, and this may also
occur from gastric reflux. They also found that gastric pH decreased
rapidly to less than 4 at the beginning of walking, continued to decrease during trotting
and galloping, and remained low until the horse has returned to a walk. So that’s kind of interesting. The more that they exercise, the more the
gastric pH decreases. So as we – could think about then – horses
in intensive training programs are then exposed to a longer daily duration of exercise so
therefore will get an increased duration of acid exposure and this could lead to acid
ulceration. The fact – let’s see, someone asked “if it’s
true that a horse sheds its stomach lining every other day, so giving it Bute on an every
other day schedule is okay?” I’m not sure exactly how long it take for
a horse to shed its stomach lining. I don’t think that it’s that frequent. But I do know that continuous exposure to
Bute will still cause this problem so it’s when you go for a long term program, we would
have to check with one of our veterinarians to see if they’re recommending an every other
day schedule but as far as I know, most people are recommending that you try to avoid non-steroidals
as much as possible except for when they’re absolutely necessary. And if you do have to give them on a regular
basis, that you consider giving something like Omeprazole or GastroGuard as a – to act
as a buffer so you can help to prevent ulceration from occurring. And we’re going to talk more about that later
on. Okay, next is our causes of Equine Gastric
Ulcers Syndrome. So we talked about this a little – okay, already. The damage occurs when aggressive factors
overpower the defenses of the gastric mucosa as we talked about. We said that squamous mucosal lesions, about
eighty percent of that actually result in increased acids. And glandular mucosal lesions, or twenty percent,
result from impaired mucosal protection. So those are the reasons that we get Equine
Gastric Ulcers Syndrome. I just wanted to share with you some of my
research which is kind of what led me down the path of working with gastric ulceration. As I said, my major professor was Dr. Frank
Andrews and he did a lot of studies with [INAUDIBLE] and the people that made GastroGuard in the
early days of it and we did a lot of ulcer studies and I was interested in looking at
nutrition and how it related to the horse. So we decided to put the horses on two different
diets – we had some cannulated mares which was actually the reason that I ended up going
to the university. We had about seven of them and he brought
me in and said you know, “If you’re not able to do the study, these horses – we may not
be able to keep them anymore.” And I was like horrified, so I was like “Oh
no, I definitely have to go there.” So we did a study and we put these horses
– we could collect gastric juice from their stomachs so we thought “well, let’s try different
diets and see how that affects them.” So we put them on an alfalfa/grain diet. And I have to tell you the truth, originally
I thought that the alfalfa/grain diet was going to be ulcerogenic because it had grain
in it and I thought that’s a highly fermentable carbohydrate so they’re probably going to
get an increase in – a decrease in pH in their stomach and they’re probably going to get
more ulcers. And then we put a bromegrass hay diet as the
other diet because I thought that’s as mild as you can get and we’d feed a lot of maintenance
horses that and they’ll probably get less ulcers. But as you can see, we had an increase in
ulceration when we fed the bromegrass hay diet. So you can see here that we had more lesion
numbers when we fed the bromegrass hay diet than we did with the alfalfa/grain diet. And another thing we found was that the ulcers
were more severe on the bromegrass hay diet than the alfalfa/grain diet. So that was kind of interesting because, you
know, we had no change in glandular lesions at all which I guess would make sense after
what we’ve learned today that those are really aren’t impacted by diet. But this was funny – so we were like “Why
did this happen? Why did the alfalfa/grain diet produce more
ulcers?” And the only thing that we could come up with
was that it must be that alfalfa acted as a buffer because it does have high protein
and high calcium and so we felt that that buffered the pH and helped prevent ulcers. And actually just recently I was, you know,
reading through some literature and I saw that someone had repeated my study which I
think that’s like a nice compliment when you see someone repeat your study or like, “Wow,
they’re really wondering if my study was authentic.” And it turned out that they confirmed my study
that alfalfa did help prevent ulcers in this study of horses that they conducted. So I felt really good about that; I was like,
“Good, my study wasn’t just, you know, something that happened once. It’s truly alfalfa does act as a buffer and
helps to raise the pH of the stomach and prevent ulcers.” So that’s kind of interesting. Okay, this is another study that I did. So – well, this is part of that, this study
in a way because when we did it, we found that certain volatile fatty acids, acetic
acid, propionic, butyric acid especially, helped to – their presence was an increased
