b'2019 AAEP CONVENTION WRAP-UPGASTROINTESTINAL TOPICS Gastric Ulcer Treatment Strategies Equine gastric ulcer syndrome is a prevalent and painful disease affecting horses stomach lining. It can also be challenging and expensive for horse own-ers and veterinarians to manage.Veterinary attendees gathered for a table topic discussion about gastric ulcer treatment, moderated by Frank M. An-drews, DVM, MS, Dipl. ACVIM (LAIM), LVMA Equine Committee professor and director of the Equine Health Studies Program and section chief of large ani-mal medicine at Louisiana State Univer-sity (LSU), and Sarah Reuss, VMD, Dipl. ACVIM, equine professional services AMY K. DRAGOOveterinarian with Boehringer Ingelheim.Gastric ulcers develop when portions of the horses sensitive stomach lining get exposed to stomach acid. Ulcers thatThe only way to definitively diagnose gastric ulcers is with gastroscopy (passing an endoscope form on the stomachs upper mucosathrough the nostril and down the esophagus to view the horses stomach).cause equine squamous gastric disease (ESGD), and those that form on the lowerimproved healing of both squamous andNutraceuticals A significant portion glandular region cause equine glandularglandular ulcers. The licensed product,of the discussion then turned to dietary gastric disease (EGGD)two similarhowever, is only available in the U.K. andsupplement options and their efficacy. conditions with different risk factors andAustralia. Andrews said he found that a liquid sea management strategies. Glandular diseaseWithholding feed In recent yearsbuckthorn berry product had no effect tends to be more challenging to treat thanresearchers have determined that treat- on squamous or glandular ulcers. A more squamous disease, said the moderators. ment might be more effective if ownersconcentrated form, however, did prevent The only way to definitively diagnosewithhold hay and feed from horses over- glandular gastric ulcers from forming, either condition is with gastroscopynight, then administer omeprazole in thebut its not commercially available.(passing an endoscope through the nos- morning. Table topic attendees, however,SmartGut Ultra is a product that tril and esophagus to view the stomach). questioned whether this is necessary. contains sea buckthorn berries, pectin, Veterinarians treatment of choicelecithin, and aloe vera, among other for ESGD is omeprazole. My first lineingredients. In a study Andrews found of treatment for EGGD is omeprazoleSupplements maythat ulcers did not recur in horses plus sucralfate, said Reuss. If thats nothelp to maintain stom- receiving SmartGut Ultra after stopping working, I may try misoprostol.omeprazole treatment, whereas they did She generally does not recommendach health and keepin controls. administering all three drugs at onceulcer scores low, butPurina Outlast is a slow-release antacid because A) You wouldnt know which onecontaining calcified seaweed. In a study worked, and B) Giving them in conjunc- theyre not going toof horses that travel extensively, Andrews tion can impact their efficacy if not timedtreat the disease.said squamous ulcer scores did not in-just right.crease while the horses were on Outlast, The moderators then discussed a vari- DR. FRANK M. ANDREWS though they did in controls.ety of other management strategies. While corn oil has been shown to re-Injectable omeprazole The currentHundreds of thousands of horses haveduce gastric acid output in some studies, FDA-approved form of omeprazolebeen treated without doing this and haveAndrews said his team did not find that it (GastroGard) is administered orally. Adone just fine, said Reuss. Its not a ruleprevented squamous ulcer formation inteam in Australia, however, has devel- but, if practical, give the horse a slowa large study. Raw or stabilized rice bran oped a long-acting injectable form withfeeder at night, GastroGard in the morn- oil also had no effect on ulcer scores. promising results, said Andrews. Theing, then wait an hour before feeding. With that being said, corn oil is certainly once-a-week injection has a slow deliveryFor every average horse with Grade 2something you can use, he added, and and bypasses the stomach, he explained,squamous ulcers, Im not going to makeits cheap.improving its bioavailability (absorptionthem revamp their schedule. But I willIf you have horses that are actively rate) over the oral form. The researcherstell them theyll get more bang for theirworking, supplements may help to main-studying this drug (Sykes et al.) have seenbuck if they do, she added. tain stomach health and keep ulcer scores 42March 2020The Horse|TheHorse.comAAEPWrapUp.indd 42 2/5/20 2:54 PM'