Nutritional management of gastric ulceration

Gastric ulcers are common in horses and equine gastric ulcer syndrome describes ulcers in the distal oesophagus, nonglandular and glandular stomach as well as the proximal duodenum. Ulcers in the distal oesophagus and nonglandular region of the stomach are probably caused by hydrochloric acid, whereas ulcers in the glandular stomach and proximal duodenum are likely to be caused by a breakdown in the mucosal defence mechanisms. Regardless of the location of ulcers, initial treatment with pharmacological agents is necessary to suppress hydrochloric acid; however, nutrition and management changes are required to maintain ulcer healing and help prevent recurrence. In addition, many dietary supplements have been marketed to help maintain stomach health and some scientific data on their effects on gastric ulcer scores and gastric juice pH are presented.     

Evaluation of diet as a cause of gastric ulcers in horses

OBJECTIVE: To measure pH, volatile fatty acid (VFA) concentrations, and lactate concentrations in stomach contents and determine number and severity of gastric lesions in horses fed bromegrass hay and alfalfa hay-grain diets. ANIMALS: Six 7-year-old horses. PROCEDURE: A gastric cannula was inserted in each horse. Horses were fed each diet, using a randomized crossover design. Stomach contents were collected immediately after feeding and 1, 2, 3, 4, 5, 6, 7, 8, 10, 12, and 24 hours after feeding on day 14. The pH and VFA and lactate concentrations were measured in gastric juice Number and severity of gastric lesions were scored during endoscopic examinations. RESULTS: The alfalfa hay-grain diet caused significantly higher pH in gastric juice during the first 5 hours after feeding, compared with that for bromegrass hay. Concentrations of acetic, propionic, and isovaleric acid were significantly higher in gastric juice, and number and severity of nonglandular squamous gastric lesions were significantly lower in horses fed alfalfa hay-grain. Valeric acid, butyric acid, and propionic acid concentrations and pH were useful in predicting severity of nonglandular squamous gastric lesions in horses fed alfalfa hay-grain, whereas valeric acid concentrations and butyric acid were useful in predicting severity of those lesions in horses fed bromegrass hay. CONCLUSIONS AND CLINICAL RELEVANCE: An alfalfa hay-grain diet induced significantly higher pH and VFA concentrations in gastric juice than did bromegrass hay. However, number and severity of nonglandular squamous gastric lesions were significantly lower in horses fed alfalfa hay-grain. An alfalfa hay-grain diet may buffer stomach acid in horses.     

Effect of a pelleted supplement fed during and after omeprazole treatment on nonglandular gastric ulcer scores and gastric juice pH in horses

Gastric ulcers are common in horses. The purpose of this study was to test the effect of a commercially available supplement, SmartGut^® Ultra pellets (SmGU) on gastric ulcer scores and gastric juice pH after omeprazole treatment in stall‐confined horses. Eight Thoroughbred horses were studied in a 2‐period, 2‐treatment crossover design, where the SmGU (40 g, twice daily) was mixed in grain feed. Horses were stall‐confined and treated with the supplement or control for 6 weeks, consisting of 2 weeks (Days 1–14) omeprazole treatment, 2 weeks (Days 14–28) following discontinuation of omeprazole treatment, one week (Days 28–35) alternating feed deprivation to induce or worsen existing ulcers and a one week (Days 35–42) recovery period. Gastroscopy was performed and gastric juice pH measured on Days 0, 14, 28, 35 and 42. Gastric ulcer lesion number (NGN) and severity (NGS) scores were assigned to each horse by an investigator (F.M.A.) masked to treatment. On Day 0 before treatment, mean NGN and NGS scores and gastric juice pH were not different (P>0.05) between treatment groups. By Day 14, mean NGN and NGS scores decreased (P<0.05) in both treatment groups. By Days 28 and 35, mean NGN score significantly increased in the untreated control horses but not the SmGU‐treated horses. By Day 42, mean NGN and NGS scores were not different in either group and were significantly lower than Day 0. Mean gastric juice pH was higher in both groups on Day 14 as a result of omeprazole treatment when compared with other days. SmartGut^® Ultra supplement added to the feed prevented the worsening of gastric ulcer number 2 weeks after omeprazole treatment, without altering the gastric juice pH. Supplementation with SmGU might aid in protection of the nonglandular stomach from recurrence of ulcers after omeprazole treatment in stall‐confined horses undergoing intermittent feeding.     

