“When I see a grade 1 gastric ulcer syndrome, I’ll often see a yellow-green coating over the nonglandular portion of the stomach mucosa and that hyperkeratosis is the body’s biological BAND-AID® trying to heal the insult. This is because 65% of ulcer suffering horses have both gastric & hindgut ulcers. Is it the horse’s diet, environment, training schedule or something else?” By simply treating the horse without uncovering the root cause of its ulcerations, the horse could be destined for recurrence and a cyclical use of medications that may not impact the real issue. The acids may burn a crater deeply enough to cause bleeding or even burn through and penetrate the gut. Equine Gastric Ulcer Syndrome (EGUS) frequently referred to as gastric ulcers in horses is a common problem among domesticated horses. Grain meals should also be limited and fed only once to twice daily at the most. Veterinary medicine is witnessing significant leaps in areas including the impact of NSAIDS, the critical role of diet, the influence of advanced nutrition and the tie between equine gastric ulcers and the horse’s gut microbiome. Dr. Whitfield’s research demonstrates that advanced nutrition can play a role in supporting a normal, healthy gut environment in horses undergoing NSAID therapy. Next, their focus landed on the impact of NSAIDs on the gut microbiota since this class of medications is well-known in human medicine to cause dysbiosis or alter the delicate balance of bacteria within the gut. When do we stop the medication and what medication would we use?’” Diagnosis is quite literally a guessing game in the absence of gastroscopy. If we don’t keep the gastrointestinal tract intact, we’re going to have to fight longer and harder with our medications than if we had thoroughly thought through the preventive steps,” says Dr. Davis as an example of his approach. “I don’t want to be months down the road looking at grade 4 ulcers thinking that I should have paid more attention to the details sooner. “We don’t actually have to do gastroscopy as often in a lot of our barns today because of the daily management changes we recommend. “Often what we’ll see, especially in these performance horses, is after they eat, they’ll get painful. “The medications we use to treat EGUS try to alter and control the environment in the stomach so that the equine body can heal those ulcerations on its own.” These therapeutics can include both proton pump inhibitors and H2‐receptor antagonists. Foals are also subject to ulcers and it is well known they can cause morbitity and mortality (Becht and Beyers). This seems to work for us. Ulcers in horses are periods of inflammation of the lining of the stomach. “Horses with a history of EGUS should be fed grain and concentrates as sparingly as possible. I know that these horses want to perform, and it’s my job to give them the best chance to perform at their highest level. How do we know exactly what condition is going on? “The gastrointestinal tract is a massive immune system organ,” states Dr. Davis. We have also learned that whether we’re talking about equine or human competitors, when we ignore the critical role of the gut in overall health and performance, we’re often faced with negative results. Equine Gastric Ulcer Syndrome, also known as EGUS, is a broad term used in equine veterinary medicine to describe ulcerative and erosive diseases of the stomach. All issues of Platinum Magazine are complimentary. Dr. Davis is quick to point out that gastroscopy is a necessity when ulcers are suspected to avoid medically treating suspected ulcers when something else entirely could be going on. The first of which was a biomarker of the permeability of the intestinal mucosa, or ‘leaky gut,’ ” explains Dr. Whitfield. My part is to make sure that I listen and act on behalf of that horse. While gastroscopy gives the veterinarian a window into the horse’s stomach and gastrointestinal tract, properly diagnosing then grading ulcers is still a challenge, especially given their location. What is the one thing that each of these contributing factors have in common? “If I have a horse that I know has ulcer issues, I usually treat them aggressively with an Omeprazole-type product for 30 to 60 days, depending on the severity of the case. “In that study, we looked at a number of things. (See figure 1.) If the overnight haynets (for those stabled) are empty, you need to provide more. Although stomach ulcers in horses may seem like a new trend, they’ve probably been around for much longer than we realise. Symptoms of Horse Ulcers . To spot ulcer symptoms in a horse, keep an eye out for behavioral changes, like increased irritability, nervousness, or fatigue, which can be a sign that a horse has gastric ulcers. I’m happy to get up every morning, be a part of the team with my clients and see their success in the ring or the arena doing what they and their horses love. We know now that the gut is vital to the horse’s overall health, and we’re learning how serious the implications can be when NSAIDs are over-prescribed or used for elongated periods of time coupled with stress, competition, travel and so many other contributing factors.”, One of the foremost experts on the effects of NSAIDs on the equine gut environment is Canaan Whitfield, DVM, PhD, DACVS, DACVSMR, of