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Ask The Vet: Gastric Ulcers - September 09
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Is your horse experiencing some of the common signs of gastric ulcers? Pose your questions to this month's expert, Dr. Doug Thal, regarding the topic of equine gastric ulcers.
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Question: My 17-year-old mare had a deep seated abcess on her gaskin, which required three surgeries to correct and was on heavy doses of antibiotics and bute for several weeks and colicked. It was determined that she had gotten ulcers from the long-term use of antibiotics and bute. We were given a regiment of gastoguard for three months and then weaned her off of it. Her diet now consists of, twice a day, two pounds of Strategy, a flake of alfalfa hay, and two flakes of coastal hay. She also receives once a day, Fastrack, a probiotic, sand clear and a daily wormer. She is retired and is out on pasture daily.
My questions are have her ulcers healed by this time or do I still need to be concerned about them? Do you see anything in her diet that needs to be changed to keep her from relapsing and getting ulcers again?
Answer: Click To View
It is impossible to know without scoping her whether the ulcers have truly healed. That said, if she is doing well, they likely are not a clinical problem, and so you should not worry about them. She was on a long course of Gastrogard and, theoretically, the ulcers should have healed during that course. If you truly want to know, you need to have your veterinarian perform a gastroscopy to visualize the stomach. There is nothing in her management now that should predispose her to ulcers.
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Question: I have a 17.3 hand Quarter/Thoroughbred gelding that is 4-years-old. When he is in his stall or even turned out, he spins in his stall (almost like a puppy chasing his tail). I have had several veterinarians examine him and diagnose it as a bad habit. However, I just don't think this is the case. I have owned him since he was six months old and he started doing this as a 2-year-old when he went into training. I know training can be stressful and was thinking maybe he had an ulcer. What are your thoughts? Any suggestions that can be given would be extremely helpful since I have worked with several veterinarians all over the country and all I want is to make my gelding more comfortable.
Answer: Click To View
In my opinion, it is hard to associate that kind of behavior with gastric ulcers. It sounds more like a behavioral vice, or even (unlikely, but possible) a physical problem associated with another body system. A thorough neurologic and physical examination should be performed first and foremost to help rule out any other cause.
If you wonder about gastric ulcers playing a role, it seems that there are two ways to solve that question. The first is to have a veterinarian perform endoscopy on the horse to see if there is ulceration. If there is ulceration, treat the ulcers and see if the behavior changes. The second is to put the horse on a reliable ulcer medication for an adequate period of time, and see if the behavior changes.
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Question: I am wondering if there are any antacids, supplements or medications other than omeprazole that provide symptomatic relief of gastric ulcers/gastric irritation due to acidity in order to provide diagnostic reference (i.e. this horse's issues resolved on this product, so it looks like an ulcer-type problem)?
Answer: Click To View
If you are using a drug trial to help you deduce whether or not your horse has gastric ulcers, you want to use a drug that you know works. There are very few medications, which are accepted to be truly effective at relieving equine gastric ulcers and helping them heal. In my opinion, the only two are omeprazole in the Gastrogard form (i.e. not generic omeprazole) and ranitidine (trade name Zantac), a histamine blocking drug, which needs to be used at full dose, three times daily to be truly effective.
Whether the over-the-counter antacids might help reduce signs, is unsure enough that I would not think about using them in the diagnostic way you are describing.
After a few days of treatment with one of the two mentioned drugs, you should see improvement in the signs, which you are atributing to gastric ulcers. Ranitidine will save you some money over Gastrogard, but you will have to treat three times daily.
I still think the best thing to do is to have the horse scoped - this way you know what you are dealing with. In the end, a sure diagnosis will likely save you money and be the best thing for the horse.
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Question: I am unable to buy alfalfa hay that my older gelding can easily chew and was wondering if (soaked) alfalfa pellets or cubes would also have a buffering effect on his stomach acids. If so, how much and how often would be beneficial? He receives straight orchard grass as his main fiber source, in addition to twice daily soaked beet pulp with a small amount of senior feed mixed in. He is an easy keeper and has "Cushings".
