Data Sheet - Equine Gastric Ulcer Syndrome

Equine Gastric Ulcer Syndrome 

Does my horse have ulcers…?
Ulcers in the horse or pony are very commonly reported to veterinarians. There are 2 broad areas where gastro-intestinal ulceration can occur in the equid – the stomach (gastric) and right dorsal colon. Colonic ulcers are very difficult to diagnose and typically occur in conjunction with other signs such as severe colitis (diarrhoea). As such, this article will focus on gastric ulcers. 
Within the umbrella of gastric ulcer syndrome, there are several places that ulceration can occur. 
These include the squamous (non-glandular) mucosa of the stomach, the pyloris (exit of the stomach) and the proximal duodenum (the start of the small intestine). 
At the basic physiological level, ulceration is inflammation and/or damage to the mucosal lining of the stomach. There are many different grading systems relative to severity and position. As such, most veterinarians chose to adopt the most universal system that classifies ulcers by naming their position and grade them from 1 to 4 (1 being mild, 4 being severe full thickness mucosal erosions). 
It is important to note that while a large number of animals do indeed suffer from the condition, it is likely also heavily over diagnosed by both veterinarians and members of the public (when clinical signs alone are used for the diagnosis).
Clinical signs
The diagnosis or symptoms of ulcers are often vague and non-specific. They may include:
• Behavourial changes around the time of feeding
• Colic like symptoms
• Changes in attitude (i.e. sour, snakey, etc)
• Resentment of work
• “Back-pain” or “girthy” like symptoms
• Looking “off” in the coat
However, it is important to highlight that these symptoms do not mean your horse has ulcers, only that is might. Many horses display these or similar symptoms and do not have ulcers. Many 
horses also have ulcers but display no outward clinical signs. No symptoms or clinical signs have definitively been shown to be diagnostic for gastric ulcers. Just because your horse windsucks or reacts to pressure or palpation at the girth, does not mean it has an ulcer!
The ONLY definitive way to diagnose ulcers is via gastroscope, whereby a flexible endoscope is 
passed into the stomach of your house and is used to visually check for ulceration to the stomach and duodenal mucosa (lining).
Causes
The causes of gastric ulcers are again varied and many. Some of the underlying causes MAY include:
• High energy diets
• Stress/excitable nature
• Lack of regular grazing
• High work-load/stressful environments
• Irregular feeding routine
• Underlying systemic conditions
Diagnosis
As stated above, the only way to definitively diagnose gastric ulcers is via gastroscope. Clinical signs are non-specific and poor indicators. Animals may also be diagnosed via response (i.e. improvement) to trial treatments, however this can also be misleading (i.e. the placebo effect – whereby we convince ourselves that an animal has a condition and needs treatment, and so are convinced that the treatment is having an effect – even if its not!)
Treatments
Treatment(s) for gastric ulcers revolve around the use of proton pump inhibitors (e.g. omeprazole). 
This product acts to decrease the acidity of the stomach and as such protect the mucosal lining. It is typically given daily in an oral paste form. Ideally it is given on a relatively empty stomach to 
enhance absorption, and initially as a higher dose. With time/clinical improvement, this is usually 
dropped to a maintenance/preventative dose or stopped entirely.
Varying feeding regimenes, other gastric protectants, changing stabling/paddock time and managing stressful environments/situations can also help improve gastric ulcers when combined with effective treatments. Gastric supplements (e.g. buffers) can also be used to help aid in the treatment of, and minimise and protect against gastric ulcers.
Sometimes treatment can result in rapid improvement in your horse, however it is still recommended that you follow the recommended treatment course (typically 1 – 3 months, relative to severity/grade of ulcers) as prescribed by your veterinarian. 
If at any time you are worried about your horse/pony’s condition, or if you have any further 
questions, please contact the Main Ridge Veterinary Clinic on (03) 5989 6232