risk factor for gastric ulceration. And the way we think this is happening if
that VFAs with a high lipid solubility and an ability to remain unassociated at a low
pH leads to cell acidification and damage to sodium transport leading to cell swelling
and necrosis and ulceration. And how did we find this out? Well, we did another study for my doctoral
degree in which we took gastric tissue from horses that had, unfortunately, had passed
away and we got it as soon as they were deceased. And we put it into something called a Ussings
chamber where we can put physiological pHs into the – bubble it through a chamber with
oxygen and keep the tissue alive for many hours and we subjected it to different levels
of volatile fatty acids and we found that this happened, that they had a high lipid
solubility, they were able to remain undissociated and they did cause cell acidification when
we looked at it on histology and cell swelling and necrosis and ulceration. So that was pretty interesting to find that
that was true. Okay, so now you’re probably wondering how
am I going to know if my horse is at risk for gastric ulceration? So the way that we can talk about some different
risk factors that different researchers have found to be risk factors for gastric ulceration. So the first one is age. Some felt – some studies have shown that risk
was highest in younger horses. My grad student for example found that the
risk was higher in horses aged two to six years. So maybe the stress of training is stressing
them. But some other studies show that the risk
of ulcers increased by age. There were racehorses in training so they
really reflected only a particular age range and use of horses – the study where they increased
by age. Whereas our study was young horses all the
way to about twenty year olds. So that’s kind of interesting to, you know
– really, I guess the jury is still out on that. And then also there’s really nothing specific
about breed. We did look at that in our study and we found
no breed differences and we did find that mares had more ulcers. And then a study performed on leisure horses
really showed no association between age and risk of ages. So really age in that study wasn’t conclusive. So again, the jury is kind of out on age and
whether that’s a factor and as far as breed and sex go, that study also found no association
between that. So I think really people, you know, we can’t
say that Arabians are more prone or this horse is more prone – no one really knows that now. So the jury is still out on age, breed and
gender but I bring it up because it comes up in a lot of studies that people wonder
about that. Okay, next is exercise. And this is definitely been shown to be one
of the most important risk factors. They – one study showed that horses in light
to heavy training for as short as eight days may be at risk for developing gastric ulcers. And a study in Australia suggested that prevalence
in racehorses increased 1.7 times for every week of training, so that’s definitely happening. And in an earlier study horses running on
a high speed treadmill had increased abdominal pressure and decreased stomach volume and
this is where they got the idea of the ‘acid splashing’ hypothesis. But again, with pleasure and leisure horses
in Denmark, there was no apparent effect of workload on the risk of EGUS although none
of these horses were racehorses. And even if they were used for equestrian
training and competition including dressage or show jumping, the level of workload was
less than that of a typical racehorse. So it may be that only strenuous exercise
results in acid injury of non-glandular mucosa. But at least in this particular study, an
alternative explanation could be the association between workload and starch intake. Since racehorses typically receive increased
amounts of starch in association with an increased workload. But competition horses in the Danish study
tended to be fed more meals but less starch because they use high quality forage and prepared
commercial feeds that typically had less starch than the cheaper straight grains fed to those
animals not in work. So the thing about that is really to take
home is that all types of work don’t necessarily increase the risk of gastric ulcers. But heavy training may put a horse more at
risk for ulcers. Okay, next we have fasting and when feed is
withheld from horses before racing or due to the feeding regimen, gastric pH will drop
rapidly and the non-glandular mucosa is definitely exposed to an acid environment. Another thing is that some researchers have
used intermittent feed – like feeding horses on and off a feed/fast model. And those can cause and increase the severity
of gastric ulcers. So they’ll alternate twenty four hour periods
of feed deprivation and then ad libitum access to hay for a total of ninety six hours of
feed deprivation and this results in ulcers in this study. This is mainly thought to be due to the lack
of mucosal protective factors in this case. Okay, the next one is pasture turnout. Grazing horses in general do appear to have
a decreased prevalence of Equine Gastric Ulcer Syndrome. Due to a continuous flow of saliva and digesta,
the stomach acid is then buffered when the horse is continuously grazing and it will
