A definitive diagnosis combined with a properly targeted treatment programme is essential to the successful management of gastric ulcers in horses – equine gastric ulceration syndrome (EGUS). These key steps should aid the chances of a speedy recovery and help prevent the problematic cycle of repeat ulcer formation.
➤ Step 1
Identify the problem. The development of significant clinical signs — appetite change, weight loss, poor performance or adverse reaction to girthing — within the preceding 6-12 weeks suggests the presence of EGUS. Gastroscopy is the definitive diagnostic test. Squamous or glandular lesions of grade two, three and four and above are considered significant.
➤ Step 2
Formulate an appropriate treatment plan. Primary squamous disease is treated with acid suppressants. The most effective is equine-specific omeprazole, with GastroGard being the most studied formulation. Superficial lesions heal very rapidly (within 14 days), whereas focal, deep lesions take a week or two longer.
The omeprazole dose can be halved if the drug is given in the morning on an empty stomach and the horse is fed 30 minutes later. This increases drug absorption by up to 300%.
Primary glandular disease is treated with a combination of omeprazole and the coating agent sucralfate, but lesions take 28 days or more to heal.
For both diseases, subtle management changes are recommended. Provide free access to roughage in the daytime, add corn oil to the diet to reduce acid production, and feed a small chaff meal within 30 minutes of starting exercise to limit splash ulceration.
➤ Step 3
Assess the clinical signs and the endoscopic response, with repeat gastroscopy, after initial treatment. If the lesions have healed but the horse’s signs have not changed, the ulcers were not relevant to the problem. If the lesions and clinical signs have only partially improved, prolonged or modified treatment is needed. If the lesions have healed, move on to preventative treatment.
➤ Step 4
Prevent ulcer recurrence with a combination of long-term management changes and therapy. A quarter-dose of omeprazole given once daily is most consistently effective. An alternative for squamous disease is an antacid supplement of calcium carbonate, magnesium and aluminium hydroxide, given up to four times daily. For glandular disease, another option is a coating agent supplement containing pectin and lecithin, given up to twice daily.
This article was first published in the 25 September 2014 issue of Horse & Hound magazine
