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Management of Equine Gastric Ulcer Syndrome (EGUS)

Management of Equine Gastric Ulcer Syndrome (EGUS). Amy M Gill, Ph.D. Grazing Herbivore. Horse evolved to eat 10-12 meals/d Thrives on low quality forages No access to concentrated grains Feeding bouts of 1-2 hours Moving constantly while grazing. Domestication = altered feeding/lifestyle.

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Management of Equine Gastric Ulcer Syndrome (EGUS)

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  1. Management of Equine Gastric Ulcer Syndrome (EGUS) Amy M Gill, Ph.D.

  2. Grazing Herbivore • Horse evolved to eat 10-12 meals/d • Thrives on low quality forages • No access to concentrated grains • Feeding bouts of 1-2 hours • Moving constantly while grazing

  3. Domestication = altered feeding/lifestyle • Confined in stables, little movement • Limited access to grazing • High stress levels • Episodic feeding - convenience • Concentrated feeds and forages • Stressed horses can be finicky eaters

  4. Ulcers – due to feeds, method of feeding, training • Starch – more acid produced • Low inclusion rate of forage – lowered saliva and bicarbonate production

  5. Ulcers – due tofeeds, methods of feeding, trainingUp to 90% performance horses, 57% foals affected • Training - Intense exercise increases acid production. No feed several hours of each day during training, abdominal movement • Exercise reduces blood flow to the stomach? • Physical Stress - Sick foals, hospitalized in pain often get ulcers • Changes in Growing Foals - stomach still developing and is easily injured by acid and enzymes • Other Factors - Shipping and extended time in stalls, certain medications given at high doses.

  6. Clinical signs of equines with ulceration of stomach

  7. Equine Stomach Physiology • Lower portion of the stomach - glandular portion - protected from acid by a mucous coating. • The upper non-glandular or squamous portion of the stomach is not intended to be exposed to stomach acid. • Hydrochloric acid secreted continually by the parietal cells in gastric glands located in lower portion of the stomach.

  8. Equine Stomach • Feedstuffs layer equine stomach - layers vary in pH balance • Coarser materials form a mat in the upper portion of the stomach - mix with saliva to keep pH in that region around 6 to 7 • Medium-density feedstuffs located in middle zone of the stomach - pH of 4 to 5. • High density fluids in lower portion of the stomach - pH is 1 to 2.

  9. When horses are not eating……… • Horse stomach continuously secretes variable amounts of hydrochloric acid • Secretion occurs without digesta. Squamous mucosa can become ulcerated in as little as 10 hours • Foals secrete gastric acid as early as 2-days-of-age • Milk appears to function as a buffer • Adult horses secrete approximately 1.5 liters of gastric juice hourly • Gastric emptying of concentrated meal occurs within 30-60 minutes, whereas complete gastric emptying of a roughage hay meal occurs in 24 hours.

  10. Why horses in training? • Monitors implanted in working horses revealed the contractions of abdominal muscles forced the lower pH liquids from the lower portions of the stomach up through the coarser feedstuff layers, exposing the non-glandular portion to the corrosive acids. Even abdominal muscle contraction secondary to anxiety caused the same reaction.

  11. Other factors • Use of non-steroidal anti-inflammatory drugs – NSAIDs - Decreased prostaglandin synthesis causes deceased mucosal blood flow, stimulates gastric acid secretion, and inhibits bicarbonate secretion by the glandular mucosa • Decrease in prostaglandins leads to a breakdown in mucosal protective factors and may be the primary cause of glandular gastric ulcers in foals and horses. • Stress – causes release of endogenous corticosteroid, which can inhibit prostaglandin synthesis.

  12. Diagnosis - Endoscope • Veterinarian inserts flexible 3 meter endoscope through horse's esophagus and into his stomach - view any ulcers. • Prior to endoscopic examination withhold feed for 12 hours, water for six hours

  13. Healthy mucosa Ulcerated mucosa

  14. Untreated After treatment

  15. Control of Acid production • Acid secretion - regulated by type and amount of food intake. • Stomach acts as its own pH meter Histamine is cause of release of HCL by the parietal cells. • By blocking the H2 (histamine 2) receptors, production of stomach acid can be suppressed.

  16. Medications • Antihistamines - Cimetidine (Tagamet) and Ranitidine (Zantac). • Inconsistent in effectiveness because parietal cells are so sensitive to histamine that frequent large doses are required to control acid secretion.

  17. Omeprazole • Gastrogard™ (omeprazole, Prilosec, human). • Proton pump inhibitor - acts to block acid secretion • Gastrogard™ does not address the underlying cause of equine ulcers - but very effective in treating ulcers • Symptoms often return when treatment is discontinued if management of horse is not altered.

  18. Treating and Preventing Ulcers • Turn horse out on pasture • Lower stress!!!! • Feed more forage – alfalfa hay • Concentrates with high soluble fiber, fat • Less starch • Increase feeding frequency • Hand graze • Increase exercise

  19. Treating and Preventing Ulcers • Medicate foals when separated from dams • Medicate horses in training when stressed • Judicious use of NSAIDS in foals/older horses • Maintain horse on ant-acids or low dose omeprazole once ulcers have healed

  20. HAPPY HORSES = NO ULCERS!!!

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