Answer: Click To View
Does he have ulcers? If so, how do you know this? I think alfalfa will retain some of its buffering capacity, but I cannot answer this for sure. I would try to feed him the same amount of dry hay that you have (should be about two percent of his body weight in dry hay). However, keep in mind that it will weigh much more when wet. Cubes will turn to a mash and this may be fine also. Start with the same as what you would feed him dry, then wet it. This sounds like a good diet. Consider one of the low starch senior feeds, which are now on the market.
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Question: I bought my Paint gelding three years ago, he was in very bad condition, thin, long hair, etc. I noticed after he got home that he cribbed. I called the old owners and they didn't think he did that when they owned him, but he was within an electric fence enclosure so they didn't know for sure. I called my veterinarian who later examined him and said that this horse had been cribbing a long time and thinks he cribs ONLY after eating grain since he had gastric ulcers. After switching his grain to what the vet recommended, he still continues to crib ONLY after eating grain or horse cookies. He is ridden lightly 4-6 times a week, on 24-hour turnout, a few pasture buddies. He does receive grain (pelleted)since he is such a hard keeper. He is 8-years-old. Any suggestions?
Answer: Click To View
It may be that he cribs when he is in pain, or when his blood sugar goes up, or it may just be behavioral - it is very hard to say why there seems to be an association in him between grain and treat feeding and the cribbing. Whether that is a behavior associated with gastric ulcers is unclear but not impossible.
The most important thing I think you can do is determine whether he truly has gastric ulcers or not. If he has them, then treat him and see if the behavior goes away. The only way to be sure he has them is to have a veterinarian perform gastroscopy on him. A vet will need to have a 3 meter scope to do this.
Keep his diet as low in carbohydrate as possible and supplement with oil to aid in keeping his weight up.
If he either does not have ulcers, or treatment of the ulcers does not have any effect on the cribbing, then management changes aimed at reducing cribbing are in order. The other thing to keep in mind is that cribbing in itself is an annoying habit, but it may not be hurting anything.
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Question: Our first ever horse is a handsome 7-year-old, 16.3 hand, off-the-track Thoroughbred. He is doing well in eventing and seems happy. He is fed three times a day (including ultium, rice bran oil, beet pulp, electrolytes, glucosamine, good hay, 8-hour turnout, works 5-6 days a week) but is having a lot of trouble gaining weight because he stall walks all night. The veterinarian has placed him on one tube of gastroguard/day for a week and then cut it down to 1/4 tube per day for the next 6 months. Will treating/healing the (probable) ulcers result in increased absorbtion of calories and weight gain? Will the ulcers return when we stop giving him the gastroguard? Do probiotics help with ulcers? NOte: The vet says he weighs about 1,000 lbs and should be closer to 1,200lbs. We have been battling the weight issue since we got him 1 1/2 years ago. Your advice is greatly appreciated.
Answer: Click To View
The question is: does he have gastric ulcers now? He should have a gastroscopy to determine that. If he still has gastric ulcers, it may take 28 days of treatment with gastrogard at full dose (versus 7 days) to get those to actually heal, and then some sort of maintenance like the 1/4 dose gastrogard for a variable length of time.
In cases in which gastric ulcers are the primary problem, treatment of the ulcers can make a tremendous difference to general health and body condition (in this case, could help weight gain).
In some cases, the ulcers do return. The most important thing is to know whether or not they are gone now after this long course of treatment. I can't emphasize enough the need to learn as much as you can about his condition before speculating about treatment, and a gastroscopy provides important information, along with other diagnostics, which your vet has likely provided.
If everything else is ruled out, it may simply be the energy expenditure of his stall vice of walking constantly that is causing him to lose weight. Trying to manage this is key. He is on a low carb, high fat diet, which is important. The fat component should be maxed out and carbs minimized. Some propose the use of various herbals to help calm nervous horses. I have not had much luck with these but do not know that much about them. I do not think that there is evidence for their effectiveness in horses. Trying different management techniques like feeding long stem grass hay at night might reduce the walking.
As far as I know, probiotics have not been shown to help gastric ulcers.
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Question: My Icelandic horse is undergoing treatment for gastric ulcers, which includes 1/4 syringe Gastrogard/day. He has a history of gastric ulcers and this is the third time he has received treatment. He is not a performance horse and he doesn't live a high-stress life, but is a very easy keeper and is often overweight. Every time I reduce his hay intake I risk him developing new ulcers. I keep hay in front of him as much as possible, but that does make it hard to reduce his weight.
