Equine gastric ulceration in practice - Veterinary Practice
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InFocus

Equine gastric ulceration in practice

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.

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