The effect of porcine hydrolysed collagen on gastric ulcer scores,gastric juice pH,gastrin and amino acid concentrations in horses

Gastric ulcers are common in horses. The purpose of this study was to test the effect of porcine hydrolysed collagen (PHC) on gastric ulcer scores and gastric juice pH in horses. We hypothesise that PHC-administration will result in improved gastric lesion scores and act synergistically with omeprazole to improve treatment efficacy. Thoroughbred horses (n = 10) were studied in a 2-period, 2-treatment crossover design, where the PHC (45 g) was administered twice daily. Horses were treated for 56 days. Gastroscopy was performed and gastric juice pH measured on Days 0, 14, 28, 42, 49 and 56. Nonglandular gastric ulcer number (NGN) and severity (NGS) and glandular ulcer number (GN) and glandular severity (GS) scores were assigned by an investigator masked to treatment and serum gastrin and amino acid concentrations. By Day 42, 2 weeks after discontinuing omeprazole treatment, NGN and NGS scores returned to pretreatment values and serum gastrin was higher when compared to values measured on Day 28. By Day 49, after the feed-deprivation period, NGN and NGS were similar to pretreatment values. By Day 56, mean NGN score was significantly lower in PHC-treated horses, compared to controls. Mean gastric juice pH significantly increased in both groups on Day 28 and the pH was significantly (P = 0.0127) higher in the PHC-treated horses. Serum amino acid concentrations were not significantly different 2 h after feeding PHC and hydroxyproline was not detected. Serum gastrin concentration did not increase 2 h after feeding in the PHC-fed horses. The PHC fed to horses enhanced the effects of omeprazole on increased gastric juice pH, inhibited gastrin secretion after feeding and resulted in fewer nonglandular ulcers after long-term feeding (56 days) in stall-confined horses undergoing intermittent feeding.     

Effects of intravenously administered esomeprazole sodium on gastric juice pH in adult female horses

Background: Gastric ulcers are common in horses and treatment of horses that cannot be administered oral medication can be problematic. Objectives: To evaluate the efficacy of esomeprazole sodium administered intravenously on gastric juice pH and gastric ulcer scores in horses. Animals: Twelve adult female Quarter Horses. Methods: Esomeprazole sodium (0.5 mg/kg IV) was administered once daily to 8 horses (treatment group) and saline (5 mL IV) was administered to 4 horses (control group) for 13 consecutive days. Gastroscopy was performed and gastric juice pH and gastric ulcer score were recorded before and 1 hour after the administration of esomeprazole sodium or saline on days 1 and 5, then on day 14, 23 hours after the 13th daily dose of esomeprazole sodium or saline. Results: When compared with values before treatment, gastric juice pH was higher in esomeprazole sodium‐treated horses after treatment (4.25 ± 2.39 versus 6.43 ± 1.18; P= .002). Also, gastric juice pH was higher (P= .001) in esomeprazole sodium‐treated horses compared with saline‐treated control horses on day 5 and on day 14 values. Gastric ulcers were seen in 5/12 (43%) horses in the study. Conclusions and Clinical Importance: Esomeprazole sodium shows promise for treatment of gastric ulcers in horses with signs of dysphagia, gastric reflux, or other conditions that restrict oral intake of the current Federal Drug Administration‐approved omeprazole paste.     

Effects of intravenously administrated omeprazole on gastric juice pH and gastric ulcer scores in adult horses

The study was performed to evaluate the efficacy of omeprazole powder in sterile water, administered intravenously, on gastric juice pH in adult horses with naturally occurring gastric ulcers. Omeprazole (0.5 mg/kg, IV) was administered once daily for 5 days to 6 adult horses with gastric ulcers. Gastric juice was aspirated through the biopsy channel of an endoscope and pH was measured before and 1 hour after administration of omeprazole on day 1, and then before and after administration of omeprazole on day 5. Gastric ulcer scores were recorded on day 1 before administration of omeprazole and on day 5, 23 hours after the 4th daily dose. Gastric juice pH and ulcer scores were compared between the times. When compared with the pre-injection value (2.01 +/- 0.42), mean +/- SD gastric juice pH was significantly higher when measured 1 hour after administration of the initial dose (4.35 +/- 2.31), and before (5.27 +/- 1.74) and 1 hour after (7.00 +/- 0.25) administration of omeprazole on day 5. Nonglandular gastric ulcer number score significantly decreased from a mean +/- SD of 3.2 +/- 0.80 to 2.0 +/- 1.1, but nonglandular gastric ulcer severity score remained the same. Few glandular ulcers were seen in the study, and scores did not change. Because of its potent and long duration of action on gastric juice pH, this intravenous formulation of omeprazole may show promise for treatment of equine gastric ulcer syndrome (EGUS) in horses with dysphagia, gastric reflux, or other conditions that restrict oral intake of omeprazole paste. Aspiration of gastric juice and measurement of pH can be of use to determine whether the desired pH > 4.0 has been reached after omeprazole treatment.     

