Equine gastric ulceration in practice

01 March 2013, at 12:00am

DAVID McDONALD outlines how his practice has seen a rapid increase in the number of horses diagnosed with gastric ulcers and presents two case histories

IT is nearly 10 years since the first and only licensed medication treatment for equine gastric ulceration syndrome (EGUS) was launched in the UK.

In that time it’s been well documented that the only way to definitively diagnose equine gastric ulceration is via a 3m video gastroscope, so it is no surprise that the number of equine practices owning a scope has increased from just a handful in 2003 to an estimated 130 in 2013.

Milbourn Equine purchased its 3m gastroscope in December 2010 and has seen a rapid increase in the number of horses presented and diagnosed with ulcers since then.

In the first 12 months after purchasing the scope we carried out 26 gastroscopies, and in 2012 this more than doubled to 65. At a cost of just over £7,500, the break even number was 42 (from purchase) so we have now exceeded that. We expect numbers to continue to grow as awareness of ulceration and the signs of the condition increases.

We organise and promote monthly gastroscopy clinics which have really helped to focus on the issue whilst creating awareness of the availability of the scope. In addition, a number of insurance company policies include the diagnosis and first treatment of ulcers, so it is worth checking with clients to see if they are covered.

Following a course of treatment for squamous ulceration it is important to set in place preventive management strategies. This is based primarily on preventing stomach acid contact with the squamous area by encouraging turnout and access to forage, feeding three or more meals a day and where possible reducing the carbohydrate portion of the diet.

It’s important to emphasise that exercise should not be carried out on an empty stomach, which sometimes horse owners find hard to get their heads around! Feeding a handful of lucerne hay pre-exercise can be beneficial.

For prevention following treatment of mucosal ulceration, our advice is focused on stress management. We help to identify increased risk of stress for the horse, for example when travelling, and may recommend 2mg/kg GastroGard (Merial) for the duration of the travelling period, or a supplement such as Equitop Pronutrin (Boehringer Ingelheim).

Increasing awareness

Many owners are aware of the more common signs of ulcers such as behavioural issues and poor condition; however, I feel fewer people consider EGUS when presented with mild recurrent colic or school issues.

There is no doubt that the advances in veterinary science in terms of both diagnosis and treatment of ulcers has resulted in significant benefits in terms of welfare and performance for UK horses.

However, with approximately 50% of the equine population estimated to have ulcers, there is still a long way to go. This presents significant opportunities for practices, in terms of both animal welfare and increased business.

Case 1

Freddie is a seven-year-old thoroughbred gelding. Six weeks after being purchased Freddie began showing signs of narcolepsy; described by his owner as “starts to look sleepy, head drops, knuckles over and falls to the ground, appears to sleep, then gets up after a few minutes”.

He had also become progressively “grumpy” and sensitive around his girth area. Freddie was in moderate body condition (4/10) and his coat appeared dull.

Clinical examination, including gait assessment, and back examination was unremarkable, and no abnormalities were detected on routine biochemistry/haematology or electrocardiogram.

Gastroscopy was carried out and revealed extensive areas of grade 4 ulceration affecting the squamous area of the stomach in the region of the greater curvature and a large area of grade 3 ulceration around the cardia. A presumptive diagnosis of sleep deprivation syndrome secondary to severe gastric ulceration was made.

Initial treatment was carried out with GastroGard (omeprazole) at 4mg/kg daily for 14 days, followed by 2mg/kg daily for 14 days. (The recommended dose is officially 4mg/kg daily for 28 days).

No further narcoleptic episodes were witnessed during the treatment period and the horse’s demeanour improved.

Repeat gastroscopy on day 28 revealed a marginal improvement in extent and severity of ulcers seen. Treatment was continued with GastroGard at a dose of 4mg/kg, in addition trimethoprim-sulphadiazine (Norodine Granules) at a standard 500kg dose twice daily was instigated. Both treatments were continued for 28 days.

Repeat gastroscopy carried out at the end of this treatment period revealed complete ulcer healing. Freddie has had no further narcoleptic episodes; his demeanour has improved greatly and he no longer appears to be sensitive around his girth area. His body condition score has improved to 6/10 and his coat is noticeably less dull.

Case 2

Cobweb is a nine-year-old thoroughbred mare used for pony racing. She was in moderate body condition 4/10 and had been wormed regularly. In the 18 months prior to gastroscopy, Cobweb had suffered three episodes of colic, all of which had been treated medically with non- steroidal anti-inflammatory drugs and had resolved quickly. Cobweb also exhibited marked windsucking behaviour both when stabled and turned out.

On race days, she was travelled without access to hay, and feed was withheld until she had been raced.

Gastroscopy revealed a large EGUS grade 4 ulcer present adjacent to the margo-plicatus in the region of the lesser curvature of the stomach. There was generalised hyperkeratosis and bile staining of the squamous mucosa. The glandular mucosa was of normal appearance. Treatment was initiated with GastroGard at 4mg/kg for 28 days.

On day 28 repeat gastroscopy was carried out and revealed a 75% improvement of the ulcer and marked reduction in hyperkeratosis. Windsucking behaviour was greatly reduced.

Treatment with GastroGard was continued at a dose of 2mg/kg. In addition, management changes included the addition of lucerne hay to Cobweb’s feed ration. She now has access to hay en route to competitions and a handful of lucerne hay is fed prior to racing. Following this period, repeat gastroscopy was not carried out for financial reasons.

Nine months following treatment, Cobweb has had no further episodes of colic, her owner feels her general condition has improved and her windsucking behaviour has reduced, especially while being turned out.