EGUS affects an incredible, staggering amount of horses. 50% of foals, 1/3 percent of stalled adult horses. Not stalled performance horses, just stalled, regular joe-shmoe horses. 60% of show horses, which around 50% have both EGUS AND colonic ulcers. Ninety percent of racehorses. Ninety percent. Nine out of every ten race horses you see has ulcers. (Maybe THAT'S why they always look so spindly...)
EGUS is a real, expensive problem when it comes to performance horses. And with most things, an ounce (or perhaps several) of prevention is worth it's weight in horsey gold. But why the post?
Back in 2007, we took Key to a show in Carlisle, PA. He ended up colicking at the show, so we trailered him home to the vet--push came to shove, and we ended up having to make the decision to take him to the New Bolton Center, back in Kenneth Square, PA, or take him home and see if he made it.
We took him to the NB Center where he stayed for six days. We had his food with us because we'd been at a show, but they wouldn't take it, so of course during his stay he also had a bout of laminitis. And that's a whole other story, but to continue the train of thought (I swear this has a point), when he came back home he ended up losing 200 pounds and cribbing like a demon before, it was controllable as long as he wasn't in a stall.
At the time, we were completely unaware of ulcers, so put him on some weight gainer and beat pulp. He gained weight, and calmed down, but Key has always shown signs of ulcers that I honestly never placed together until a few months ago. And in my quest to do what's best for him, I thought I'd put up a post for those who compete, so they can deal with problems they have now, or prevent ones in the future.
So. In order to understand ulcers and some of the problems associated with them we have to understand, at least a little bit, the stomach. Ta-dah:
The two things we have to concern ourselves with is the non-glandular region (Yellow), and the glandular region(pink). The non-glandular region is called the Esophageal Region (or Squamous epithelium), because the cells act like those of the esophagus. In the 'ER' region, the cells are less resistant to acidic injury, and therefore, 80% of equine ulcers occur here. The glandular region (glandular epithelium) is where mucus is secreted to protect the stomach lining, and where the hydrochloric acid and other proteins/enzymes are secreted. This area is much more resilient to ulcers, so the other 20% of ulcers happen there.
The equine stomach holds about 4 gallons, or 8-17 qts. There's a lot of information about how much equine stomachs can and cannot hold, so I like to lowball it when I'm feeding ;). In humans, our stomachs produce acid when food is present--not so in horses. In horses, acid production is absolutely independent of food intake. What does that mean for us? That means that the stomach will produce anywhere from seven to eight gallons of acid a day, about six cups per hour. Trickle-feeders, indeed!
Not only can you find ulcers in the stomach, but also in the duodenum (the beginning of the small intestine), the colon, and the esophagus. Duodenum ulcers are more common in foals; colon ulcers in performance horses.
So, what actually causes ulcers? Scientists and vets have done plenty of research, and although there is not always a definite answer, they have some ideas, and some causes for specific ulcers. One very obvious cause is fasting; if a horse goes without food for eight-ten hours, ulcers most likely are forming. With all that acid being produced and nothing to soak it up, it's only logical that a lack of food for long periods of time would cause issues.
Bute (Phenylbutazone), Banamine (Flunixin Meglumine), and other long-term use of NSAIDs (Non-steroidal anti-inflammatory drugs), cause ulcers by preventing the stomach from protecting itself with it's own mucus. Any time a horse is on long-term NSAIDs, treat and be prepared for ulcers. This is a big motivating factor to not just 'bute your horse up' whenever you feel like it! It is amazing how many people turn into horsey pharmacists at shows, or in their own backyards. These are prescription drugs for a reason; you can't just feed them like candy.
But there are plenty of performance horses who have access to food at all times, are not fed bute, and have ulcers--so why the obscenely high number?
