Monday, January 26, 2009

EGUSSTED!

Time to get back into the educational swing of things with a long overdue post on, you guessed it--EGUS. Equine Gastric Ulcer Syndrome. For those competing, lend me your ears! Or eyes.

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.

Yup, ulcers.

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:

Horsey tummy

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.

Baby Baltic!


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:

Phase one


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.

Fifth phase

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.

U-7, buffer


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.
Examples: Sucralfate

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.

13 comments:

wolfandterriers said...

Great post! My holistic vet in VA has convinced me to keep my sport pony on probiotics. I have heard there is a bit of evidence in the endurance world that probiotics are useful. I've always thought that continuous feeding of small amounts (um...hello automatic feeder once I start school!!) along with great hay is a good start--but you can always improve somewhere and somehow!

Funder said...

Yep, really wonderful post. Especially the biology - I know you're bitter about Findlay, but man I'm jealous that you got such concentrated equine bio instruction!

Another blog I lurk at, The Barb Wire, just finished up a big series on ulcers in endurance horses. This last post details her ulcer control strategy, which I thought was pretty interesting and you might like reading too.

And you're right, trailering is stressful and I'd forgotten that. If you had a horse with no known ulcer history that you were going to, say, trailer 10 minutes away a couple times a week, what would you do as a preventative measure? The last thing I need to do is push my highstrung mare over the edge into ulcers. :(

Stacey said...

Awesome post! Thank you for writing it!

Andrea said...

Great post! Funder, I was just about to think to that post at the Barb Wire about the alternative treatment options.

Did NB Center not give you any Gastrogard upon discharge? They LOADED me up with the stuff at my local private hospital when Metro was discharged after a nasty colic which left him stuck there for a week.

I love how a horse's body is designed to work, how the 'gut piston' pushes and pulls air in and out of the lungs to create efficient and easy breathing during strenuous exercise. You forgot to mention though that a flake of alfalfa hay (or regular grass hay) before exercise helps to offset that sloshy acid at the canter. A horse isn't going to develop ulcers just because he's cantering, cause we'd have no feral horses left! He might though on an empty stomach! ;)

Michelle said...

I have had fantastic results with a product called Nutrient Buffer (www.vitaroyal.com). I've used it on 3 or 4 horses. One with a poor haircoat, standing camped under and a bit depressed and sour. He was actually the toughest one and it took 3 months or 3 bottles until he didn't relapse when I took him off it. Another was Leroy (www.savingleroy.blogspot.com). He was an aged Amish workhorse/feedlot rescue guy, who drooled profosely, didn't want to be touched, just really miserable and sour and an unhappy boy. I think I had him on Nutrient Buffer for a month, and he never went back to drooling, and became a lovebug. Another was Jen, who didn't show any symptoms, but considering she was a condition score of 1.5, there was a pretty damn good chance she had ulers (www.savingjen.blogspot.com). The last one was my girl, Lakota. I sent her for training for a month, and when she came back she was miserable, and didn't want to be caught or touched. I noticed she looked a little tucked up, after 3 days on NB she was back to her loveable old self again.

I ALWAYS mention ulcers to anyone who is having trouble with their horses weight, attitude, cribbing, eating dirt, and most of them respond to treatment.

DressageInJeans said...

Wolfandterriers,

Much agreed! I'm excited to see the changes in Key. I'm probably being picky because no one ELSE saw the problems, but I like to try to do everything I can for them, since I ask them so much.

Funder,

Sadly, our anatomy class at findlay was like putting round pegs in round holes (If you got that far). The kids weren't too bright, so it was dumb-ed down tremendously so they could pass. I took several biology classes/anatomy in high school and college, and love it tremendously so I continually do my own research. There are plenty of good books that are general anatomy for horses, so if you ever need one, let me know and I'll hook you up with something worth while. ;)

I read that too, and I did enjoy it!

With your mare, since it's a short trailer ride, I'm sure people would agree to just give her some kind of hay before, during, and when you get there just to soak up the acid.

Stacey,
No problem! :)

Andrea,
NB gave him nothing but laminitis, heart-bar glue-ons, and ulcers! Lol I can't say it wasn't topnotch care otherwise, and we were there when Barbaro was, so maybe they were busy. lol
Also, I'm dumb. Lol, I meant to mention that-- I also meant to mention that hay stays in the body for almost 24 hours, and stays in the stomach for much longer then alternative forages and feed. Duuumb.

Michelle,
I'll have to check that out! Haven't heard of it (I'm usually a smartpak.com or a horse.com homebody...lol). Thanks for the info.