have a pH greater than or equal to four or more for a large portion of the day. So that’s why we think that grazing is so
beneficial. In Thoroughbred races and training horses
with access to some turnout were actually less likely to have ulceration and this was
actually even lower if they were turned out with other horses. Pasture turnout is actually considered to
be advantageous in many reviews but there was one study of sixty two broodmares – thirty
three pregnant and twenty nine not pregnant that were kept under similar management pasture
although no details on the feeding program were given. And there was a relatively high prevalence
of about sixty seven percent in the pregnant mares and about seventy six percent in the
non-pregnant mares. So we think that it may be possible that dietary
management may be involved in this study. We haven’t really been able to do – this was
a study in Japan and unfortunately we’ve been unable to communicate with them. Additionally, there was no effect on intergastric
pH of horses that were housed on a grass paddock, a stall on their own, or in a stall with an
adjacent companion when they were fed ad libitum grass hay and grain twice a day. So that had no effect. So housing may not affect gastric pH and being
in a paddock itself may not provide any benefit. It may be that the actual eating of the grass
is what provides the benefit. And another thing is that with that study
there’s really no information on the amount of starch given to each horse per day because,
as we talked about a high intake of starch enhances the influence of low pH by reducing
that mucosal integrity in the squamous mucosa. So that brings us to starch intake and as
I was saying in my study, you know, we had thought that grain would be a problem and
starch and grain intake has been associated with an increased risk of Equine Gastric Ulcer
Syndrome in animals working at various levels of intensity. In 2005 a study found that there was an increase,
a marked increase in ulceration when non-exercising animals were stabled and fed grain at one
percent of body weight, about 3.7 to 5.1 kilograms of grain per horse per day one hour before
hay was fed. Which is another reason we like you to feed
the hay before the grain. And this diet was designed to provide one
and a half times the digestible energy requirement for maintenance. So in this study, exceeding two grams per
kilogram of body weight of starch per day was associated with approximately two fold
increase in the likelihood of gastric ulcers. Severity greater than or equal to two out
of five and feeding more than one gram per kilogram of body weight of starch per meal
was associated with a 2.6 times increase in the likelihood of a gastric ulcer score greater
than or equal to two in the non-glandular part of the stomach. So starch in this case was independent of
workload and increased level of work was not associated with increased risk so it was felt
that the influence of starch on gastric ulcers was significant. So we’ll find more starch in things like grains
and also in our pastures sometimes, our starches and sugars will be high at the beginning of
the season with our pastures when they’re rich and lush. And that will have an effect greatest on the
non-glandular mucosa. So again, this is the penetration of volatile
fatty acids produced by the gastric bacterial fermentation of starch and this results in
decreased mucosal barrier function. So feeding a lot of starch can definitely
be a problem. So that’s why we want to always maximize forage
in the horse’s diet. If you think about how a horse evolved in
the wild, wild horses were always grazing and moving from place to place, so as much
as we can simulate that natural environment that they had – that’s what their stomach
was evolved to handle. And as much as we can do that, that’s what’s
going to work out the best for our horses. Another study found that there was development
of ulcers in all horses within fourteen days of their removal from pasture, stabling with
six kilograms of concentrate feed per day, and entering a simulated training regimen. And there was another study where dams were
supplied with concentrate feed and foals were allowed to eat their dam’s feed and when more
concentrate was fed to the mares, lesions in the squamous mucosa were more prevalent
and more severe in those foals. Another study found that small low starch
meals empty from the stomach significantly faster than large high starch meals. So that may be another reason that this ulceration
is occurring because we’re getting emptying and then the stomach is empty and these volatile
fatty acids are then able to penetrate. So on a percentage basis, low starch meals
emptied significantly faster than higher starch meals and large high starch meals emptied
the slowest. But when we compare meals of unequal size,
large high starch meals emptied significantly faster. So meal size as well as composition may actually
effect gastric emptying. And then when we think about it also cereals
tend to be low in calcium and possibly other potential buffering agents so this may also
increase the risk of ulceration. So looking at forage feeding now and type
of forage, when fed hay and pasture horses produced about 400 to 480 grams of saliva
