SmartPak's Understanding Equine Ulcers & Gastric Health

Understanding Equine Ulcers & Gastric Health

Lydia F. Gray, DVMMedical Director/Staff Veterinarian

Jessica NormandSenior Director – SmartSupplements™

July 18, 2012

Your Presenters

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Agenda

• What are gastric ulcers?• Risk Factors• Signs• Diagnosis• Treatment & Prevention

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Gastric Ulcer Statistics

It has been well-documented that as many as 90% of racehorses and nearly 60% of active show horses have gastric ulcers.

Simulated conditions representing activities typical in the recreational use of horses were determined to cause gastric ulcers in as little as five days.

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McClure SR, Carithers DS, Gross SJ, Murray MJ. Gastric ulcer development in horses in a simulated show or training

environment. J Am Vet Med Assoc. 2005 Sep;227(5):775-777.

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What are gastric ulcers?

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• Gastric = stomach• Ulcer = erosion• Equine Gastric Ulcer Syndrome (EGUS)

Illustration courtesy of Rick Gore Horsemanship, ThinkLikeAHorse.org

A horse in his natural state…

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Grazes almost 20 hours per day

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Risk Factors for Gastric Ulcers• Diet– Infrequent hay feeding– High grain diets

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“Feeding horses more than five pounds of grain every five to six hours can cause gastric ulcers.”

-Frank Andrews, DVM, MS, DACVIMLouisiana State University

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Risk Factors for Gastric Ulcers• Intense exercise

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Risk Factors for Gastric Ulcers• Stress– Training/competition– Transportation– Schedule changes– Injury or illness

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Risk Factors for Gastric Ulcers

• Excessive use of NSAIDS

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Signs of Gastric Ulcers• Physical– Mild, recurring colic– Weight loss– Poor appetite– Dull hair coat

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Signs of Gastric Ulcers

• Behavioral– Poor attitude– Irritability– Resistance– Dullness

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Signs of Gastric Ulcers

• Performance– Lead swapping– Reluctance to bend/collect– Hitting jumps– Slower times– Lack of energy

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Signs of Gastric Ulcers• None– Subclinical– “Silent”

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Diagnosis of Gastric Ulcers• History• Signs• Endoscopy• Response to treatment

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Diagnosis of Gastric Ulcers

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Reproduced from Andrews F, Bernard W, Byars D, Cohen N, Divers T, MacAllister C, et al. Recommendations for the diagnosis and treatment of equine gastric ulcer syndrome (EGUS). Equine Vet Educ 1999; 1 (2): 122-134.

Treatment & Prevention of Gastric Ulcers

• Goal is to create a permissive environment in the stomach for tissue healing, which requires a combined approach:1. Pharmacologic agents2. Natural agents3. Dietary changes4. Management changes

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Treatment & Prevention of Gastric Ulcers

1. Pharmacologic Agents– Proton pump inhibitors (FDA-approved)• GastroGard® (Rx)• UlcerGard®(OTC)

– Histamine type 2 receptor antagonists• Cimetidine (Rx)• Ranitidine (Rx)

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Treatment & Prevention of Gastric Ulcers

2. Natural Agents– Antacids– Amino acids– Herbs– Others

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Natural Agents: Antacids• Calcium, magnesium, aluminum

Clark CK, Merritt AM, Burrow JA, Steible CK. Effect of aluminum hydroxide/magnesium hydroxide antacid and bismuth subsalicylate on gastric pH in horses. J Am Vet Med Assoc. 1996 May 15;208(10):1687-1691.

Murray MJ, Grodinsky C. The effects of famotidine, ranitidine and magnesium hydroxide/aluminum hydroxide on gastric fluid pH in adult horses. Equine Vet J Supple. 1992 Feb;(11):52-55.

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Natural Agents: Amino Acids• Glutamine, threonine, glycine, collagen

Zhong Z, Wheeler MD, Li X, et al. L-Glycine: a novel anti-inflammatory, immunomodulatory, and cytoprotective agent. Curr Opin Clin Nutri Metab Care. 2003 Mar;6(2):229-240.

Noe JE. L-Glutamine use in the treatment and prevention of mucositis and cachexia: a naturopathic perspective. IntegrCancer Ther. 2009 Dec;8(4)): 409-415.

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Natural Agents: Herbs• Licorice, marshmallow root, slippery elm, aloe vera,

adaptogens, seabuck thorn

Aly AM, Al-Alousi L, Salem HA. Licorice: a possible anti-inflammatory and anti-ulcer drug. AAPS PharmSci Tech, 2—5 Sep 20;6(1):E74-82.

Lee EB, Kim OJ, Kang SS, Jeong C. Araloside A, an anti-ulcer constituent from the root bark of Aralia elata. Biol Pharm Bull. 2005 Mar;28(3):523-526.

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Natural Agents: Others

• Pectin, lecithin, silica, gamma oryzanol

Ferrucci F, Zucca E, Croci C, et al. Treatment of gastric ulceration in 10 Standardbred Racehorses with a pectin-lecithin complex. Vet Rec. 2003 May 31;152(22):679-681.

Venner M, Lauffs S, Deegen E. Treatment of gastric lesions in horses with pectin-lecithin complex. Equine Vet J Suppl. 1999 Apr;(29):91-96.

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Treatment & Prevention of Gastric Ulcers

3. Dietary Changes– Provide constant access to good-quality hay– Or, provide hay frequently throughout the day– Offer alfalfa hay, if possible– Limit the amount of grain– Or, feed grain in small, more frequent meals

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Treatment & Prevention of Gastric Ulcers

4. Management Changes– Give “down time” from competition, travel– Provide pasture turn out, with “buddy” if possible– Keep a regular schedule– Reduce stress

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Questions & Answers

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Questions1. What is the best way to manage a horse with ulcers on very limited pasture?

Is one type of hay better than another for a horse with ulcers?2. Once you treated the ulcer with something like GastroGard for 30 days, what

is the best on-going prevention so that you don't have to incur the costly treatment of GastroGard?

3. What effects does heavy training have on ulcers if the horse already has them, and is it a cause of them?

4. Does cribbing have anything to do with ulcers? 5. Once a horse has been diagnosed with an ulcer, does treatment cause the

ulcer to go away, or merely the symptoms being presented for the ulcer? 6. My horse's ulcers seem much better when he is on grass versus hay. Any

research that confirms this?

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Questions7. I've a 14 y.o. welsh x qtr pony leased to a therapy program. I understand

performance horses are prone to ulcers but are lesson horses also prone? Can light work cause ulcers? Or not enough work? We're at 1 week with my pony on SmartGut and Ranitidine. Any other suggestions?

8. Is it true that horses that are on a bit of supplements are prone to colic and ulcers?

9. I have a mare that "tummy aches" not a true colic; she acts achy only after she eats. The vet said it is was 90% chance it was ulcers due to a high amount of grain, stall time and performance time. What types of feed can I give her to reduce this affect?

10. My horse was scoped and diagnosed with gastric ulcers. He was treated for the recommended time and dosage of GastroGard. Should I have him re-scoped to ensure the ulcers are gone?

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Questions11. How long can a horse go without hay between meals and still be safe from

ulcers? A couple of hours?12. GastroGard vs. UlcerGard13. Any relationship between a bacteria and an ulcer like in people?

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