Effect of paddock vs. stall housing on 24 hour gastric pH within the proximal and ventral equine stomach

REASONS FOR PERFORMING STUDY: Stall housing has been suggested as a risk factor for ulcer development in the equine stomach; however, the exact pathogenesis for this has not been established. OBJECTIVES: To investigate the effect of 3 environmental situations (grass paddock, stall alone or stall with adjacent companion) on pH in the proximal and the ventral stomach. METHODS: Six horses with permanently implanted gastric cannulae were used in a randomised, cross-over, block design. Each horse rotated through each of three 24 h environmental situations. Horses remained on their normal diet (grass hay ad libitum and grain b.i.d.) throughout the study. Intragastric pH was measured continuously for 72 h just inside the lower oesophageal sphincter (proximal stomach) and via a pH probe in the gastric cannula (ventral stomach). RESULTS: Neither proximal nor ventral 24 h gastric pH changed significantly between the 3 environmental situations. Mean hourly proximal gastric pH decreased significantly in the interval from 01.00-09.00 h compared to the interval from 13.00-20.00 h, regardless of environmental situation. Median hourly proximal pH only differed in the interval from 06.00-07.00 h compared to the interval 14.00-19.00 h. Neither mean nor median hourly ventral gastric pH varied significantly with the time of day. CONCLUSIONS: The change in housing status used in the current study did not affect acid exposure within either region of the equine stomach. The pH in the ventral stomach was uniformly stable throughout the study, while the proximal pH demonstrated a 24 h circadian pattern.     

The Effect of a Seaweed-Derived Calcium Supplement on Gastric Juice pH in the Horse

Low gastric pH for extended periods of time can increase the risk of gastric ulceration in horses. Therefore, nutritional interventions that buffer stomach acid may be helpful to decrease ulcer risk. The objective of this trial was to evaluate whether the incorporation of calcified Lithothamnion corallioides and Phymatolithon calcareum (Calmin; Celtic Sea Minerals, Cork, Ireland) into an equine ration would buffer equine gastric juice. Nine mature, Thoroughbred-cross horses, including 6 geldings and 3 mares (524 ± 49 kg) were housed in stalls and fed 2 kg/day of a texturized concentrate (Purina Omolene 100) and 1.5% BW grass hay/day. On testing days 0, 7, and 14, the horses received one of three pelleted dietary treatments (CON, MIN1 ×, MIN2 ×) in a randomized, crossover design. CON contained no added Calmin, MIN1 × provided Calmin at a 1 × concentration, and MIN2 × provided a 2 × dose. All horses underwent gastroscopy (Karl Storz, El Segundo, CA) prior to feeding the treatments, and at 2 and 4 hours postfeeding. Gastric juice was aspirated and pH measured using a benchtop pH meter (ThermoOrion pH Meter Model 410A). Overall, there was a significant time effect (P < .0001) with an increase in gastric juice pH from time 0 (2.31 ± 0.58) to 2 hours (5.52 ± 0.48) and 4 hours (3.59 ± 0.48). Gastric juice pH at 2 hours was higher (P = .0122) in MIN1 × (5.92 ± 0.58) and MIN2 × (5.92 ± 0.57) than CON (5.08 ± 0.58). These results demonstrate that adding Calmin to a meal increases buffering capacity at 2 hours postfeeding.     