per hundred grams of dry matter consumed versus when a concentrate is fed, they produce about
half of that – 206 grams of saliva per one hundred grams of dry matter consumed. And we know that forage consumption, if you
think about trying to eat hay, it does stimulate saliva production. So saliva produced in sufficient quantities
will contribute to buffering gastric acid and it will actually help to coat the squamous
mucosal tissue. And without this, damage may occur and ulcers
may develop. So we feel that free access to fibrous feed
like grass or digestible forage or frequent forage feeding may actually reduce the risk
of gastric ulceration. So that’s another risk factor, would not be
feeding that – so feeding less forage. Feeding alfalfa hay/grain results in higher
gastric pH and less peptic injury to the gastric squamous mucosa than feeding bromegrass hay
or costal bermuda hay with no grain – that was that repeated study I was telling you
about. So forage type may also be important. Actually straw may provide low levels of buffering
support because it has low protein and calcium and it may result in mucosal irritation so
we don’t recommend feeding straw or bedding with straw if horses are not going to be fed
sufficient forage that they’ll begin eating the straw. Also, time between forage meals greater than
six hours compared with more frequent forage feeding with intervals less than six hours
also increase the likelihood of non-glandular ulcers. So you really want to keep time between forage
less because as you increase that time between forage, you’re taking a risk of more gastric
ulcers from occurring. And then water intake. I remember visiting a farm in the summer,
I was looking at it from an environmental awareness program that I was doing and the
guy – I asked the guy, “Do you have trouble getting them to come in from the pasture?” He was like, “Oh, I find it very easy to catch
them because I don’t give them any water during the day.” And I was like, “Oh, no!” So providing water continuously especially
in a pasture situation, and really any situation can also help reduce the risk of EGUS or Equine
Gastric Ulcer Syndrome in horses. Horses without access to water in their paddock
were more likely to have Equine Gastric Ulcer Syndrome greater than or equal to two. So horses really need to have water provided. So you really have to make sure that they
have water intake because this may result in dilution of gastric fluid and increased
pH and help prevent ulcers. So horses without water provided have more
than 2.5 times the risk of getting gastric ulcers. Okay, someone heard that you should feed about
a half pound of grass hay before taking a horse out for training to help keep the pH
of the stomach more natural during training exercise. Okay, I would say to you we’re going to talk
about recommendations at the end but, you know, really what we’re saying is before exercise,
you know, you don’t want to feed a big grain meal and you can continue to give them hay. Bur if they’re going to be racing or something
like that, you don’t want to give too much feed. So we say to give forage up to about three
hours prior to a heavy workout or race. So if it’s going to be, you know, a heavy
workout or a race, then we want to wait and don’t give it within three hours of the workout
or race. So if it’s going to be, you know, a heavy
workout or a race, then we want to wait and don’t give it within three hours of the workout
or race. But after that, you can again offer forage
and then don’t feed concentrates until at least two hours after exercise. Okay, I hope that helps. Okay, next is our non-steroidal anti-inflammatory
drugs and they’re a risk factor. Okay, so we did find that after – basically
there’s been an association between gastric ulcers – well, basically non-steroidal drugs
have long been implicated in causing gastric ulcers in horses. But evidence of an association between gastric
ulceration and administration is kind of lacking in the literature. One thing that they found was there was a
difference in blood protein albumin and globulin which is part of the immune system between
control horses and horses treated with phenylbutazone alone. Basically after treatment with phenylbutazone
alone, three out of four horses had no non-glandular ulceration while one of the horses had a non-glandular
ulcer score of grade two out of four. When they were treated with phenylbutazone
and Flunixin Meglumine, two horses had a non-glandular ulcer score of grade two out of four, one
had a non-glandular ulcer score of three out of four, and the horse that had a non-glandular
ulcer of two after treatment of phenylbutazone alone had a non-glandular ulcer score of grade
four out of four. So this indicates that using a combination
non-steroidal to treat horses should be approached with caution because this may result in negative
effects. We know that horses have individual responses
and variability in what is an acceptable strength and length of time to be on a traditional
non-steroidal treatment. Horses that are at risk of developing ulcers
either with a clinical symptoms already showing or previous history of ulcer disease should
receive prophylactic administration of anti-ulcer medication. So preventative administration or you could
