By Matt Witzel, DVM
Does your horse have an attitude problem? Maybe you’ve seen a decrease in its athletic abilities? Have you seen multiple colic episodes in the past few years? Does your horse seem to get nervous or worked up easily? These are some questions I often ask that may lead us to investigate the likelihood of stomach ulcers in horses. Unfortunately, ulcers are one of the most under-diagnosed problems in horses which can lead to a huge variety of problems. Sure, in the worst cases we see horses not wanting to eat or colic as a result of stomach pain, but there are thousands of horses out there right now who are suffering while only showing subtle hints of ulcers. These may include:
- attitude change/grumpy behavior
- decrease in performance
- weight loss
- splashing in water bucket
- picky appetite
- being “girthy/cinchy”
- being unwilling to perform tasks that were previously not a problem
- any recurrent colic episodes
It would be easy to overlook these signs unless you know what to look for and what they might mean!
Some horses are at a higher risk of developing stomach ulcers than others. Ulcers are often diagnosed in horses in training or competition, horses that travel often, horses in boarding facilities where stablemates are frequently changing, or even horses that naturally have a more nervous demeanor. Diet and habits can also play a role in the development of gastric ulceration. For instance, horses that are on pasture are typically at a lower risk than horses fed twice daily in a stall or paddock. Highly concentrated grain or high sugar content in feed can increase the acidity in the stomach which can lead to ulceration. Cribbing or wind-sucking is a behavior commonly associated with ulcers in the stomach as well.
Why are stomach ulcers in equines so common? The answer is simple: Horses produce stomach acid 24 hours a day. This is unlike humans and most other mammals which only produce acid at meal time. Horses were designed to graze all day long so as they eat, the saliva produced and the feed material ingested act as buffers against stomach acid to prevent damage to the stomach lining. So long as grazing is not repressed, the need for a meal-driven acid production system is unnecessary. But then humans come along, put them in a pen, only feed them twice daily, and the horse’s stomach acid sits in an empty belly the rest of the day wreaking havoc on the stomach’s epithelial lining!
Another reason horses are more prone to stomach ulcers is because half of the equine stomach is lined with squamous epithelium, or an unprotected type of tissue that is highly susceptible to acidic damage or ulceration. Humans, dogs, cats, and other mammals have a stomach entirely lined with glandular epithelium that will secrete a substance which protects against acid. This doesn’t mean the glandular part of the equin stomach cannot be ulcerated, but it makes it harder.
Having two different types of tissue potentially ulcerated also makes treating gastric ulcers in horses more challenging. It was once only known as Equine Gastric Ulcer Syndrome or EGUS. As our understanding of the causation and treatment response to ulcers in different regions of the stomach has advanced, we have further divided gastric ulcers into two separate diseases: Equine Squamous Gastric Disease (ESGD) and Equine Glandular Gastric Disease (EGGD). Unfortunately, the treatments required for ESGD and EGGD are different making it imperative to know which disease process is present in order to avoid a misdiagnosis and incorrect treatment.
Diagnosis of gastric ulcers in horses can only be confirmed through the use of a gastroscope, or a camera on the end of a 2.5-3 meter flexible tube. The gastroscope is passed into the stomach through the horse’s nostril to examine the esophagus, both the squamous and glandular epithelium of the stomach, and the duodenum, or the first part of the small intestines which the stomach empties into. Performing a complete gastroscopic exam can be difficult at times, especially in acquiring adequate views of all parts of the stomach. However, until ALL areas of the stomach have been examined, EGSD and EGGD cannot be ruled out as a possible cause of discomfort in your horse.
After having a gastroscopic exam, if the horse is diagnosed with squamous ulcers, the best therapy is 4 weeks or more of omeprazole, or GastroGard. However, GastroGard alone will often fail to heal ulcers in the glandular part of the stomach. Most often the horse will need to be placed on a medication called sucralfate along with Gastrogard to give the horse a fighting chance of getting better. Occasionally, horses will also need to be placed on other gastrotherapeutic medications such as ranitidine or misoprostol to help some of the more stubborn ulcers heal up.
As you have probably guessed by now, some ulcers heal relatively quickly while others (usually the glandular ulcers) can be extremely difficult to treat. Considering that treatment of these gastric diseases can be very costly and frustrating, here are a few things you can do to help prevent your horse from suffering from these potentially debilitating diseases:
- Minimize your horse’s stress by reducing travel as much as possible and changing stablemates as infrequently as possible
- Increase meal frequency– ideally allowing pasture time for the horse but if that is not possible split their total feed amount into as many meals as possible throughout the day; Slow feeders can be very useful to prolong the feeding period during the day
- Avoid exercising your horse on an empty stomach which would allow the stomach acid to splash up to the more sensitive squamous region of the stomach
- Feed adequate amounts of roughage, or hay, and avoid high carbohydrate feeds
- Prevent cribbing by your horse as much as possible
- Consider gastric supplements which often include probiotics to increase the overall health of your horse’s gastrointestinal tract
Lastly, it is important to note that if you have any question or suspicion that your horse may be suffering from ulcers, please speak with your veterinarian about it as soon as possible. Ulcers are always easier and less expensive to treat if they are caught early. If ulcers are left untreated, it is possible for horses to colic as a result and, although much less commonly, pass away from that same colic episode. So please pay attention to the subtle warning signs your horse might be giving you and as always feel free to call Western Montana Equine if you have any questions or concerns regarding your horse.