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.     

Rethinking equine gastric ulcer syndrome: Part 1 – Terminology,clinical signs and diagnosis

Equine gastric ulcer syndrome (EGUS) is a common condition in the horse. A series of recent articles highlighting differences in healing of squamous and glandular ulceration have reinvigorated interest in the condition. The purpose of this series of articles is to review the current thinking on EGUS with particular emphasis on the differences between diseases of the squamous and glandular mucosae. This article, the first will review the terminology, clinical signs and diagnosis of EGUS in the horse.     

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.     

The prevalence and anatomical distribution of equine gastric ulceration syndrome (EGUS) in 201 horses in Denmark

Reasons for performing study: The prevalence (up to 93% in Thoroughbred racehorses) and severity of equine gastric ulceration syndrome (EGUS) have been correlated with the type of training and associated management practices. However, there have been few reports to confirm these findings in nonracehorses in Europe. Objectives: To describe the prevalence, anatomical distribution, severity and number of gastric ulceration lesions in a population of Danish pleasure horses; and to investigate differences for groups based on age, breed type and workload. Methods: A total of 201 horses not in active race‐training, age 7 months‐27 years, were evaluated, representing 23 different stables from all 5 regions of Denmark. These horses were considered to be healthy by the owner and not on veterinary treatment for EGUS. Endoscopically observed ulcer lesion scores were based on the number present (0–4) and severity (0–5). The presence or absence of ulcers in the glandular and/or nonglandular regions of the stomach was recorded and which site the most severe ulcers were found. Results: The prevalence of EGUS severity score ≥2 was 53%. The most severe lesions were commonly observed at the margo plicatus. Although older horses were not more likely to be affected by clinically significant EGUS they were more likely to have lesions in both the glandular and nonglandular regions. Differences in location of EGUS lesions were identified in different age groups, breed types and in horses exposed to different levels of work. Conclusion and potential relevance: This study confirms that gastric ulceration can be prevalent in a group of apparently clinically normal horses, not in intensive work. Further investigation of reasons for differences in EGUS location between different populations may aid toward the development of novel preventive measures.     

Management of fractures in endurance horses

This paper provides relevant information for veterinarians responsible for treatment of endurance horses, including a retrospective study of fractures in endurance horses presenting to one referral hospital and to treatment clinics at 3 different race venues. Treatment and case outcome were also noted. The information presented provides clinicians working with high level endurance horses increased awareness of common sites of fractures, of prefracture stress related bone injury within this population of athletes and guidelines in order to manage them more effectively. The most common fractures involve the metacarpo‐(tarso‐)phalangeal joint. Most distal limb fractures can be diagnosed radiographically, but magnetic resonance imaging or scintigraphy may be required in some cases.     

The prevalence and risk factors of oesophageal and nonglandular gastric lesions in Thoroughbred racehorses in Saskatchewan

The objective of this study was to investigate the prevalence, severity and risk factors associated with oesophageal and nonglandular gastric lesions in Thoroughbred racehorses in active training in Saskatoon. Mature Thoroughbred horses (n = 94), stabled at Marquis Downs racetrack in Saskatoon, Saskatchewan, Canada, and trained by different trainers (n = 14) for a minimum of one month were included in the study. Horses were examined by gastroscopy and a lesion grade was assigned for each individual horse. Of the 94 horses, 79 (84%) had nonglandular gastric lesions, 70 (74.5%) had gastric ulcers, giving a prevalence of 74.5%, and 9 out of 94 horses (9.6%) had hyperkeratosis and/or hyperaemia. None of the horses had oesophageal lesions. Gender, age, number of races raced, place obtained in those races, history of lameness, history of medical conditions, and history of medications in a 2 month period prior to the gastroscopic examination were not statistically significant as potential risk factors for the prevalence and severity of nonglandular gastric lesions.     

Surgical colic in racing endurance horses

A retrospective study was performed of horses that developed colic during endurance racing, and subsequently required surgery. Fifteen horses met the inclusion criteria, of which 13 (87%) had small intestinal volvulus. Nine of the 15 horses (60%) had a small intestinal resection and anastomosis performed. Post operative ileus, particularly in those horses that had a resection performed, was a common complication. Eleven of the 15 (73%) survived, and 4 (27%) have since raced.     

A comparison of the prevalence of gastric ulceration in feral and domesticated horses in the UK

Equine gastric ulcer syndrome is common in domesticated horses, especially those performing in athletic endeavours. However, the prevalence of equine gastric ulcer syndrome in feral populations of horses is not documented. This study investigated the prevalence and severity of squamous and glandular gastric ulceration in an abattoir population of horses in the UK. Both squamous and glandular ulceration were more prevalent in domesticated horses when compared to the feral horses studied.     

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.     