Increased workload increases the intra-abdominal pressure, which ends up compressing the stomach. This presses all of the acid that is resting in the Glandular region up into the sensitive Esophageal region--causing ulcers. This happens especially with an empty stomach at the canter--and with the help of this site's pictures and trusty MS Paint, I'll explain:
In the first phase of the canter, the horse's viscera (guts, insides, nasty gunky stuff), all lean back with the motion of the canter. If you've ever had the privilege to see a horse's intestines/etc. taken out of the horse, you'll know why this happens--all of those guts weigh A LOT. It's so much bigger then you think it is, if you've never seen. (Yay, equine science class.) With the guts hanging in the back of the body, this also makes it easier for the horse to expand his lungs and breathe. Anyway, like so:
However, when we get to the fifth phase of the canter, right before the moment of suspension, all of the viscera is shoved down and forward. This helps press the air in the lungs out, as well as squeeze the acid of the stomach up into the 'ER' region.
And wha-la, instant ulcers.
There are other ulcer inducers, like stress (trailer rides and shows), but as of yet, the bacteria that causes almost 80% of human ulcers, Helicobacter pylori, has not been found in equines.
We know most of the common symptoms of ulcers: attitude change, low-grade, reoccurring colic, poor appetite, weight loss. But there's a slew of symptoms, and whilst one may not guarantee ulcers, several may. Diarrhea, slow eating, decreased performance, gradual loss of body condition, pot belly appearance, teeth grinding, lying on their backs. Reluctance to canter. Cribbing. I have always wondered why so many horses swish their tales when taking the canter--perhaps for a few, we have a reason?
Teeth grinding, lying on the back, and salivating are common symptoms of duodenum ulcers in foals, and are not often seen in adult horses.
Horse's that seem edgy/pained around eating time often have stomach ulcers. Those who seem pained and edgy 30 minutes to an hour later, often have duodenum ulcers.
Just for educational purposes, I'll put up Key's 'symptoms'. When we first got him, he would grind his teeth. Lovely habit that thankfully, I have not seen him do in a year or two. When he ate, he would 'wring' his back feet often, almost like a horse colicking and kicking at his stomach. He would occasionally lose weight for little or no reason, and he never seemed to really mind if he was fed, or not. Always ate slow. Reluctant to canter, ridden or in the pasture. When we first got him, did NOT like his sides touched. Could occasionally be girthy. Cribbed horribly after his stay at New Bolton; only cribs now when anxious (aka, when Clyde chases him off of hay or feed. Which, no longer happens, woo!).
Sounded like ulcers to me!
So now we talk about the important things, the things that cost moolah. Prevention and treatment.
There are a few drugs on the market, and a slew of supplements for horses with ulcers, and to prevent EGUS. Only one drug is FDA approved, but it's long-term effects are not yet known. On to the treatments!
H2 Blockers: These block the action of histamine. This prevents the stomach from being able to produce acid, to some degree. They have not, however, been FDA tested for horses, and in the past have been under-dosed, so they were ineffective. Nowadays, I've heard much better things from them. Horses are usually taken out of training for the duration of treatment (usually around a month).
Examples: Cimetidine (Tagamet), ranitidine (Zantac) and famotidine (Pepcid AC)
Proton Pump Inhibitors: This too inhibits the stomach from producing acid, and totes the only FDA approved drug for treating ulcers in Equines. There have been some owners/vets seeing an increase in acid production after the horse is taken off of this drug.
Examples: omeprazole (Gastroguard in horses, Prilosec in humans)
Antacids: Like in humans, antacids buffer the stomach from the acid by increasing the pH (thereby, making the stomach less acidic). These are relatively ineffective for treating already prevalent ulcers, as its effects only last about an hour or so--not nearly enough time for the stomach to heal. Good uses for them: before times of stress, like trailering. Common problems with antacids: Most are made with magnesium, or aluminum. Too much magnesium causes diarrhea, and too much aluminum causes constipation. Calcium-containing acids can sometimes stimulate the stomach to produce MORE acid to make the stomach acidic again. (Rebound Acidity). I'm going to use a 'buffer' for trailering, but it's going to be followed with plenty of hay to soak up any extra acid once we arrive.