use the new cox ones bearing non-steroidal drugs like [INAUDIBLE] and those are less
toxic to the equine gastrointestinal tract compared to the more non-selective non-steroidals
like phenylbutazone. So it really varies on whether or not non-steroidals
affect the horse. I mean, for sure a combination has caused
ulcers and people always say that it does but there is individual variability so your
veterinarian should always be consulted about that. Okay, let’s talk about some clinical signs
now that we can find with the ulcers. So how do I know if my horse has an ulcer? One would be acute and recurrent colic. So we know that colic is really any type of
abdominal pain. The horse will look at its sides, may paw,
it may kick at its side, it will appear to be in discomfort and so cases of acute or
it suddenly occurred or recurrent where the horse keeps on having colic, this can be a
sign of a gastric ulcer. Another would be a poor body condition. So I don’t know if you’re familiar with body
condition scoring, if you’re not you might want to check out our website, That tells you how to do body condition scoring
and that will help you figure out what a good body condition score would be about five – the
scale is one to nine. One would be very poor and nine would be,
you know, the horse is extremely overweight. So you might want to get familiar with that
system so that you could use that on a monthly basis to body condition score your horse and
then you will know when your horse is in poor body condition. Another would be poor appetite. Horses are usually very good eaters so when
they are not eating well, that is usually a sign that something is wrong. Also, a variable appetite like one day eating
well and another day not or slowed eating, that can be another sign. We also may see weight loss or the inability
to maintain or gain condition, that’s another sign. Poor grinding of teeth is another sign and
a very common gastric ulcer sign so the horse will keep on grinding its teeth. Some other signs that we can see, kind of
more less specific I guess would be poor performance. And then attitude changes so your sweet natured
horse suddenly becomes evil when you go to tack it up. So that could be another sign that, you know,
besides saddle pain that the horse is experiencing an ulcer. Or just in general, its general outlook has
changed to a not as good attitude as it had before. Diarrhea can be another sign, so can stretching
to urinate, and dorsal recumbency in foals. That’s when they lay on their back with their
feet in the air so that’s dorsal recumbency. So those are all signs of a gastric ulcer. So the true way to make a diagnosis is really
to do what we call an endoscopy. So in the endoscopy you’ll see this tube up
here that we can see and this is an endoscope and we’ll put this tube down through the horse’s
nostril and it will go down through their trachea and into their stomach and on our
way down we can look at the trachea and see if there’s anything abnormal, look at the
larynx and the arytenoid cartilages. The horse will be under sedation during this
but it will be standing. You can also do it recumbent; a horse can
lay down while you’re doing it but it’s a little more difficult a lot of time to see
inside the stomach when you do this. And you do need to fast the horse for at least
twelve hours in order to get a good visualization of the stomach. And down here we can see a picture of what
we would see, we’d have like a little TV screen – this is the tube here going through into
the stomach and this is part of the stomach that we can see there. So that will help us to look along the margo
plicatus, greater and lesser curvature all along the squamous and glandular epithelium,
we can go all the way to the pylorus and the esophagus and we can visualize the stomach. Okay, so now we’ll talk a little bit about
medical management of gastric ulcers. So one would be antacids. So a lot of people want to use antacids much
like they would take a Tums because they have an upset stomach. So in horses antacids that are commonly used
would include aluminum hydroxide, magnesium hydroxide. These have a moderate effect, they’re kind
of short lived. They have a very short lived effect on pH,
it usually only lasts for about three hours at the maximum. So that’s kind of the problem with using antacids
as medical management. So that’s one reason that we don’t really
recommend them because you would have to give them so frequently that it really wouldn’t
be effective. Okay, next we have histamine type 2 receptor
antagonists. Some examples of these are Cimetidine and
Ranitidine and basically in the horse’s stomach a histamine receptor is part of what acts
to release gastric acid and what these receptor antagonists do is bind to that receptor and
prevent gastric acid from being released. So these really have poor bioavailability
after oral administration. Now what that means is that the body’s really
not able to use it after it’s given orally. So it has to be given about every six to eight
hours and it does have a poor ability found in studies to produce ulcer healing. So that is one of the problems with using
histamine type 2 receptor antagonists. They can still be used in combination with