Texas A&M University. “What makes me so passionate about this area of research is that equine GI disease is a leading cause of morbidity and mortality in horses, and we now realize that this class of medications actually does quite a bit of harm in both people and animals when not used properly and sparingly.” Together with Dr. Lauren Richardson of Tryon Equine Hospital, Dr. Whitfield documented the effects of NSAIDs on the equine gastrointestinal tract and showed that, in fact, NSAIDs do cause intestinal inflammation and gastric ulcers. There are two sections of the horse’s stomach; the glandular portion, which secretes acid and enzymes to break down food, and the stratified squamous portion. This inspired them to point their practice down a more functional and integrative path, focusing on whole-horse wellness and preventive medicine by, in part, implementing complementary therapies into their treatment protocols. Unfortunately, it’s not quite as simple as adding both medications to your horses feed and waiting for the results. This scenario can cause an overgrowth of bacteria not only in the stomach but throughout the GI tract,” explains Dr. Davis. “Feeding grain or concentrates has consistently shown to increase the incidence of ESGD,” explains Dr. Belgrave. Of course we all live with a certain level of managed inflammation, both horses and humans alike. Simple things like opting for the best product you can find can save you a lot later down the line. Look for symptoms of stomach ulcers in adult horses. It was at this point that their goal became to not only reduce the number of gastroscopies but rather to get to the root of the problem that was requiring this diagnostic step in the first place. Horses are natural grazers, evolving on a variety of grasses, barks and mineral-rich forages while grazing up to 18 hours per day. Copyright © 2020 Platinum Performance. “We’re sport horse veterinarians, but we approach our patients from a functional and integrative medicine perspective,” says Dr. Davis. No matter how big, no matter what the success story is. Many misconceptions exist about ulcers and horses. Intestinal ulcers are an unfortunate fact of life for many performance horses. Why Horses Get Stomach Ulcers and How To Treat Gastric Equine Ulcers Naturally! Although the most common location for ulcers is the upper region of the stomach, ulcers have been known to develop in other areas, including the lower portion and the duodenum. EGUS can be broken down into two distinct classifications, Equine Squamous Gastric Disease (ESGD) and Equine Glandular Gastric Disease (EGGD), with these classifications being based on the affected region of the stomach. Breaching of the intestinal barrier can lead to systemic inflammation and eventually contribute to many disease processes. Prevalence of ulcers in horses Studies indicate the prevalence of gastric ulcers is high: 93% of Race horses 63% of Performance horses 37% of Leisure horses (that’s a 1 in 3 chance of developing gastric ulcers!) Ulcers touch an overwhelming percentage of the horse population, making them one of the more prolific struggles faced by both riders and equine veterinarians. This discomfort impacts their performance, and we see these horses often kicking out when their rider puts a leg over them or becoming uncharacteristically temperamental when they’re in the ring. Veterinarians and physicians have gleaned vast knowledge from translational research that has shown positive effects in human athletes and is thus adopted for equine competitors and vice versa. The inflammation subsequently gives rise to erosion, and eventual ulceration of the mucosa,” explains Dr. Belgrave. It’s a battle he knows well, as he and many veterinarians like him work to turn the tide in preventing inflammation rather than attempting to treat it after it’s a present threat. Our recommendations are designed to nourish and manage gastrointestinal health, and in an animal that relies predominantly on fermentation as his primary source of calories, you had best get that fermentation and that bacterial flora right. A diagram of the inside … At Platinum Performance, we love to showcase the success of our clients, their horses and the veterinarians that care for them. Furthermore, hindgut ulcers are hard (and expensive to diagnose) so treating them, while you treat gastric ulcers makes sense. That inflammation works against veterinarians in several ways, including hindering a horse’s ability to properly absorb both nutrients and medications. Length of treatment is important. We have to know our patients.”, One of the greatest advancements in recent years has been a fresh and significantly more thorough understanding of how NSAIDs impact the horse’s GI system and play a role in the formation of equine gastric ulcers. They’re our go-to.”