Examples: There are many, so here are a few:Gastro (includes Calcium Carbonate), Neigh-Lox (almost primarily calcium), Pro CMC (Calcium, Magnesium), TractGard (Calcium), U-Gard (Calcium Carbonate, Magnesium), U-7 (does NOT contain calcium, magnesium or aluminum... will most likely be using this to trailer.) There are plenty more, but these are from Smart Pak's site.
Protectants: These help block acid from coming into contact with stomach lining, although it has not been found very effective in the 'ER'--more effective for duodenum ulcers.
Potluck: Here is the 'other' category, with things that aren't drugs but have been noted to help.
Polar lipids: Non-hydrogenated oil. This helps protect the lining of the gut as well as the rest of the intestines. However, corn oil has been shown, in long term use, to cause inflammation of the joints and in the intestines, this is due to the high level of Omega 6 acids, instead of Omega 3's. Linseed oil can cause colic and turn horses off of feed. Vegetable oil has variable ingredients. Be careful what oil you use to supplement!
Alfalfa Hay: This is the specific hay I'll be using when I trailer; horses like eating it! It helps soak up excess acid in the stomach, and it's higher levels of calcium are supposed to help without flooding the stomach (like buffers do) so there is no rebound acidity.
Glutamine and Threonine: These are amino acids that are both now considered 'conditionally essential'. This means that the body usually makes enough on it's own, however research has shown that in times of stress, the body may not be able to create enough for the horse. Glutamine may help the stomach lining renew and heal, and Threonine helps create mucus.
Dietary Fiber: This includes your hay, beat pulp, most brans, and supplemental fiber. The stomach takes longer to empty fiber, therefore it helps use up the acid--hay most especially.
Bananas? Bananas apparently have phospholipids to line the stomach, as well as papayas. Weird.
Concluding thoughts on treatment:
Gastroguard (omeprazole) has created a huge monopoly with Equine owners. Being the only company who went through with getting their product FDA approved, they claim they are the ONLY drug and you MUST use it--at, get this, a 1000 dollars a month. That is a completely ludicrous number, and h2 blockers work in much the same way with a much lower price tag. Most websites claim that omeprazole is great and everything else is crap, which is clearly untrue--plenty of people have had great success with h2 blockers, and some just on antacids. If you ever run into an acid problem, look at your options before choosing gastroguard. (Again, I'm no vet, so this is just IMO.)
Most antacids are ineffective for prevention if fed daily, and are completely ineffective for healing ulcers.
My new line of defense is SmartPak's 'SmartDigest Ultra', which contains glutamine and no antacids. (VERY hard to find anything with no antacids!) From the website: it contains "probiotics (beneficial bacteria) and prebiotics (food for the beneficial bacteria), it also provides digestive enzymes, soluble fiber, soothing herbs, and amino acids that support G.I. cell health." I feel that this will help keep Key healthy and regular, along with constant turnout and hay to prevent the stomach from building up acid. [SmartPak also has an ulcer supplement with more glutamine, but it also has antacids.] Oil will also be added, though I have not been able to decide exactly what, just yet!. Feed buckets are always on the ground as this promotes a more natural eating profile, and maybe the bugger will find some bananas in his feed just for kicks.
So far, cribbing has been reduced, cantering is no problem with no swish of the tail, he no longer stomps his back feet, no longer touchy/girthy. He's putting on weight! He was never drastically thin, he could just never get to that '5.5' body score that I wanted him at. I want him just a little heavier then the perfectly ideal, like most show hunters are. Not plump, just carrying an extra 40 pounds or so.
|Key looking 'trim'|
|Key with weight, right before the Regional Show|
Ulcers are a constant battle, and I believe every horse owner should be aware of them so that they know what to look for, and are aware how to prevent. I hope I found some new information for some of you, and if anyone has heard recent studies/tips/what not, always feel free to post to argue a thought or show a new line of thinking--nothing is set in stone for EGUS yet, and I am always open to new ideas.