some other things sometimes. And then we have omeprazole or GastroGuard. And this has been shown to be an effective
treatment for gastric ulcer syndrome and usually at a dose of four milligrams per kilogram
orally once daily. And usually treatment for about twenty eight
days results in a ninety two percent improvement and about seventy eighty percent healing. So that’s really pretty good. And we can use a lower dose, about two milligrams
per kilogram every twenty four hours to prevent recurrence. So that is something – so basically what happens
with our omeprazole is it is a proton pump inhibitor so it binds irreversibly to the
parietal cells, H+, K+, ATPase which is a proton pump. So it basically keeps hydrochloric acid from
being secreted. And it can block acid secretion for about
twenty four hours in horses. And you want to make sure that you’re using
an equine specific pH stable form of omeprazole since use of the human form has poor bioavailability
– only about sixteen percent is available to the horse. And the duration of acid suppression of the
human form is only about twelve hours versus twenty four, so that’s not too good. You also have to be careful about buying some
compounded products. There was one study that showed that compounded
omeprazole was not effective. You can get a generic – I’m not sure about
generic omeprazole being available right now. I don’t think that it is but you could always
check with your veterinarian to see about that. I believe it might still be under its preliminary
stage where it’s not available as a generic but you could check about that. As far as coating or binding agents, we have
Sucralfate and bismuth subsalicylate – I can’t talk today. Basically what these do is they bind to the
stomach ulcers and promote healing. Used alone, they’re not really effective but
they may promote healing if they’re used in combination with omeprazole, especially for
glandular ulcers. And sucralfate is basically a hydroxyl aluminum
salt of sucrose octasulfate and it binds to the negatively charged particles in the ulcer
bed and helps to buffer hydrochloric acid by increasing bicarbonate secretion and stimulating
prostaglandin production. It usually – used in combination with other
drugs, it’s effective for about eight to twelve hours. And bismuth has a coating effect similar to
sucralfate and it will inhibit or reduce the activation of pepsin. In humans it’s actually used as part of the
therapy of helicobacter pylori-induced ulcers, so we can see that. Various feed supplements to treat or prevent
gastric ulcers are available but only a few have been tested in controlled clinical studies. And a study of a pectin-lesothin complex called
Pronutrin on gastric ulcer healing during an eleven day period in two twelve horse groups
showed a significant reduction in gastric mucosal lesions. So that could have a beneficial effect on
the healing of gastric ulcers so that’s called Pronutrin. Okay, now we will go on to our prevention
and management segment and one of our persons said that they had seen their horse have a
positive difference in attitude and performance when they changed to a low starch diet feed,
but they had him endoscoped for ulcers and he was clean. So they were wondering if it was lucky or
just good management in general for this horse with a high performance sport. And, you know, it’s hard to say whether that
was just lucky or – but it really is just good management in general to have, to feed
as low a starch feed as you can and still give the horse sufficient energy that it needs
to perform as it can. So again, as much as we can mimic the horse’s
natural diet – feeding the highest amount of forage that we can but still making sure
we meet the energy demands and maybe now that is by feeding more fat because fat has actually
been found to be beneficial and has not caused ulcers although it’s not less ulcerogenic. There was one study that looked at that and
did not find fat to be less ulcerogenic but there haven’t been a lot of studies on fat
preventing ulcers so we don’t really know, jury’s kind of out on that. But definitely feeding the lower starch feed
if you can and feeding more forage would be a good practice as much as you can. But again, you don’t want to skimp on energy
so that your horse ends up losing condition. So that’s why we do want to keep up with body
condition scoring so that we can make sure that our horse is maintaining the condition
that it needs to be healthy which would be about body condition score of about five. It’s going to depend some – my colleague likes
to see horses more at a six which is maybe a little bit overweight and another one of
my colleagues likes to see it at a four. So, you know, endurance horses are kept at
a four, most polo horses are a four. So it kind of does depend – beauty really
is in the eye of the beholder I think in a lot of these cases. But again, checking with your veterinarian
is always good to see what he thinks your particular horse should be maintained at. Okay, now for our continued talk on prevention
and management. We want to feed as much roughage as possible
and at least one to one point five kilograms per one hundred kilograms of body weight. So really we want to make sure that their