. “NSAIDs, while beneficial for numerous conditions and injuries, have become wildly overused in both human and equine medicine,” says Dr. Smith. “There is an increased likelihood of ESGD when straw is the only forage provided, though feeding alfalfa hay has been shown to have a protective effect of the gastric squamous mucosa in adult horses.” Dr. Belgrave is a strong advocate for pasture access, and for those times when horses are stalled, he recommends continual and gradual access to good-quality hay while keeping grains and concentrates to a minimum and only feeding them when a sufficient amount of hay is in the stomach to buffer the gastric acid released upon their consumption. “If it’s getting insulted by things that are ingested, then that immune system is going to have to combat whatever it’s being insulted by. Prevention is key because once the horse is in a disease state it becomes a battle,” says Dr. Davis. It is mediated by a variety of acids (hydrochloric, valeric, volatile fatty acids) that come into contact with the mucosa of the stomach. “If you’re going to introduce stressors on that gastrointestinal tract that naturally come with training and competition, you have to find a way to manage them,” insists Dr. Davis. Two drugs of choice, omeprazole and ranitidine. “Gastroscopy allows for a thorough evaluation of the stomach, grading and localization of the ulcers, as well as assessment of the proximal small intestine (duodenum),” confirms Dr. Belgrave. While Platinum GI provides a crucial balance between foundational wellness and GI-specific pre- and probiotics, there is a second step in the playbook for horses diagnosed with any level of EGUS. Ulcers are, unfortunately, a common part of horse ownership. They’re not performing to their abilities because of that gastric pain.”, Clayton Smith, DVM,Brazos Valley Equine Hospital in Navasota, Texas, Rodney Belgrave, DVM, MS, DACVIM,Mid-Atlantic Equine Medical Center in Ringoes, New Jersey, Chad Davis, DVM,Davis Equine Sports Medicine in The Plains, Virginia, Canaan Whitfield, DVM, PhD, DACVS, DACVSMR,Texas A&M University in College Station, Texas. A steady supply of forage – all the time, all day, and all night – will put the acid to its proper work and protect your horse’s stomach. “All portions of the stomach need to be investigated,” asserts Dr. Davis. Most ulcers occur here because the horse’s stomach continuously secretes acid, even when empty. “A lot of these case presentations can mimic the symptoms of mild to severe colic,” says Clayton Smith, DVM of Brazos Valley Equine Hospital in Navasota, Texas. A lot of times they’ll eat a part of their feed and then lie down, mirroring the symptoms of a mild colic. “The entire horse plays a role in most conditions that we’re addressing, and this demands that we look at the horse from nose to tail and everything in between.”, In the case of EGUS and the stable of pharmaceutical drugs that veterinarians commonly rely on, Dr. Davis sees the benefit of these therapies and uses them frequently while always falling back on a functional and integrative whole-horse approach. Sign in or register below to view your Horse profile. That’s for them and their riders to sort out, but for me, it’s the love of the athlete that drives me to do what I do.”, Whether it be sports medicine in general, or specifically the challenge of gastric ulcers in equine athletes, the world of veterinary medicine is shifting toward stewarding a new era of root-cause medicine. That’s not my part. Lastly, ultrasound provides a noninvasive option that can be easily administered. While grains and concentrates can have a detrimental effect in some cases, forage choices and grazing behavior can both positively and negatively impact a horse’s propensity for ulcers as well. “I try to incorporate pre- and probiotics often,” says Dr. Smith. Ulcers can range from mild to severe and require medical attention in order to be properly treated. While not accommodating the level of detail that the gastroscopy can offer, ultrasound can provide valuable imagery, particularly if the veterinarian is looking to confirm or rule out a specific concern. Dr. Whitfield’s most recent research, presented at the ACVS Surgery Summit in 2019, focused on Phenylbutazone- induced gastrointestinal injury. “What can happen with this approach is that you take a horse that naturally tends to be normally more acidic and repeatedly push it into a more neutral or basic realm for extended periods of time. Administered daily, the acid-pump will effectively block the production of gastric acid throughout the 24 hours after administration. “If you have the pH wrong, you’re going to get improper fermentation,” says Dr. Davis. Equine Gastric Ulcer Syndrome is a daily challenge for veterinarians, with a horse’s performance and overall health being challenged by ulcers and their secondary effects. “Two forms of ESGD exist,” explains Dr. Belgrave further. The volatile fatty acids produced when greater than 1 to 2 kg of grain is fed per meal, can exert damage on the squamous mucosa, thus leading to ulceration. According to the American Association of Equine Practitioners (AAEP), up to 90 percent of racehorses and 60 percent of performance horses are afflicted with gastric ulcers, with non-performance horses and foals impacted as well. In some cases, it’s those performance-related changes in a horse that often indicate a potential ulcer issue and cause veterinarians to investigate further. They first studied both classes of NSAIDs — COX-2 selective NSAIDs such as Equioxx® and nonselective NSAIDs such as Phenylbutazone (Bute) and Banamine® — and showed that both classes caused gastric ulcers and intestinal inflammation, albeit at different levels of severity. For seven days after that, the horses were placed on a restricted diet to stimulate ulcer formation. It seems like an obvious thing, but taking care of diet, nutrition, proper conditioning and stress management, it’s all so important in everything we do as veterinarians, and we’ll continue to see greater results as we forge this new way of thinking and practicing.”