Equine gastric ulcer syndrome in adult horses: a review

In recent years, gastric ulceration has been recognised as a common, possibly performance-limiting disease of adult horses. Here, we aim to provide the reader with a useful review of recent literature covering all aspects of equine gastric ulcer syndrome (EGUS) in adult horses. The anatomy and physiology of the stomach, with particular reference to secretion of acid and mucosal protective mechanisms, are reviewed, as are the differing theories relating to the aetiopathogenesis of gastric ulceration. We also explore the possible influence of various management factors on development of the disease. The prevalence of the disease in racehorses has been reported to be as high as 100%. In general, horses that are in active training for racing tend to have a prevalence of around 90%, whereas pleasure horses in full work have a reported prevalence of approximately 60%. Emerging diagnostic tests which could obviate the need for gastroscopy are introduced and current recommendations for treatment are summarised, focussing on proton pump inhibitors, in particular omeprazole, administered orally. The oral administration of omeprazole has been shown to be effective in both treating horses with gastric ulceration and at preventing re-occurrence whilst the horses are in training, provided that daily dosing is maintained.     

Effects of hydrochloric,acetic, butyric,and propionic acids on pathogenesis of ulcers in the nonglandular portion of the stomach of horses

OBJECTIVE: To identify the pathogenesis of gastric ulcers by comparing injury to the nonglandular gastric mucosa of horses caused by hydrochloric acid (HCl) or volatile fatty acids (VFAs). SAMPLE POPULATION: Gastric tissues from 30 horses. PROCEDURE: Nonglandular gastric mucosa was studied by use of Ussing chambers. Short-circuit current (Isc) and potential difference were measured and electrical resistance calculated for tissues after addition of HCl and VFAs to normal Ringer's solution (NRS). Tissues were examined histologically. RESULTS: Mucosa exposed to HCl in NRS (pH, 1.5) had a significant decrease in Isc, compared with Isc for mucosa exposed to NRS at pH 4.0 or 7.0. Also, exposure to 60mM acetic, propionic, and butyric acids (pH, 4.0 or 1.5) caused an immediate significant decrease in Isc. Recovery of sodium transport was detected only in samples exposed to acetic acid at pH 4.0. Recovery of sodium transport was not seen in other mucosal samples exposed to VFAs at pH < or = 4.0. CONCLUSIONS AND CLINICAL RELEVANCE: Acetic, butyric, and propionic acids and, to a lesser extent, HCl caused decreases in mucosal barrier function of the nonglandular portion of the equine stomach. Because of their lipid solubility at pH < or = 4.0, undissociated VFAs penetrate cells in the nonglandular gastric mucosa, which causes acidification of cellular contents, inhibition of sodium transport, and cellular swelling. Results indicate that HCl alone or in combination with VFAs at gastric pH < or = 4.0 may be important in the pathogenesis of gastric ulcers in the nonglandular portion of the stomach of horses.     

Effect of a feed/fast protocol on pH in the proximal equine stomach

Reasons for performing study: Risk factors for the development of gastric squamous ulcers include various management procedures, such as intermittent feed deprivation that can occur during weight management regimens or stall and dry lot confinement. Objectives: To investigate the effect of intermittent feed deprivation relative to continuous feed intake on proximal intragastric pH, specifically in the region of the squamous mucosa of the lesser curvature. Methods: In 6 horses, pH electrodes were placed just inside of the oesophageal sphincter in the stomach for each of two 72 h protocols (A and B) in a randomised, cross‐over design. Protocol A consisted of 12 h fed, 12 h fasted, 24 h fed and 24 h fasted, in sequence. Protocol B consisted of 72 h fed. During the fed periods of each protocol, horses had ad libitum access to coastal Bermuda hay and were fed sweet feed (1 kg, b.i.d.). Horses had ad libitum access to water at all times. Results: Proximal intragastric pH was significantly lower during protocol A, than during protocol B. However, hourly mean pH was significantly different only during the day and evening hours between protocols. During protocol B, mean proximal pH decreased significantly from 03.00 to 09.00 compared to 19.00 to 23.00 h. A moderate positive correlation of hay intake vs. proximal gastric pH could be established. Conclusions: Intermittent feed deprivation decreased proximal gastric pH in horses relative to those horses for which feed was not restricted. However, the effect was only significant when fasting occurred during the day and evening hours, as a nocturnal decrease in pH occurred simultaneously in the fed horses. Potential relevance: Episodes of daytime feed deprivation should be avoided if possible, as proximal gastric acid exposure rapidly increases during such events.     

