Equine Gastric Ulcer Syndrome

erosion and ulceration most veterinarians turn to antiulcer therapies with the aim of suppressing or neutralizing gastric acid.
H2 antagonists such as ranitidine Zantac or famotidine Pepcid can successfully raise the gastric pH and resolve gastric ulcers in foals and adult horses. However the degree and duration of acid suppression by H2 antagonists varies from horse to horse. Practitioners routinely administer antiulcer drugs to critically ill neonatal foals as a prophylactic measure but its effectiveness remains controversial. Treatment responses vary and theres also a concern that the use of prophylactic antiulcer therapy may suppress the function of gastric acidity in preventing bacterial translocation in neonatal foals. The acidic environment in the foals stomach is one of the normal protective barriers against potential invading microorganisms.
Proton pump inhibitors such as omeprazole available under the trade name Gastrogard have been effective in healing naturallyoccurring cases of gastric lesions. Several research studies show that omeprazole is effective in reducing or eliminating the severity of gastric ulcers in Thoroughbred racehorses undergoing intensive training. Omeprazole is considered the gold standard for treating and preventing gastric lesions in horses. It is important to note that there are some compounded omeprazole products which are generally cheaper than the commercial products. The Canadian Veterinary Medical Association states in its Guidelines for the legitimate use of compounded drugs in veterinary practice 2006 that compounded drugs are unapproved drugs that have not undergone the Health Canada approval process. These compounded products have not been evaluated by Health Canada for safety stability potency efficacy and consistency of manufacturing therefore only commercial products approved by Health Canada such as Gastrogard are recommended for the treatment and prevention of gastric ulcers.
Sucralfate Carafate is effective in treating peptic ulcers in humans but its efficacy in treating ulcers in the equine gastric squamous mucosa is unknown. Sucralfate may be effective for treating stressinduced ulcers in neonatal foals but so far there is no clinical evidence to support this theory.
Antacids such as Maalox can reduce gastric acidity in horses but their effects are shortlived lasting approximately two hours and require large doses several times a day.
Prokinetics can be part of a therapy plan when veterinarians suspect delayed gastric emptying without any physical obstruction in a patient. This treatment is also useful in treating foals with duodenal disease and gastroesophageal reflux.
Horses are designed to graze around the clock and a horses stomach continues to secrete hydrochloric acid regardless of
whether he is actually eating.
To treat or not to treat?
Many veterinarians and owners argue the need for treatment of gastric lesions in horses. However the fact that such a high percentage of horses up to 90 percent of Thoroughbred racehorses in training have gastric lesions and that most of these horses with gastric lesions do not show clinical signs might lead others to believe that EGUS is not something to worry about. Nevertheless no one would dispute that a horse with gastric lesions and showing clinical signs should be treated. So the question becomes should a horse with gastric ulcers that is not showing clinical signs asymptomatic be treated?