. If a horse is suspected of having gastric ulcers, gastroscopy will confirm the presence, severity and location of the ulceration. “We’ll pass through the pyloric sphincter in the pyloric antrum into the small intestine. At first glance, equine ulcers seem well understood with an established diagnostic process and tried treatment modalities. A primary factor to keep in mind is that the horse’s stomach is a naturally-acidic environment with a pH that can range from an acidic 1.5 to a more neutral 7, depending on each horse’s unique chemistry. Then, there is the glandular mucosa, where acidic pumps are predominantly located and where acid is being produced. They can diagnose it definitively using an endoscope (a device that can see the inside of the horse stomach) … Gastric ulcer syndrome, a very common disease in horses (up to 60-90% of horses in some studies) is an erosion of the stomach mucosa. “Prevention is where it’s at in so many ways. If like most of us you have a busy schedule, multiple haynets can be a convenient way to spread the feeds as needed (or a haynet inside a haynet for the greedy ones!). “For us, those preventive steps encompass several things, with diet being of paramount importance.”, Beyond the typical stressors that are commonly attributed to EGUS, diet and the manner in which horses are fed have been identified as critical factors in both the prevention and treatment of ulcers. A study looking at feed type on gastric ulcer formation showed an increased risk of gastric ulcers in young growing horses consuming high grain diets as compared to a forage diet. This barrier can be damaged by things such as antibiotics and NSAIDs. In this post, we’ll be discussing some of the things you need to know to take proper care of your horse if it develops stomach ulcers. The progress happening in the understanding, treatment and — perhaps, more importantly — the prevention of equine gastric ulcers is incredible. In the pyloric region the acidity level only goes up, ranging from a pH of 1.5 to 4. Ulcers develop from the build-up of hydrochloric acid within the stomach. “Chronic use of NSAIDs can easily lead to gastric ulceration and a disrupted equine gut microbiome, which then trickles down to a host of other secondary concerns. You can treat horse ulcers with medication available online with no prescription required. However, I do agree that horses with ulcers are just like people and need to become “gluten” free from grains. “Everything’s related. I see that and think, ‘Well, the horse has obviously been dealing with this for some time and is trying really hard to be able to manage this condition all on its own. “Their job is to quiet that acid production such that the acid cannot insult the mucosa that is trying to heal,” continues Dr. Davis. “Continued research to better understand EGUS, EGGD in particular, and how to prevent and treat it more effectively is needed,” says Dr. Belgrave, hopefully. A new horse will come into a barn and immediately we’ll put them on Platinum Wellness or Platinum GI, we’ll examine and correct their diet, we’ll become familiar with their stressors and we’ll get a complete picture of their health and risk factors. There’s always a trail of bread crumbs. Abler medications contain the same active ingredients as the ‘big name’ medications but are more affordable because there isn’t a big marketing push behind them. “Continued research to better understand EGUS, EGGD in particular, and how to prevent and treat it more effectively is needed,” says Dr. Belgrave, hopefully. These two linings are separated by a border referred to as the margo plicatus,” explains Rodney Belgrave, DVM, MS, DACVIM, owner of Mid-Atlantic Equine Medical Center in Ringoes, New Jersey. When shopping for supplements, you should buy the best ulcer supplement for horses you can find. That’s the top portion of the stomach, which also contains a cardiac sphincter where the scope enters the stomach,” he explains. Platinum Performance® Equine: Wellness & Performance, Platinum Performance® CJ: Wellness & Performance + Complete Joint, Platinum Performance® GI: Wellness & Performance + Digestive Care, Barn Pricing Guide for Foundation Formulas, Platinum Colic Coverage™ Qualifying Formulas, Online Form - Request Platinum Magazine - Magento. Developments in technology have meant that vets can now endoscope horses and see the ulcers in the stomach, adding to our understanding of the condition. You should also look out for signs of wood-chewing, which is a common behavior in horses with ulcers. Because ulcers can be so uncomfortable for horses, the temptation for their owners is to reach for the product that will offer the quickest relief, usually in the form of conventional drugs. “Primary ESGD occurs in the absence of other gastrointestinal abnormalities, while the secondary form occurs in relation to existing gastrointestinal abnormalities such as duodenal and pyloric