AAEP Ask the Vet: Gastric Ulcers

Gastric Ulcers
  1. I have a 15-year-old gelding that I am concerned he might have Vesicular Stomatitis. I noticed today while feeding him he was having difficulty chewing. I had given him Bute in his grain a couple of days ago with molasses for some pain in his hooves, which are being treated by a farrier trained in corrective work. When my gelding is being worked alot he has occasional discomfort as this is why we give him bute occasionally and very sparingly. While checking his mouth, I noticed some raw spots on his gums and he seems to be eating very carefully as if it were painful. I have him in with our two miniature horses, which don't seem to be showing any signs. He is also pastured during the day with our mini donkeys. I have not checked them but will tomorrow. Could this be a result of the bute or possible stomach ulcers? Please advise as there has been cases of VS in my location of Colorado. Thank you so much for your time. 

    I would recommend contacting a veterinarian immediately for evaluation of possible Vesicular Stomatitis, which is a viral disease that can cause vesicles and blisters of the lips, gums, nostrils, corners of the mouth, and tongue.  Your veterinarian would be best able to perform a physical exam and diagnostic testing to further investigate this issue.  NSAIDs such as Bute can cause ulceration of the mouth and tongue, but this is rare and usually is a sign of toxicity associated with high doses or chronic use, especially if you are using a tablet or paste that is formulated for oral administration.  Gastric ulcers can cause a horse to become inappetent, especially with respect to grain, but do not cause the mouth pain that you describe. Jean-Yin Tan, DVM, Syracuse Equine Veterinary Specialists, Manlius, NY

  1. I have a 32-year-old warmblood with a history of serious ulcers (before retiring.) He was treated with GastroGuard initially and again when he seemed to have trouble again due to being fed inadequately 12 hrs apart. His diet is now excellent and he is holding weight beautifully. He even has his top line back. He is given omeoprazole powder with his food. Is there any point to that powder? Once the ulcers are treated with Gastroguard, is that all that is necessary?

    First of all, congratulations on successful treatment of his ulcers and getting him to an ideal weight! These are all indications that the initial ulcers have healed. However, having suffered from ulcers twice, I would agree that he is predisposed to developing ulcers and should be kept on whatever preventive strategies are possible. 

    As you mentioned, feeding practices and management are of paramount importance when aiming to prevent gastric ulcers. I would not only recommend small frequent feedings, but recommend that his forage be primarily alfalfa, which contains natural buffers to help with his stomach acidity. It is also important to minimize any changes in routine, and to treat him with medications (specifically,UlcerGard) beginning 3-5 days prior to any trailer rides or stressful events.

    Besides management, it is also ideal to keep your horse on some form of medication or supplement preventative. While it is true that the brand name omeprazole pastes GastroGard and UlcerGard are the only FDA-approved and scientifically proven treatment and preventative, respectively, for Equine Gastric Ulcer Syndrome (EGUS), I understand that keeping him on UlcerGard indefinitely can be cost-prohibitive. You are correct that many other formulations of omeprazole have been tested for efficacy for treatment of EGUS and have shown a lack of significant effect. Therefore, for treatment of ulcers, the omeprazole powder is not likely to be helpful to your horse. That said, scientific studies have not focused on testing medications in terms of their effectiveness as prevention for gastric ulcers. Therefore, veterinary practitioners resort to a variety of medications which are believed to have some positive effect on gastric ulcers, such as ranitidine and compounded omeprazole, for prevention. There are also feed additives and nutraceuticals such as aloe vera juice, buffering supplements, and prebiotic/psyllium products. Due to the small number of published research trials on preventing ulcers, there is no true right or wrong answer in terms of which medication or supplement you use. Most recently, a Norwegian feed additive called ImproWin, which is a combination of B vitamins and salts of organic acids, has been shown in a research trial to assist in equine ulcer healing. I hope you can use this information to formulate a strategy that best works for you and your horse. Jean-Yin Tan, DVM, Syracuse Equine Veterinary Specialists, Manlius, NY

  1. I have a 9-month-old colt weanling that I believe has ulcers. I have contacted the vet thinking he was colicing as he began kicking at his belly. The veterinarian told us it was likely gas colic. He does this every night with his night feeding, he eats a bit, starts getting uncomfortable, drinks water, has more food, drinks more water, kicks at belly scratches/nips at his belly underneath his legs (raises leg and looks like he is scratching). He has access to lucerne hay throughout the day and he is put in an open paddock with a companion mare at night. During the day he is in his own paddock so he can eat without being bothered by the mare. I have stopped training him as it seems to make it worse. My question is: Why only at night does he have this problem and not during day, and how do I treat him? I have'nt been succesful with ulcers as I recently had to put down my 30-year-old this year since no matter what I did, they would not heal. Australian omogaurd costs $85 a tube, which is only 4 days worth of treatment. Very costly when you have to do it for months. Any help would be greatly appreciated.

