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Equine Ulcers

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When faced with a diagnosis of ulcers in their horses, many clients are shocked. “My horse could not possibly be stressed. I give him a great life.” Sound familiar? Many people think they are doing what’s best for their horses, but despite their good intentions they’re often working with the wrong information.

Stomach linings x 2

Horses are meant to graze all day, which means they produce stomach acid 24/7. They can produce up to 16 gallons of acidic fluid every day. Horses’ stomachs also have two different linings:

1. The glandular mucosa is a stronger protected lining at the bottom of the stomach where the acid sits. The glandular mucosa is where you will see ulcers from NSAID use/overuse due to decreased blood flow to the stomach lining.

2. The squamous mucosa makes up the top half of the stomach and is a non-protected lining.

These two types of stomach lining meet at the margo plicatus. This is where you most often see the beginnings of stress ulcers; as they get more severe, they can cover the whole squamous mucosa.

EGUS in horses

Equine Gastric Ulcer Syndrome (EGUS) is a very common disease. As many as 93% of racehorses , 63% of competitive horses , 51% of foals and 71% of broodmares can have them. Some of the stressors causing ulcers are competition, travel, training, trailering, limited turnout or grazing, lay up, changes in routine, and changes in herd dynamics or facility.

Symptoms you will see in EGUS horses include changes in eating and drinking behavior, weight loss and poor hair coat (usually seen in long term cases), a change in attitude, recurrent colic, and decreased or poor performance. Foals will grind their teeth or lie on their backs. Stomach pain, back pain and cinchiness are also signs.

Two types of “ulcer horses”

1. High energy and outwardly nervous horses tend to show their stress, whether through behavior, sweat, poor performance or other signs. 2. The silent sufferer is what is called the “internalizer”. These horses do not show signs or symptoms. They may simply have a poor hair coat, an inability to put on weight, or display a slight change in behavior.

Educating the client

The first step in treating stomach ulcers is helping your client understand what EGUS is. Most clients are horrified and feel a lot of guilt when they find out their horse has stomach ulcers. They feel responsible and can take it very personally. Once you start to explain how a horse’s stomach works and how it is different from a human’s, they will start to open up to the conversation .

Find the source of stress

The next step to treating stomach ulcers is finding the source of stress and helping the horse cope with whatever he is being faced with. For example, an old retired horse was moved into a new pasture and started to go downhill quickly. He lost weight rapidly and his coat became dull. After a scope, he was diagnosed with severe ulcers. All it took for him to recover was a change in pasture with other horses that let him eat and were nice to him.

In another case, a horse was kicking at his sides and biting the air when he ate his grain every night. The grain turned out to be acidic and was producing excess stomach acid, which was irritating his stomach. By changing his feed, the kicking and biting went away.

Sometimes you cannot avoid the stress that causes ulcers, as in the case of performance horses. “I believe it is difficult, if not impossible, to ask elite equine athletes to perform at their optimum level when they are suffering from EGUS,” says Dr. Wayne Browning of Bayhill Equine Clinic. For these horses, you will need to find a way to help them cope with the stress and treat the ulcers.

Treatment choices

There are many treatment options available for ulcers. Some are efficacious and some are not.

• The first option is rest. A horse’s stomach can heal itself. If he is removed from the stressful situation, he will usually heal within a month. The problem with this method is that most people do not want to turn their horses out for a month and lose that time for training or showing while they wait for the ulcers to heal.

• Many medications treat ulcers, including acid pump inhibitors, H2-antagonists, and antacids. They work to varying degrees, but the most important thing when using them is knowing how long the drug works in the system and remembering that a horse’s stomach produces acid 24 hours a day.

• There are also many natural approaches: slippery elm, aloe vera juice, licorice, papaya and more. Very little or no research has been done on the effectiveness of these treatments. Most of the information has been anecdotal.