Effect of an indwelling nasogastric tube on gastric emptying rates of liquids in horses

OBJECTIVE: To evaluate the effect of an indwelling nasogastric tube on gastric emptying of liquids in horses. ANIMALS: 9 healthy adult horses. PROCEDURE: A randomized block crossover design was used. For treatment group horses, a nasogastric tube was placed and 18 hours later, acetaminophen was administered; the nasogastric tube remained in place until the experiment was complete. For control group horses, a nasogastric tube was passed into t stomach, acetaminophen was administered, and the nasogastric tube was removed immediately. Serial blood samples were collected 15 minutes before and after administration of acetaminophen. Serum concentration of acetaminophen was determined by use of fluorescence polarization immunoassay. The variables, time to maximum acetaminophen concentration (Tmax) and the appearance constant for acetaminophen (Kapp), were determined. The values for Kapp and Tmax in horses with and without prolonged nasogastric tube placement were compared. RESULTS: No significant difference was found in Kapp between horses with and without prolonged nasogastric tube placement; the median difference in Kapp was 0.01 min(-1) (range, -0.48 to 0.80 min(-1). No significant difference was found in Tmax between horses with and without prolonged nasogastric tube placement; the median difference in Tmax was 5 minutes (range, -30 to 50 minutes). Reanalysis of data following the removal of possible outlier values from 1 horse resulted in a significant difference in Tmax between horses with and without prolonged nasogastric tube placement. CONCLUSIONS AND CLINICAL RELEVANCE: Although no clinically important impact of 18 hours of nasogastric intubation was found on gastric emptying in healthy was found among horses.     

Effects of hydrochloric,valeric, and other volatile fatty acids on pathogenesis of ulcers in the nonglandular portion of the stomach of horses

OBJECTIVE: To identify in vitro effects of hydrochloric acid, valeric acid, and other volatile fatty acids (VFAs) on the pathogenesis of ulcers in the nonglandular portion of the equine stomach. SAMPLE POPULATION: Gastric tissues from 13 adult horses. PROCEDURE: Nonglandular gastric mucosa was studied by use of Ussing chambers. Short-circuit current (Isc) and potential difference were measured and electrical resistance and conductance calculated after tissues were bathed in normal Ringer's solution (NRS) or NRS and hydrochloric, valeric, acetic, propionic, and butyric acids. Treated tissues were examined histologically. RESULTS: Incubation in 60mM valeric acid at pH < or = 7.0 abruptly and irreversibly abolished Isc, which was followed by a slower decrease in resistance and an increase in conductance. Incubation in 60mM acetic, propionic, and butyric acids and, to a lesser extent, hydrochloric acid at pH < or = 7.0 significantly decreased Isc, which was followed by an increase in resistance and a decrease in conductance. CONCLUSIONS AND CLINICAL RELEVANCE: Incubation in valeric acid at pH < or = 7.0 caused a dramatic decrease in mucosal barrier function in the nonglandular portion of the stomach. Changes in barrier function attributable to exposure to valeric acid were associated with histopathologic evidence of cellular swelling in all layers of the nonglandular mucosa. Because of its high lipid solubility, valeric acid penetrates the nonglandular gastric mucosa, resulting in inhibition of sodium transport and cellular swelling. Valeric acid and other VFAs in gastric contents may contribute to the pathogenesis of ulcers in the nonglandular portion of the stomach of horses.     

Placement of an indwelling percutaneous gastrotomy (PEG) tube for the measurement of intra‐gastric pH in two horses

Intra‐gastric pH monitoring is an important tool in the validation of acid suppressive drugs. To date, several methods of monitoring intra‐gastric pH in the horse have been described. However significant limitations are present in the existing models. This article describes the placement of a percutaneous gastrotomy (PEG) tube secured with a button gastropexy in the standing horse through which the pH of the ventral stomach can readily be measured under both fed and fasted conditions.     