    I am sorry to hear about the troubles you have been having with your 30-year-old and now with your weanling. The clinical signs of discomfort and chronicity of the issue that you describe do sound consistent with gastric ulcers. However, the only method of achieving a definitive diagnosis to guide treatment would be to perform a gastroscopy. This is a procedure where he would likely be lightly sedated, and a long endoscope would be passed through his nose into his stomach to quantify and visualize the number, location, and severity of the gastric ulcers you are dealing with. The diagnosis will help to guide what methods of treatment could be used and duration of treatment, all of which would have an impact on cost.

    Gastric ulcers are common in young horses and affect up to 57% of foals. Clinical signs may include diarrhea, inappetence, weight loss, teeth grinding, and colic. In particular, horses at this age may also have involvement of the duodenum, which is part of the small intestine closest to the stomach. Treatment, corresponding to the severity of the ulcers, can range from simple treatment with omeprazole (Gastrogard, Gastrozol) which is a proton-pump inhibitor, to compounded treatment with omeprazole, sucralfate (coats the stomach and provides symptomatic relief), and misoprostol (prostaglandin analog which mimics the protective agents of the stomach), to surgery. In addition, you can make some management changes that can help, which is increasing the number of feedings/day when he is not in pasture, and providing a forage source high in alfalfa.

    As far as the cost-effectiveness of treatment, a new study has just been released that shows that treatment with enteric-coated omeprazole (Gastrozol in Australia) is just as effective at treating ulcers at the low 1mg/kg dose as the high 4mg/kg dose. This can result in significant cost savings for you, should you decide to pursue diagnostics and treatment for your foal. Jean-Yin Tan, DVM, Syracuse Equine Veterinary Specialists, Manlius, NY

My horse has a hoof abscess and has been on bute for a month. Do I need to treat for ulcers?

The stressful event and any change in routine brought about by the foot abscess, combined with the use of the non-steroidal anti-inflammatory phenylbutazone, are all predisposing factors for gastric ulcers. Ideally, if the changes can be predicted, a horse should be started on 1mg/kg of omeprazole paste (Merial Gastrogard in the U.S.) beginning 3-5 days prior to the change, to prevent the formation of gastric ulcers. Since you are already a month into treatment, your horse likely has either developed gastric ulcers, or is not going to develop them. Before instituting treatment for possible gastric ulcers, I would recommend a discussion with your veterinarian on any changes you may have noticed to his weight and condition, appetite, and any signs of discomfort that can be associated with ulcers. His age, breed, and personality can also be factors that relate to his risk of gastric ulcers. Definitive diagnosis to determine if he does need to be treated would be achieved through a gastroscopy. Jean-Yin Tan, DVM, Syracuse Equine Veterinary Specialists, Manlius, NY

 

Would gastric ulcers cause a horse to get thumps (horse holds his breath) or wind suck? (View Answer)

Yes, cribbing and wind sucking has been associated with increased numbers of gastric ulcers but we are not sure if there is a causative relationship there, as not all horses that wind suck have ulcers. One of the theories for the association between wind sucking and gastric ulcers is increased comfort when sucking in air, inflating the stomach, and drawing the ulcerated upper portion of the stomach away from the acids below. For this same reason, holding his breath may also provide temporary relief from gastric ulcers. To further investigate the possibility of gastric ulcers, I would recommend a gastroscopy.

Diaphragmatic thumps (synchronous diaphragmatic flutter, or hiccups), however, are associated with dehydration and severe electrolyte abnormalities in horses. If he is experiencing diaphragmatic thumps, immediate veterinary attention with lab work would be warranted. Jean-Yin Tan, DVM, Syracuse Equine Veterinary Specialists, Manlius, NY