How to keep gastric ulcers at bay: simple 12-step plan

Richard Hepburn MRCVS outlines how to heal gastric ulcers and prevent their recurrence

Your horse has been diagnosed with gastric ulcers in the squamous tissue lining the top third of his stomach — so where do you go from here? An online search will reveal a bewildering array of advice and so-called remedies, yet treatment and ongoing management is effective and relatively straightforward if broken down into two stages.

Stage one: the most effective way to resolve ulcers is with an equine-specific form of omeprazole, given at a bodyweight-appropriate dose for a period of time sufficient for the severity of his case. Squamous lesions that are widespread and shallow heal faster (within 14-21 days) than more focal, deep lesions, which can take up to 28 days. At the same time, subtle changes should be made to feeding and management to limit gastric acid production and the mobility of acid within the stomach.

Stage two: complete healing occurs in up to 80% of squamous cases. Gastroscopy should ideally be repeated, but if the horse has responded well then this can be skipped and the horse put onto maintenance treatment for two to three months. Simply stopping all treatment at this point is associated with a high ulcer recurrence rate (approximately 80% within six weeks).

For squamous lesions there are two maintenance options: first, continue using equine-specific omeprazole, but reduce to a quarter dose. This is very effective and also user-friendly as it is a once-a-day treatment.

The second option is to use an acid-neutralising feed supplement (containing aluminium hydroxide, magnesium hydroxide and calcium carbonate — think “Rennie” for your horse). This approach is less consistent and the supplement must be given three to four times daily, as its effect is short-lived.

With either option it is vital that protective feeding and management changes are continued.

This two-stage plan has worked in thousands of horses over the past 15 years. There are a variety of other supplements containing different fibres or proteins, seaweed, plant or mineral extracts; however, none of them has been shown to be clinically effective in either the treatment or prevention of squamous ulceration.

Glandular ulcers, affecting the bottom two-thirds of the stomach, will need additional treatment with the mucosal protectant sucralfate.

12-step plan for preventing gastric ulcers in horses

• Allow access to high-quality forage, predominantly during the day (7am to 11pm), at a minimum daily rate of 1.5kg/100kg body weight (BWT). This should ideally be given continuously or at no more than 6hr intervals.
• Create multiple forage sources in the stable to improve eating consistency and allow foraging activity.
• Use hay (dry, soaked or steamed) or haylage as a forage source — there’s no difference between them in relation to ulceration.
• Feed no more than 0.25kg/100kgBWT of straw. This should not be the only forage source.
• Provide continuous access to fresh, clean water 24hrs a day.
• Split the concentrate ration into three rather than two meals per day.
• Opt for grains such as barley and oats instead of sweet feeds.
• Add chaff to all meals.
• Remember that completely pelleted diets generate more stomach acid than the same diet formulated as a coarse mix.
• Buy high-quality feed, but bear in mind that there is no evidence to support the use of specific “gastric healthy” commercial diets, nor of one manufacturer’s feed being better than another’s.
• Add a little corn oil or rapeseed oil (50-100ml per day) to help reduce the amount of stomach acid produced.
• Consider using fermented probiotics and the yeast saccharomyces cervasii, which may increase the digestibility of the horse’s diet, so improving large intestinal function.
• Also, try feeding chaff before exercise — 2 litres chaff given within 30mins of exercise may trap acid and limit ulceration, and improve gastric blood supply. Use a 2-litre plastic drink bottle with the top cut off as a measure.

H&H 24 December 15