Effects of exercise on gastric volume and pH in the proximal portion of the stomach of horses

OBJECTIVE: To assess effects of exercise on a treadmill with changes in gastric volume and pH in the proximal portion of the stomach of horses. ANIMALS: 3 healthy adult horses. PROCEDURE: A polyester bag of approximately 1,600 mL was placed into the proximal portion of the stomach of each horse via a nasogastric tube. Changes in bag volume, determined by an electronic barostat, were recorded before, during, and after a training session on a treadmill with and without prior withholding of food. In separate experiments, pH in the proximal portion of the stomach was continuously recorded during exercise for fed and food-withheld conditions. Finally, changes in intra-abdominal and intragastric pressure were simultaneously recorded during a training session. RESULTS: Bag volume rapidly decreased to nearly zero during trotting and galloping. Conversely, a return to walking resulted in a sharp increase in volume and a return to pre-exercise values. Intragastric and intra-abdominal pressures increased almost in parallel with walking, trotting, galloping, and galloping on a slope. Gastric pH decreased rapidly to < 4 at the beginning of walking, continued to decrease during trotting and galloping, and remained low until a return to walking. CONCLUSIONS AND CLINICAL RELEVANCE: Increased intra-abdominal pressure during intense exercise in horses causes gastric compression, pushing acidic contents into the proximal, squamous-lined region of the stomach. Increased duration of acid exposure directly related to daily duration of exercise may be the reason that squamous lesions tend to develop or worsen when horses are in intensive training programs.     

Effect of GastroGard and three compounded oral omeprazole preparations on 24 h intragastric pH in gastrically cannulated mature horses

REASONS FOR PERFORMING STUDY: Ulceration of the squamous gastric mucosa is commonly associated with intensive training programmes in horses, but only one compound ('Gastrogard') has been subjected to controlled scrutiny as to therapeutic efficacy. OBJECTIVES: To compare the gastric acid inhibitory efficacy of one manufactured ('GastroGard') and 3 generic pharmacy-compounded preparations of the proton pump inhibitor omeprazole (OME) in the mature horse. HYPOTHESIS: All OME preparations tested would induce a clinically acceptable effect. METHODS: Six healthy mature gastrically cannulated horses of various breeds, 3 mares and 3 geldings, were used. Each product was administered per os once daily (0730 h) at an equivalent dose of 4 mg OME/kg bwt, in a randomised complete repeated measures design for sequence of individual preparation treatment per horse. There was a minimum of 14 days between treatment regimens. A portable unit that recorded pH continuously was attached to a recording electrode fixed within the gastric lumen via the gastric cannula. Three 24 h recordings were made one day before and during Days 2 and 7 after commencement of a 7 day treatment with each of the 4 individual preparations. The horses were fed as usual throughout the study. RESULTS: Only the GastroGard and one other preparation induced a significant increase over baseline in mean percentage of time that the pH was > 4.0 and mean median intragastric pH, during the first 14 and 12 h post treatment respectively, for both Days 2 and 7 post treatment. Both these products had a vehicle pH > 8.0, in contrast to the 2 less effective products, where the vehicle pH was < 6.0. CONCLUSIONS: OME at 4 mg/kg per os s.i.d. can effectively maintain intragastric pH at an accepted anti-ulcerogenic level for at least 12 h post administration in mature horses. In contrast to GastroGard, it should not be expected that all compounded preparations of OME are equally effective in achieving this performance. It appears that vehicle pH might play an important part in determining preparation efficacy. POTENTIAL RELEVANCE: Optimal timing for daily dosing of athletic horses with an effective OME preparation, in order to suppress gastric squamous ulceration, might be 4-8 h prior to a training session.     

Effects of supplements containing turmeric and devil’s claw on equine gastric ulcer scores and gastric juice pH

Supplements containing turmeric (Curcuma longa) and devil’s claw (Harpagophytum species) are commonly fed to horses to decrease inflammation and pain, but because these supplements contain spices and plant irritants, warning labels such as 'these supplements might cause gastric irritation' are required. The purpose of this study was to determine whether supplements containing turmeric and devil’s claw cause or worsen gastric ulcers in stall-confined horses, as suggested in required cautions that appear on the labels of these animal products. Twelve clinically healthy Thoroughbred horses with naturally occurring equine gastric ulcer syndrome (EGUS) scores >0 were included in a noncrossover study design. Horses were stratified by EGUS score and assigned to either the treatment (supplements containing turmeric and devil’s claw) or control (same supplements without active ingredients) group and fed the supplements for 28 days. Gastroscopy was performed on Days 0, 14 and 28. The EGUS score, nonglandular ulcer number (NGN) and severity (NGS) scores, and glandular number (GN) and severity (GS) scores were recorded during each gastroscopy by a masked investigator (F.M.A.). In addition, bodyweight, gastric juice pH, packed cell volume (PCV), total protein (TP) and blood biochemical results were measured on Day 0 and Day 28. Mean EGUS and NGS scores were significantly lower in both treatment and control groups by Days 14 and 28, when compared to Day 0. NGN score was not different among groups. Bodyweight, gastric juice pH and blood parameters did not change during the study. In conclusion, supplements containing turmeric and devil’s claw did not cause or worsen gastric ulcers or alter health parameters after 28 days of feeding.     