Plantar fasciitis in 19 endurance horses: Diagnosis,treatment and follow-up

Lesions of the peritendinous–periligamentous soft tissues of the tarsus (plantar fasciitis) commonly result in a curb-like appearance and are considered overrepresented in Standardbred racehorses; however, plantar fasciitis is also quite common in endurance horses. Nineteen endurance horses of different ages (median: 7 years; range: 3–13) and athletic activity level comprising a total number of 25 plantar fasciitis cases were described in this study. In nine cases, injury developed during a training session, and in 16 cases, it developed during competition. In 18 cases, there was swelling, heat and pain on palpation, and in six cases, only swelling was detected. Eight cases were not lame at the time of examination, while in 17 cases, lameness ranged from grades 1–3 on the American Association of Equine Practitioners modified grading scale. The degree of swelling was significantly related to the lameness grade. Ultrasonography revealed differing amounts of thickening of the plantar fascia plantar to the superficial digital flexor tendon and peritendinous–periligamentous oedema of heterogeneous appearance. Horses were treated conservatively with several combinations of rest, controlled exercise, ice-therapy, corticosteroids, local application of working counterirritants and therapeutic shoeing. Seventeen of 25 cases (68%) did not develop re-injury after treatment and rehabilitation, whilst eight of 25 (32%) developed one or more re-injury/injuries. Overall, 21 of 25 cases (84%) returned to the previous or a higher level of competition; in one case (4%), the injury was the cause of retirement from athletic activity. Plantar fasciitis can be considered a sport-related injury in endurance horses of all ages and athletic activity level. Re-injury rate is low; however, adequate rest and rehabilitation protocols are important. Plantar fasciitis rarely leads to retirement from athletic activity, but it can result in 2–5 months out of training and competition.     

Risk factors associated with equine gastric ulceration syndrome (EGUS) in 201 horses in Denmark

Reasons for performing study: The prevalence (up to 93% in Thoroughbred racehorses) and severity of equine gastric ulceration syndrome (EGUS) has been associated with type of training and differing management practices. However, there have been few studies to confirm these findings in nonracehorses in Europe. Objectives: To investigate the prevalence of EGUS in a population of Danish horses, during winter when the horses had been housed and fed for at least 8 weeks and to analyse the influence of feed, work level and environment on the risk of EGUS of §grade 2 in severity. Methods: A total of 201 horses, not in active race‐training, were evaluated, representing 23 different stables from all 5 regions within Denmark. All horses were considered to be healthy and not on medical treatment for EGUS. Endoscopically observed ulcer lesion scores were based on the number present (0–4) and severity (0–5). Univariate and multivariable mixed effects logistic regression models were developed using EGUS score as the dependent variable. An ulceration severity score of §2 was regarded as being clinically significant. Separate models were developed for horses with ulcers in either the glandular or nonglandular regions of the stomach graded §2 (EGUS §2) and for those horses that had nonglandular ulcers graded §2 (NG §2). Results: In this population, 53% (107/201) of horses were graded as having EGUS §2 with 95 (47%) horses having NG §2. Three variables were significantly (P<0.05) associated with EGUS §2: straw being the only forage available; exceeding 2 g/kg bwt of starch intake/day or §1 g/kg bwt/meal; and water not being available in the turn out paddock. Risk of NG §2 significantly increased when straw was the only forage available, 1 g/kg bwt of starch/meal was exceeded, water was not available in the turnout paddock and the interval between forage feeding was <6 h. Conclusion and potential relevance: This study has confirmed that components of the diet, readily modifiable, may have an important impact on the risk of EGUS in the nonracehorse. Differences in the multivariable models produced for all ulcers and nonglandular ulcers support differences in the aetiology of ulcers in different locations of the stomach.     

Prevalence of Gastric Ulcerations in Horses with Colic

The goal of this study was to determine the prevalence of gastric ulcers in horses with acute abdominal crisis (colic) and to examine the temporal effect of hospitalization on ulcer development in equine patients treated for colic. In addition, other factors that may be associated with gastric ulceration were also explored. The study design was a prospective original study incorporating 169 horses that presented to the George D. Widener Hospital for examination. One hundred and twelve horses presenting with the chief complaint of colic were included in the study group, and 57 horses that presented for non-colic or nonemergency complaints were evaluated and included as case controls. Gastroscopy was performed on equine patients presenting with the chief complaint of colic or horses presenting for reasons other than colic (control); mucosal changes were scored 0 to 3. Additionally, horses presenting for colic were gastroscopically evaluated twice during a 5-day period. Medical records were reviewed for history, clinical findings, laboratory results, and treatment. Seventy-six of 112 horses presenting with the chief complaint of colic had gastric ulceration compared with 41 of 57 horses in the control group. There was a significant association between age of the patient and chief complaint (ie, colic vs control) and between breed and chief complaint. There was no association between gastric ulcer score and chief complaint (colic vs control). Thirty-eight of the 112 horses presenting with colic deteriorated in ulcer score while hospitalized. Using a Pearson chi-squared test, there was no statistically significant association between gastric ulceration with age, breed, or sex. Horses with gastric ulceration in the colic group had lower packed cell volumes compared with horses presenting with colic without gastric ulcers, and this was statistically significant (P < .001). The high incidence of gastric ulceration in the study and control groups supports the reports of other investigators that gastric ulcers in horses, no matter the presenting complaint, are widespread. There was a significant association between breed and chief complaint (P = .005); however, breed and outcome of gastric ulceration were not related (Thoroughbreds were the least likely breed to present for colic). Although a trend in increasing gastric ulceration was seen in hospitalized colic patients, it was not statistically significant. This suggests that horses that are hospitalized may be at increased risk for developing gastric ulcers because of stress, feed deprivation, and administration of treatment. Thus, horses that present for colic should be gastroscopically evaluated if clinical signs raise the index of suspicion for gastric ulceration.