My veterinarian said that ulcer preventative supplements on the market have not been proven effective, but I can't afford to give him omeprazole every day for the rest of his life. In addition to giving him a small amount of alfalfa hay several times a day to buffer his stomach acids, is there anything else I can give him to prevent new ulcers? Thanks for any help.
Answer: Click To View
Firstly, has he been scoped to establish the diagnosis? This is key to knowing what you are treating. Even if the original diagnosis was made this way, a repeated scoping would be helpful.
For lack of a better alternative, I would try the ulcer preventative despite the lack of supportive evidence for its use. These supplements are relatively inexpensive and they may help a little. Consider weaning him off the gastrogard and putting him on one of these. If he shows signs of a problem, you will need to reassess.
I have recommended feeding corn oil (in your case in very small amounts - 2 oz per day). There is thought to be a mild protective effect on the stomach lining from feeding this. You will have to feed a little less hay to account for the additional calories.
Consider low dose thyroid supplementation- despite the lack of evidence for hypothyroidism in horses, I use this to help this kind of horse maintain a healthier weight.
I hope this helps.
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Question: I purchased a 6-year-old Quarter horse two years ago. He was treated for ulcers with tagamet and then coliced a few months later. He was taken to Cornell University and after being scoped, was diagnosed with having a few grade one ulcers and evidence that others had healed. He continued to colic every once in a while and I did some research to find out he was not getting enough of the tagament. I consulted with my veterinarian and decided to switch him to Zantac. We also switched him to a senior feed, as recommended by Cornell, to help reduce the acid in his stomach. He has continued to do well on the Zantac, gaining weight and overall looking great. However, one other symptom he has is that he burps and it is an awful smell. A few months ago, we decided to start backing him off the Zantac. He is out to pasture all day on grass, is grained twice a day (senior) and is given hay in the morning and night.
Now that we have started backing him off the Zantac, he is burping more and showing some of the same signs that we saw in the beginning. Laying down and stretching while standing. He is ridden lightly, 30 to 40 minutes, three to four days a week and it out to pasture the rest of the time.
My question is, can a horse have acid reflux without having ulcers? When I tell people he burps, they look at me like I'm crazy. I have been trying to get help for this horse but there are not a lot of people knowledgable on this condition.
Answer: Click To View
It is likely that this horse does have clinical gastric ulcers. The Zantac helps his clinical signs, but for whatever reason, the signs are persistent. Although there is new evidence that even horses at pasture have a relatively high incidence of gastric ulcers, it is unusual in my experience for a horse to show long-term clinical signs when managed as you have managed your horse. The ones that did seem to persist had issues with gastric outflow- the stomach could not empty properly and so the acid level raised up to where it caused persistent and hard to control gastric ulcers.
Alfalfa is actually a better feed for horses with gastric ulcers than grass hay. Alfalfa has a buffering effect, which increases stomach pH (lowers acidity), so that is one change you could slowly make. Adding corn oil ( two to eight ounces per concentrate feeding) to feed is reported to help protect the stomach lining and may be helpful to manage ulcers.
As far as I know, the over-the-counter equine antacid supplements may slightly reduce stomach acidity. My feeling about these is that they may be helpful in a mild case, but they have not been shown to support the healing of gastric ulcers, as Gastrogard (and to a lesser extent Zantac, clearly has). That said, it may not be a bad idea to try one of these as they are relatively inexpensive and likely will not hurt.
When all is said and done, you will likely be best off having a second gastroscopy performed on the horse so that you understand better what the state of the problem is now. This would allow your veterinarian to visualize the stomach, the esophagus (for evidence of reflux) and even the outflow of the stomach (in case there was a problem there). It has been two years since the first scoping and there may now be an explanation that was not there before. The investment in some diagnostics now may pay off in the long term.
I prefer treating horses with persistent gastric ulcers with a full 28 days of Gastrogard, and then try to maintain them with the 1/4 dose (packaged as Ulcergard). This at least reduces the cost to 1/4 that of the treatment dose, and is conveniently dosed only once a day, versus at least twice daily for Zantac (ranitidine).
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