Look at medicinal mushrooms

Mushrooms have a number of modes of action for both preventing and treating EGUS. Reishi has been shown to balance adrenal function – reducing adrenalin response to stress from travel, separation anxiety, modifications to training schedules, etc. Medicinal mushrooms contain a prebiotic platform for probiotic development and healthy mucosal flora. Powerful beta glucans unique to medicinal mushrooms activate the immune system to be “battle ready” for exposure to bacteria, viruses and contaminants.

Recent research on the super antioxidant l’ergothioneine derived from medicinal mushrooms has established that it is the only antioxidant with a cellular transport mechanism. This mechanism senses inflammation and transports l’ergothioneine into the cell to reduce free radical activity.

Medicinal mushrooms also contain high levels of B vitamins, vitamin D, digestive enzymes and proteins. Finally, Reishi is highly regarded as an adaptogen to balance behavior, promote focus and reduce hyperactivity.

As a natural whole food, dehydrated medicinal mushrooms can help treat and prevent ulcers with no potential side effects.

Prevention tactics

The last step to treating stomach ulcers is preventing them. This is a step most people forget or ignore. Just because the ulcers have been treated and healed, it doesn’t mean they won’t come back as soon as the horse is reintroduced to the stress that caused them in the first place. “In our experience, a horse that is stressed for any reason (prolonged transport, systemic illness, major husbandry change, etc.), particularly one that is inappetant, is an ulcerated stomach waiting to happen,” says Dr. Jill Higgins of Loomis Basin Equine Medical Center. “Keeping these horses eating, decreasing stress as much as possible, and being proactive in prevention are key.”

Reducing stress and using natural solutions like medicinal mushrooms will provide the horse with a well rounded prevention plan. Other ways to help prevent stomach ulcers include having a full hay net available to the horse at all times, to promote “grazing”, or feeding him more frequently during the day. If you have an easy keeper and feeding hay all day is not an option, try soaking the hay in water prior to putting it in a hay net. This will help decrease the calories.

Without prevention or removing horses from stressors, the patients you have treated will get ulcers again. This is an important message to stress to clients. It will keep your patients ulcer-free and their owners happy.

Kitchen DL, Merritt AM, Burrow JA. Histamine-induced gastric acid secretion in horses. AJVR 1998; 59(10): 1303-1306. Murray MJ, Schusser GF, Pipers FS, Gross SJ. Factors associated with gastric lesions in thoroughbred racehorses. Equine Vet J 1996; 28:368-374. Mitchell RD, Prevalence of gastric ulcers in hunter/jumper and dressage horses evaluated for poor performance. Association for Equine Sports Medicine, September 2001. Murray MJ, Endoscopic appearance of gastric lesions in foals; 94 cases (1987-1988). JAVMA 1989;195(8): 1135-1141. Le Jeune SS, Nieto JE, Dechant JE, Snyder JR. Prevalance of thoroughbred broodmares in a pasture: A preliminary report. The Veterinary Journal September 2009;181(3):251-255.

A demonstration they’ll remember

One trick to use when explaining stomach ulcers to clients is a plastic Ziploc bag. Draw a line 2” from the bottom of the bag. Explain the two types of stomach lining.

Then pour a liquid in the bag to just below the line you have drawn. When a horse is in training, his stomach shrinks: grab the bottom of the bag so the liquid rises above the line or “margo plicatus” into the “squamous mucosa”.

Then show what happens during times of stress by simply adding more liquid to the bag — when horses are stressed they produce more stomach acid.

Lastly, show what eating roughage does to help the situation: pour a bunch of shavings from the stall into the bag and watch the liquid be absorbed back down below the line. This is a very visual way to teach your clients about the equine stomach and how it works.

Jenna Hahn is Director of Marketing and Animal Health Sales for Matrix Healthwerks. Her professional experience includes the pharmaceutical industry, veterinary practice outreach, small start-up animal health companies, on-line equine development, work with competition managers, horse trainers and more. After graduating from University of CA, Davis with a double major in economics and organizational sociology, Jenna worked for Hill’s Science and Prescription Diets. She is very active in the veterinary industry where she has spent most of her career working with veterinarians and their staff to help improve the quality of life for animals. Jenna has been an avid show jumper her whole life.