strictures.”, While a clear grading system exists as a diagnostic tool for squamous ulcers, glandular ulcers have no clear-cut grading system. They may only suspect the presence of ulcers because of small noticeable changes in their horse’s condition. Some of the most widely held beliefs are that they only affect the horse’s stomach (gastric ulcers), and they only plague high performance horses, horses that travel frequently, or horses that are nervous or stressed. This is the "gold standard" for ulcer treatment in humans and promises to be a cure for ulcers in horses. As Dr. Whitfield mentioned in his findings, inflammation can be a significant contributing factor to equine gastrointestinal disease, including gastric ulcers and Leaky Gut Syndrome. With that, we celebrate the wins. Symptoms of Ulcers in Horses. While a high-quality, forage- based diet is essential, the type of hay fed can also factor into a horse’s risk of developing ulcers. However, if the ulcer symptoms are from the glandular portion of the stomach, GastroGard will be ineffective. I don't dampen the feed and she gets a scoop of alfa before she is ridden as well. Affiliate Disclosure, Guide on Choosing the Proper Treatment for Ulcers in Horses, What Are the Symptoms and Risk Factors of Stomach Ulcer in Horses, Med-vet Pharmaceuticals Gastro-plex Paste, Gooseberry Ulcer Guard for Stomach Balance, Our final thoughts on treating ulcers in horses, Best Equine Probiotic: Top 15 for 2020 (Reviews & Guide), The 15 Best Treatment for Rain Rot 2020 (Reviews & Guide), The 15 Best Horse Treats 2020 (Reviews & Guide), The 15 Best Horse Wormer for Fall 2020 (Reviews & Guide), The 13 Best Wound Cream for Horses 2020 (Reviews & Buying Guide), 12 Best Hoof Supplements for Barefoot Horses 2020: Reviews & Guide, The 11 Best Horse Feed for Weight Gain 2020: Reviews & Guide, The 15 Best Stall mats for Horses 2020 (Reviews & Guide), The 15 Best Cordless Horse Clippers 2020 (Reviews & Guide), The 15 Best Horse Riding Helmet 2020 (Reviews & Guide), The 12 Best Joint Supplement For Horses 2020: Reviews & Guide, The Best Horse First Aid Kit 2020 (Reviews & Guide), Best Natural Fly Spray For Horses: Top 15 in 2020 (Reviews & Guide), Prolonged use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). The “Your Horse Ulcer Free” series will equip you with the knowledge to recognize, treat, and ultimately prevent equine ulcers in a better, more lasting way. When treating horses with ulcers, it is important to substitute any sweet feeds, barley or oats where possible for lucerne hay or good quality grass. We’ll use one of these formulas to provide our patients with that backbone of wellness and performance support, as well as GI-specific nutrients for daily support. The 15 Best Coat Supplement for Horses 2020 (Reviews & Guide) The 15 Best Horse Feed For Performance Horses 2020 (Reviews & Guide) The … It’s when that inflammation inches above the disease threshold into an unmanaged state that significant clinical issues can arise. The horse’s ulcers are a combination of this hydrochloric acid, as well as volatile fatty acids and bile acids. With most grains and concentrates having an inverted ratio of omega-6 to omega-3 fatty acids — meaning they are considerably higher in more pro-inflammatory omega-6 fatty acids — these feeds can exacerbate the condition in horses with confirmed or suspected EGUS. Likewise, increased starch intake on a daily basis increases the risk of development of ESGD as well.”. It’s not uncommon that horses will be on different feeds and various products, but with Platinum, I know I have that strong base, and I know I’ve looked at their diet and given them the best chance for success. Monumental advancements in the role of diet and advanced nutrition is one area of medicine that has moved into mainstream practice as a vital complimentary therapy and preventive tool in recent years. “We documented that Phenylbutazone resulted in an increase in this biomarker of leaky gut, but there was not an increase in either the control group or in horses treated with both Phenylbutazone and a nutritional therapeutic,” outlines Dr. Whitfield. Some of the symptoms that foals exhibit may also become apparent in adult horses. Wheat, barley and rye have gluten in them which most humans and animals cannot break down to digest in the small intestine. In fact, 50 to 90 percent of equines experience the symptoms of horse ulcers and later receive a positive diagnosis for them. “Knowing that we approach our cases from a whole-horse perspective, we’re making sure the hay source is of a good quality, we’re potentially looking at a ration balancer, we’ve prescribed either Platinum Wellness or Platinum GI as a building block and we’re potentially adding Platinum Gastric Support for cases undergoing treatment for EGUS,” outlines Dr. Davis. “Whether it be from a housing standpoint, a nutrition standpoint or a sports/transportation standpoint, it comes down to how well horses are able to adapt to the multifactorial environmental conditions we put them in.”, Above all else, EGUS can cause anywhere from mild to extreme discomfort and pain in the horse, resulting in behavioral issues and, inevitably, an impact on their ability to perform as athletes. 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