Health Care

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Treating Gastric Disease

Equine gastric disease is common across all breeds and equestrian disciplines. Until recently, the term Equine Gastric Ulcer Syndrome (EGUS) was used to describe both Equine Squamous Gastric Disease (ESGD) and Equine Glandular Gastric Disease (EGGD).

However, we now know that they are distinct diseases and are completely unrelated in terms of their appearance, risk factors, treatment and management. They both just happen to occur in the horse’s stomach!

Before treating

Before treating a horse for gastric disease it is important to recognise that, depending on the clinical signs present, a range of diseases should be considered and that it is important to seek veterinary guidance. For example, poor appetite and unexplained weight loss are two of the most common clinical signs of gastric disease, but they may also be present in a range of other diseases such as dental disease, parasites or underlying illness. Similarly, poor performance and behavioural changes are common complaints from owners of horses with gastric disease, but issues such as orthopaedic or muscular disease, or sand colic, can cause identical clinical presentations. Considering this, it is essential that you consult with your veterinarian prior to treatment.

Signs of gastric disease can be vague and non-specific but may include one or more of the following:

  • Poor body condition
  • Weight loss
  • Recurrent colic
  • Girthiness
  • Poor hair coat
  • Reduced appetite / change in eating patterns
  • Change in rideability
    • Reduced willingness to work
    • Reluctance to go forward
  • Attitude & behaviour changes
  • Sensitivity over flanks
    • Resenting girthing/leg pressure
    • Resenting grooming/rugging

Is gastroscopy essential?

Gastroscopy remains the only method of definitively diagnosing gastric disease. It is also the only way to distinguish between squamous (ESGD) and glandular (EGGD) disease. This distinction is important as the treatment regimens for the two conditions varies, as does the emphasis on specific management changes to prevent recurrence.

While gastroscopy remains best practice, there may be situations where this is not available or feasible. In this situation, the veterinarian may decide that a treatment trial is warranted to help establish a diagnosis. Prior to attempting a treatment trial, consideration should be given as to whether ESGD or EGGD is more likely in the individual horse, with the treatment trial adapted accordingly. It is important to keep in mind that not all horses with gastric disease will respond to a treatment trial. If gastric disease is still considered likely, then gastroscopy should be performed to confirm the diagnosis.

Treating gastric disease

There is no ‘standard protocol’ for the treatment of either squamous or glandular disease. Every lesion is different. Every horse is different. Your vet will tailor a specific treatment plan for your horse.

  • Acid suppression is the cornerstone of treatment for both squamous and glandular disease
  • Omeprazole paste is very effective for treating squamous disease, but it needs to be given 30-60mins before feeding, first thing in the morning, following an overnight fast to be most effective. Most importantly, it has been recognised that the presence of food in the stomach will significantly decrease the absorption of omeprazole, and therefore how effective it is at treating squamous disease.
  • Considering this, current recommendations for the administration of omeprazole are as follows:

    horse ulcer treatment

    horse ulcer treatment

    • The feed at this time should consist of 1-2 large flakes of Lucerne hay, or a highly palatable roughage substitute, followed by concentrate feeding (if necessary).
    • Horses naturally reduce their feed intake overnight and this approach simply prevents the horse from eating in the morning before the medication is given, allowing more of it to be absorbed.
  • With proper treatment and management changes, squamous lesions should heal in 14-21 days.
  • Treatment of glandular disease is not always straightforward. Your veterinarian will advise as to what treatment is likely to be most effective for your horse.

What now?

A follow-up gastroscope is very important to evaluate the effectiveness of treatment and management changes are critical in preventing the recurrence of both diseases.

  • As ESGD is largely due to diet and exercise, management strategies to help prevent the occurrence of ESGD include:
    • Allow contact with other horses
    • Reduce the intensity and duration of exercise
    • Maximise turnout, preferably with other horses
    • Maximise the amount of roughage in the diet
    • Feed good quality, palatable forage (eg. lucerne chaff) first thing in the morning
    • Ensure feed is provided at least every 6 hours
    • Minimise starch and grain in the diet
    • Allow constant access to water in the stable and at pasture
    • Feed 2-3 litres of chaff or an equivalent volume of forage 30 mins prior to exercise
  • For EGGD behavioural stress as well as frequency of exercise plays a large role in the development of this condition and strategies to help prevent the recurrence of EGGD include:
    • Reduce exercise to less than 4-5 days per week or exercise every second day.
    • Provide at least 2-3 complete rest days per week.
    • Reduce the frequency of competition and intense exercise
    • Feed roughage prior to exercise to maintain blood flow to the stomach
    • Minimise management changes
    • Minimise changes in riders and handlers
    • Minimise changes in herd dynamics; ensure turnout with compatible paddock mates

Take Home Messages

  • Remember, two distinct diseases can occur in the horse’s stomach – Squamous Disease & Glandular Disease.
  • Gastric disease is very common across all horse populations and clinical signs can vary.
  • The only way to diagnose gastric disease is via gastroscopy.
  • Omeprazole paste is effective for squamous disease but not for glandular disease.
  • Omeprazole paste should be given on an empty stomach to maximise effectiveness.
  • Management changes are vital to prevent and manage both diseases.
  • Feed 2-3L of roughage prior to exercise to help minimize ‘acid splash’ and maintain blood flow to the stomach.

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