diet is at least seventy five percent roughage, especially if they’re prone to gastric ulcerations. So you can weigh your horse or use a weight
tape to get the weight of your horse and then you want to feed at least one to one point
five kilograms of forage per hundred kilograms of their body weight. And you can convert to pounds – there’s two
point two pounds in a kilogram. So we can just do the math on that. And also if we can give a high protein or
high calcium forage especially in the case of those horses that may be prone to ulceration
so this may help to prevent them from getting it. So this may be a combination of alfalfa and
grass hay and I know that our friends out in California don’t like to feed too much
alfalfa because they feel that it leads to the horses getting enteroliths or those intestinal
stones. So, you know, you would want to do what is
right for your horse so if you’re afraid of alfalfa, maybe just making sure they have
plenty of grass hay. So that’s another way that you could deal
with it. And then we want to avoid feeding sweet feeds
as much as possible especially for those horses that are prone to ulceration – that are at
risk for ulceration or that have already been found to have ulceration. So we want to feed less than one gram of starch
per kilogram of body weight per meal and less than two grams per kilogram of body weight
per day. So again, we would figure out how much grain
we should feed and then we would want to keep our starch as low as we could and still meet
the energy demands of the horse, so perhaps by supplementing with fat or something of
that sort. If giving concentrates we would want to feed
them more frequently. I always tell my students never to feed horses
more than five pounds at any one meal. So feeding more frequent meals is going to
help to keep that stomach full with contents, we’re going to feed hay always with our concentrates
and feed hay before our grain because that’s going to help to buffer the stomach and then
we can feed our concentrates and we do wan to feed more frequent meals rather than a
large concentrate meal at once. That will also help with preventing other
diseases as well. And then providing pasture turnout whenever
possible or frequent forage. Let’s face it, pasture turnout really can’t
hurt them although I guess they could get into a tiff with another horse or something
but providing pasture turnout really simulates the most of what they are used to, what they
have evolved from. And even though our horses are domesticated,
they really haven’t changed all that much in their needs. So providing pasture turnout whenever possible
or frequent forage feeding hay as much as you can, four to six meals a day, or having
hay in front of them ad libitum. Those would be the best for your horse. Oh, and then we have a person who asked us,
“Would a high quality grass hay have a more buffering capacity than a low quality grass
hay?” And that’s definitely true. A hay that has protein of twelve to fourteen
percent should theoretically have more buffering capacity than a low quality grass hay protein
of six to eight percent. So for sure you could get your hay tested
to see what the protein level was and then try to feed as high a protein level – I mean,
you don’t want to go too crazy with protein because it secretes nitrogen and things into
the environment but if your horse is predisposed to ulcers, than feeding a higher protein hay
would be better. Another thing that we spoke about was providing
fresh clean water continuously. Really we should do this no matter what. You know, I always talk to me students about
what the most important nutrient is and they think of a million things but they never think
of water. And you know, just a twelve to fifteen percent
loss of water can actually be fatal so not feeding water can be really bad for the horse. It’s really needed for every metabolic activity
that takes place in the body. And I guess I you know, kind of did not think
a lot about it either. My parents were always impressing on me when
I worked at different stables to make sure that I provided water. But one time I was working at the stable and
while I was away no one watered the ram for about a week while I was off looking at colleges. And when I came back the ram was dead and
he had gotten dehydrated and died. So that impressed on me the fact that, you
know we take water for granted but it’s really key. Someone has asked about research on hindgut
ulcers. There is some research on that area. I myself am not a specialist in that area. Anthony Blikslager is a good resource for
that if you wanted to Google him. I could type his name in here right now for
you to see. But he does a lot with colonic ulcers.Okay,
there you go. And whenever possible we want to avoid stressful
situations with horses especially those prone to ulceration so long distance travel would
be one, changing in environments, long periods of confinement where they’re confined to a
stall, and avoid leaving horses more than six hours without forage during transports. So if we are transporting them, stop at least
every, you know, less than every six hours and provide them with some forage and some
water as well. So we do want to make sure that we do that. And we can also consider giving anti-ulcer