Bex said...

I'm a little behind the curve here as I'm coming in late, but I really enjoyed this post!

I recently started my mare on SmartPak's 'SmartDigest Ultra' with fingers crossed it would help with her chronic diarrhea. I've had a couple vets check her out and we've done everything from blood work to power paks. The mess has been going on for nearly a year now...

I started thinking the diarrhea might have been related to ulcers after I started reading about all the different supplements available and now your post makes me wonder even more.

I show my mare and ride her often but wouldn't say she is worked heavily. All the trailer rides and shows, though, along with the more stringent riding routine just may have contributed. She used to be a trail horse and now she's a show horse and we take lessons once a week.

Lately I've been having problems getting her to canter. Now, being a trail horse, she and I hardly ever cantered and suddenly she's being asked to canter, collect, slow down, get round, etc... I know she's not conditioned to be good at cantering this early in the game. So I just thought the attitude during transitions was from the fact that she hasn't developed the muscles she needs... but maybe, if she DOES have uclers, it's related to that as well.

I'm waiting to see how the new supplement does, but I may start pursuing the ulcer route... it just might be the answer!

in2paints said...

Bex is actually me! Too many darn gmail accounts!

Rising Rainbow said...

This is a great, informative post. I am hosting a horse blog carnival Feb 1, would you consider submitting this post to the carnival so it can get some more coverage? If so the submission form is on my blog MiKael's Mania - Arabian Horses

DressageInJeans said...

in2paints,
Hey, great to see you here! :) Thanks for stopping by!

I know my gelding doesn't have to be shown a lot--he was just sort of prone to them. At the end of the season he was starting to get edgy with being saddled--no problems thusfar and I'm aiming to keep a careful eye on it.

If smartDigest Ultra doesn't work, you might want to try the probiotics, only because it has more of the good bacteria and bacteria food in it then the SDU does. If, however, it's caused by ulcers, then you might have to start on a medication like an H2 blocker. It might be interesting to put her on an antacid before you ride/for a few weeks and see if there's any change at all, if you can't get a vet out to tube her to see if she has them. (man, I wish there was an easier way to tell!)

Good luck! Wish the buggers could talk.

Rising Rainbow,
Wow--sure! Thanks a lot! I was just looking to help people who had Mr. Grumps of their own... lol.

jme said...

wow, so much great info here, i'm going to have to bookmark this one and read it a few times :-)

i also use the smartdigest ultra, and so far i'm liking it. my other digestive-health must have is haynets with small holes so they have to eat their hay ration slowly and continuously overnight - this seems to help with a lot of issues... and one of my old clients had a horse with suspected ulcers and with some management changes we also fed him aloe with good success.

my horses are not currently showing (or working for that matter) and have 24 hr access to either pasture, hay or both, so they are less likely to have ulcers. but we did have a horse many years ago who was a stressful animal, showed frequently and was boarded at the kind of stable where every flake of hay is strictly rationed, and he's spend the entire night in his stall with no hay. he would have one of the low-grade colic episodes you describe about once a week. back then no one knew the reason, but after the first ulcer research came out, i knew that was him. we never needed medication - we just changed his management and he got better...

anyway, great post. like i said, this one's a keeper :-)

dp said...

jme sort of answered my question.

Raven is a typically high-strung TB with a unpleasant-sounding past. She spent a lot of time (like 24/7 for months on end) stalled because she was deemed to be unmanageable. I brought her home, turned her out 24/7, let her eat as much hay as she wanted. In the first few months she had several (maybe 5) low-grade colics and one more serious. The vet suggested ulcers at the time, but she didn't have a lot of other symptoms. She just seemed like a horse who would probably suffer from ulcers.

Anyhow, we haven't had any colics for months now and overall her health is great. But if she did have ulcers would they shrink/disappear under new management, or would they just be controlled?

DressageInJeans said...

jme, thanks! I was hoping to make some people aware of the problem it can be, and I think I accomplished that for some. Woo! :)

dp,

I think it really depends where the ulcer is. If it's up high in the ER region, then I think it would have a great chance of healing without medication, and correct management. If there is enough hay/food to soak up all of the acid being produced, in theory it wouldn't be able to get up into the ER anymore and cause irritation. Therefore, the ulcer would have plenty of time to heal on it's own.
Bad ones sometimes form in the bottom portion of the stomach, and those are the ones that are going to be a pain in the ass to heal--because they'd always be in contact with acid.

That's just my guess though; mainly because a lot of horses seem to do a 180 with correct management. I don't think they'd react so positively if the ulcer wasn't healing!