Ulcer Prevention for the Competitive Sport Horse from Palm Beach Equine Clinic

Today's competitive sport horses are asked to perform at their absolute best at the most prestigious competitions all over the world. Travel and life at the show grounds can be extremely stressful for horses. Ulcers can affect any horse, but competitive sport horses with the extra stressors from a life of work and travel are especially prone. The veterinarians at Palm Beach Equine Clinic (PBEC) strive to ensure that horses under their care remain healthy and ulcer-free. There are many precautions that can be taken to prevent ulcers from developing, but if a horse does suffer from ulcers, PBEC is there to assist with treatment.

What are ulcers?
There are two different kinds of ulcers - gastric ulcers and hindgut ulcers. Horses can develop one or the other, or both in combination, but gastric ulcers are most common. Gastric ulcers develop in the stomach, which is comprised of two different halves. The lower half of the stomach secretes acid and digestive enzymes to properly digest food. If the acid splashes up to the upper half of the stomach, there is minimal protection and causes painful erosion of the stomach lining.

Increased acidity in the stomach heightens the chance that acid will come in contact with the larger, unprotected portion, resulting in damage to the stomach lining. There are many different factors that can change the environment of the stomach and cause increased acid production, ultimately resulting in ulcers. The most common factors are drastic changes in feeding times or types of feed, undue stress, and corrosive medications.

For the competitive equine, the stress of traveling and showing, as well as any change in environment or increased work, can increase the chances of ulcers forming. Abnormal sleep patterns at shows can cause added stress. It is important to ensure that the horse has ample bedding and space to feel comfortable enough to lay down to rest. Joint pain or other physical pain can also cause unnecessary stress to the horse's system. Joint supplements, routine injections, and alternative therapies such as chiropractic and acupuncture can be used to keep the horse comfortable and stress-free.

Another major cause of gastric ulcers is chronic administration of phenybutazone (bute), banamine, or other nonsteroidal anti-inflammatory drugs (NSAIDs) as these medications can be corrosive to the stomach lining.

How are they diagnosed?
Ulcers can be difficult to diagnose as early signs can easily be confused with colic. Many times, horses with ulcers show mild, chronic, colic-like symptoms that resolve fairly quickly. Owners and trainers may notice that the horse seems sore after eating, denies feed entirely, or has colic-like symptoms such as upper lip movement, biting at its side, or pawing. If the ulcer is undiagnosed and the horse is given banamine to treat the colic symptoms, ulcers can actually be exacerbated.

There are several ways to diagnose ulcers. First, if ulcers get severe enough, they can cause the stomach to bleed, and can be tested in a quick blood test to check for a low red blood cell count or anemia. A small amount of dark blood present in the stool can detect bleeding gastric ulcers or the right dorsal colon, but usually it is a microscopic amount and it can be difficult to visualize. A fecal test to test for blood in the stool can be performed but it is not the most specific or reliable method.

The most definitive way to diagnose gastric ulcers is the use of a gastroscope to provide an internal scan. A small camera is inserted down the esophagus and into the stomach, which allows for a clear picture of the separation between the glandular bottom portion and the upper unprotected portion of the stomach. On the gastroscope, ulcers with ranging severity can appear to be a minor red irritation or actual holes, which are depressions of the lining of the stomach. With the gastroscope, a veterinarian can also visualize the beginning of the small intestine, which is another common area for erosions to occur.

Hindgut ulcers can easily be identified by a non-invasive ultrasound of the colon.  With an ultrasound, the veterinarian is able to determine if a specific area of the colon wall is thickened.  Thickening of the wall is abnormal and is a primary sign of colonic ulcers. The drugs to treat hind gut ulcers differ from gastric ulcers but the treatment period is still four weeks or more.

Treatment and Prevention Tips
If ulcers are diagnosed to be present, they are graded as to their location and severity. A treatment plan is determined according to these factors.

1. The gold standard treatment is Omeprazole for four weeks - one tube a day for 28 days. The most common Omeprazole treatment is Gastrogard. Oral supplements, such as calcium, which help to neutralize the stomach acids and act as a buffer to protect the stomach lining, are also sometimes recommended.
2. If your horse is diagnosed with ulcers, it is important to avoid bute and banamine, if possible. Also, maintaining a consistent feeding schedule is important to avoid causing any major increases in acid production in the stomach.
3. Keep the pH of the stomach neutral by adding one flake of alfalfa to the horse's hay per day. It helps to lower the acidity of the stomach. Changes to a horse's diet should always be discussed with a veterinarian.
4. A proven way to prevent ulcers is to prophylactically give Omeprazole a day or two before a stressor. If you know the horse is traveling or going to a show, start administering Omeprazole three to four days prior. Gastric medications can be given every day during the stressor time period, at the show, and then a day or two following the show.

Have further questions about equine ulcers and how PBEC can help prevent them? Call the clinic today at 561-793-1599 to learn more.