medicine before transport either if we have a horse that we think maybe at risk for ulcers
or already has had an ulcer. That might be good preventative medicine. Okay, and then we want to use the minimal
effective dose for non-steroidals and we may want to treat simultaneously with anti-ulcer
medication. And then we can talk a little bit about racehorses
prior to racing they should be given their normal ration. We can give forage up to three hours prior
to a heavy duty workout or race and we don’t want to feed hay or concentrates within three
hours of their workout or race. After, again, we can offer forages but not
feed concentrates until at least two hours after exercise and water can be offered free
choice after exercise but initially we should have them drink it slowly. So really the best thing to think about with
ulcers is trying to prevent them and just giving medication alone is really not going
to change whether a horse gets an ulcer or not. Like you may treat that particular ulcer but
by not changing your management it may be that the horse will get an ulcer again later
after this one heals. So the key when a horse gets an ulcer is to
look at your management and see how you – I mean it may be that you’re doing everything
right. Some horses may be just more predisposed to
ulcers than others. They’re continuous gastric acid secretors,
some secrete more acid than others so that can predispose them. So just do take a hard look at your management
and say is there anything I can do differently that will prevent this in the future because
that can be a really important thing. So we know that gastric ulcers have many causes,
it’s very multifactorial. There’s also a long list of potential risk
factors that we’ve gone over here tonight. And it is important to evaluate the horse’s
diet and daily management to prevent them because as I said, just the medical management
alone isn’t going to keep them from recurring. So by following these recommendations it may
be possible to prevent or reduce the risk of gastric ulceration. But feeding and management practices must
change to prevent recurrence and these are some resources that I have used tonight which
may be of help to you. And I know that we’re going to be archiving
this webcast and I would just like to acknowledge my coauthor Nanna Luthersson who helped me
write a recent chapter on gastric ulcers, Dr. Frank Andrews who was my mentor and was
on the Equine Gastric Ulcer Syndrome Council, and Richard Hepburn who wrote a great article
in March in Equine Practice on gastric ulcers. And then if anyone’s local, I just wanted
to mention some upcoming events at UConn so that would include our trailer driving clinic
which is – oops, just trying to figure it out here – it’s nine to twelve on Saturday
March twenty sixth and we have a natural horsemanship clinic that same day, one to four. And spring clinic with Deb Monahan on Sunday. And then we have our Sigma Alpha Open Horse
Show coming up on April third and a HorsePlay lecture at UConn – op, here we go. [AMANDA BODLE] I think we’re both clicking
the arrows, you have to use the arrows at the bottom to get here. [JENIFER NADEAU] Oh, okay. Oh, you got it ? Okay. Okay, and then we have our Riding Camp Safety
Certification Clinic on June eleventh and our Summer Riding Program which is open to
the public. So if you do have any questions, then do feel
free to email me and I will try to answer you as much as I can. And one participant has asked me, “How do
I feel about free choice grass hay?” I think it’s an excellent idea and I think
it definitely will help buffer your stomach, your horse’s stomach. So I do say that would be great if you can
do free choice grass hay. Okay, thank you very much! You’re going to receive a survey by email
in one to two days so if you could a few minutes to give us your feedback it will help Michigan
State University and the rest of us to better serve you. And there is an upcoming webcast on April
nineteenth at eastern daylight time, Understanding and Evaluating the Gaited Horse. So thank you very much for attending and,
let’s see – a person just talked about a website that has omeprazole 700mg tablets, entericoated
better priced than paste. I think you should check with your veterinarian
to see how he feels about it. So why don’t you check with him about feeding
those tablets. Okay, thanks everyone for attending and I’ll
stay on to answer any questions for the next little bit here. Thank you very much! [AMANDA BODLE] Okay, thank you so much for
your presentation. And I want to thank all of you for participating
and if you want to go ahead and type questions in the chat box that’s okay, I just wanted
to take a minute to say thank you and let you know that, again, this webcast was recorded
and will be uploaded to our website by the end of the week and you can send us your comments
and suggestions to [email protected] and you can also become our fan on Facebook
or follow us on Twitter for more up-to-date information about upcoming events, special
promotions and more. And thanks again; have a great night!

1 Comment

  1. My horse is on full pasture. She carries a loss stool but seems to be in great shape. Is this a worry she not a cow ha ha.

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