Effects of orally administered enteric-coated omeprazole on gastric acid secretion in horses.

OBJECTIVES: To determine the effects of orally administered omeprazole, as enteric-coated capsules, on baseline and stimulated gastric acid secretion in horses. ANIMALS: 5 healthy 8-year-old mixed-breed horses fitted with gastric cannulas. PROCEDURE: Enteric-coated granules of omeprazole were mixed with corn syrup and administered orally once daily for 5 consecutive days. On days 1 and 5 beginning 5 hours after omeprazole administration, 4 gastric fluid samples were collected, each for 15 minutes, via the gastric cannula (baseline samples). Pentagastrin was administered IV as a constant infusion for the subsequent 2 hours, and 15-minute gastric fluid samples were again collected (stimulated samples). Fluid volume, acidity (mmol H-/L), and pH and gastric acid production (mmol H+) were determined for all baseline samples and for stimulated samples collected during the second hour of pentagastrin infusion. Control experiments were done in a similar manner after giving corn syrup alone to the same horses. RESULTS: Compared with values obtained during control experiments, baseline and stimulated gastric fluid acidity and gastric acid production significantly decreased, and the mean pH of gastric fluid samples significantly increased, after horses were given 5 daily doses of omeprazole. CONCLUSIONS AND CLINICAL RELEVANCE: Enteric-coated omeprazole (1.0 mg/kg of body weight; PO) administered once daily for 5 days significantly inhibited unstimulated and pentagastrin-stimulated gastric acid secretion in horses. This commercially available formulation of omeprazole may be efficacious in the treatment of gastroduodenal ulcers in horses.     

Aspiration pneumonitis (Mendelson's syndrome) as perianaesthetic complication occurring in two horses: A case report

No published reports on the occurrence of Mendelson's syndrome (pneumonitis caused by aspiration during anaesthesia) in horses were found in the literature. Although the peculiar anatomy of the equine stomach makes horses less prone than other species to regurgitate, gastric reflux may still occur in horses with colic under certain circumstances. The colic horses in this report had in common stomach impaction, abdominal distention and preanaesthetic placement of a nasogastric tube, which was not withdrawn prior to induction. In both cases, a significant volume of gastric reflux was noted pouring from the endotracheal tube during general anaesthesia for exploratory laparotomy. It was hypothesised that the cause of gastric reflux was the combination of increased intra-abdominal pressure and patency of the cardia, and that inhalation of gastric content occurred at induction, before tracheal intubation. Treatment, which failed to improve oxygenation, consisted of repositioning of the horses to facilitate passive drainage of gastric content from the airways, active suction through the endotracheal tubes, ventilation strategies, improvement of haemodynamics to increase the pulmonary perfusion, and administration of bronchodilators. One horse was subjected to euthanasia owing to poor prognosis. Aspiration pneumonitis should be regarded as a life-threatening, although rare, perianaesthetic complication in equine colic cases. Patency of the cardia and increased intra-abdominal pressure are possible predisposing factors. Partial or even total withdrawal of the nasogastric tube prior to anaesthetic induction and tracheal intubation performed with the horse positioned in sternal recumbency may be undertaken as preventive measures in patients at high risk of developing Mendelson's syndrome.     

Prevalence of gastric ulcers in endurance horses--a preliminary report

Gastric endoscopy was performed at the end of a 50 or 80 km endurance ride. Gastric ulceration was evident in 67% of the horses with ulcers on the squamous region of the stomach found in 57% of the horses and active bleeding of the glandular mucosa in 27%. Three horses (10%) had lesions only on the glandular mucosa. Values of albumin, creatinine and glucose were higher in horses without gastric lesions. We conclude that horses from endurance competitions have a high prevalence of gastric ulceration that is similar to that observed in performance horses. However the severity of ulceration is less severe than has been reported in Thoroughbred race horses in active training. Owners should be aware of the high prevalence of gastric ulceration in horses that perform in endurance competitions. The high incidence of active bleeding from the glandular mucosa of the stomach in these horses requires further investigation.