Ulcers – what they are, what to do about them, & why I know so much about them

Most people in the horse world have, at the very least, heard of ulcers. Perhaps, you have even had a horse with one, or even experienced one yourself. What are they? Well, in essence, ulcers are lesions in the protective mucosal lining of either the foregut or the hindgut. This lining gets irritated, and is then eroded, leaving the intestinal wall exposed to the acidic environment, which ultimately turns into a painful wound.

ulcer_stomach
Retrieved from The Atlanta Equine Clinic

There are two major categories of ulcers, gastric or foregut ulcers which primarily occur in the stomach, and colonic or hindgut ulcers which mainly occur in the colon. Gastric ulcers can be further broken down into two categories, glandular and non-glandular ulcers. The glandular portion of the stomach is the lower section, and it is protected by a thick layer of mucosal lining. This section is constantly producing hydrochloric acid (HCI) through millions of pumps, designed for the horse to be constantly grazing. This region also secretes mucus to prevent the stomach from digesting itself. The non-glandular portion of the stomach is the top section, and it is not as well protected, being covered with a thinner lining of squamous epithelium that does not secrete as much mucus to protect the stomach. As a consequence, the non-glandular region is most commonly afflicted with ulcers.

Non glandular region
Retrieved from McKee Pownall

There are many different factors that can cause gastric ulcers, but essentially, anything that causes the HCI from the glandular region to splash excessively onto the non-glandular area, either from an overproduction of HCI, or an empty stomach, will cause them. The stomach will produce more HCI during times of stress, or if the horse is being fed a diet high in grain and starchy foods. Diets that are low in forage, intense training, an overuse of NSAIDS, or horses being fed large meals a couple of times a day, rather than being allowed to eat food constantly throughout the day, are the most common reasons why ulcers develop. Since most of these reasons are typical of a performance horse, it is no surprise that ulcers are very common among these horses. Hay and other types of forage act as a buffer to prevent the HCI from “attacking” the non-glandular portion of the stomach, but when horses are denied free access to forage, the HCI is then able to erode the non-glandular region.

horse
Retrieved from Dr. Jess

Ulcers usually manifest themselves by the horse developing a loss of appetite, loss of weight and condition, becoming colicy, having a decrease in performance, being girthy, and a general change in attitude.

Gastric ulcers are diagnosed through endoscopy, which is a camera attached on the end of a long tube that is inserted into the horse’s nostril and down into their stomach. The vet is then able to take a look at the inside of the horse’s stomach and determine whether there is ulceration or not. More often, however, ulcers are “diagnosed” through the symptoms that the horse is presenting.

Gastric ulcers are treated with omeprazole, a proton pump inhibitor, which blocks some of the pumps that produce HCI. The stomach is still able to secrete enough HCI to digest food, but not so much as to cause it to splash onto the non-glandular region and continue to irritate the ulcer, allowing it to heal.

Hope was diagnosed with gastric ulcers through the symptoms she was presenting when I first got her. She was girthy, had a poor appetite, and needed to gain more weight. I put her on omeprazole (some people use the FDA approved product Gastrogard, but I just used the generic stuff from my vet), and her appetite increased and she finally started to gain weight. I am also careful with her diet, and ensure that she has 24/7 access to hay and also give her a probiotic, I use Biotic 8 from Omega Alpha (best stuff ever!). I had noticed that she has a tendency to start acting like she possibly had ulcers after shows, so I now put her on a preventative dose of omeprazole a couple of days before, during, and for a couple of days after shows. This seems to do the trick, and I haven’t had any issues with gastric ulcers since I’ve started this regimen.

Hindgut ulcers are a whole nother kettle of fish entirely.  They are typically caused by stress and an overuse of NSAIDS, although parasites can also cause them. Hindgut acidosis is caused when the acidity of the hindgut is too high, usually caused by feeding too many starchy and sugary foods (such as grains and processed feed). This increased acidity can then have the potential to create an ulcer.

The symptoms of hindgut ulcers are very similar to those of gastric ulcers. Horses will typically have a loss of appetite, experience weight loss, have poor performance and resistance under saddle, become girthy and grumpy when their abdomen is touched or brushed, and have a change in their attitude. The only addition is that horses with hindgut ulcers will be particularly sensitive on the right side of their abdomen, some going so far as to even kick out undersaddle when any right leg is applied. Hindgut ulcers are frequently called Right Dorsal Colitis, as the ulcers tend to develop on the right side of the colon (which is why horses afflicted with them are more sensitive on their right side).

Hope started to display this behavior, becoming very grumpy whenever I brushed her abdomen, especially her right side, and started to kick out her right hind leg undersaddle whenever I put my right leg back (for certain lateral movements, or when asking for the left lead canter). Because her kicking out was only with her right leg, and only when I used my right leg further back, I assumed that she might have hindgut ulcers.

Screen Shot 2017-05-22 at 1.45.44 PM
Hope wasn’t a happy camper, and was plainly letting me know

Hindgut ulcers can be clinically diagnosed through ultrasound of the colon. In ulcerated areas, the colon will appear thicker. I chose to not get Hope ultrasounded, because this can sometimes be inaccurate and finicky. I decided to just go ahead with the treatment instead. Depending on the severity of the ulceration, some veterinarians recommend taking your horse off of all long stem forage, to allow the colon to rest and heal itself. We decided to not follow this route however.

I put Hope on Sucralfate, a complex of aluminum that coats any ulcers present in the hindgut with a protective lining. This medication is a little annoying, because it has to be given three times a day, 1-2 hours before or after meals. Sucralfate comes in pills that need to be crushed up, have water added to, and then syringed to your horse. Asides from the administration being a little tedious, it seems to work quite well. I noticed a difference in Hope after a couple of days.

I suspected that her hindgut ulcers were caused by hindgut acidosis, because she had been on a high starch grain (she is an extremely picky eater, and it was the only grain she would eat). When she started displaying symptoms of hindgut ulcers, I immediately stopped feeding the high starch grain, and put her on a low starch, low sugar feed instead (much to her disappointment, but after about a week of refusing to eat it, she finally gave in, and has been eating it ever since). I also had to find a product to decrease the overly acidic environment of her hindgut. Equishure by Kentucky Equine Research was the most well recommended, so I decided to go with it. Equishure is a time-released hindgut buffer, essentially, it is encapsulated baking soda. The encapsulation ensures that the product gets to the hindgut (normal baking soda would be destroyed in the stomach, it would never reach the hindgut), which allows it to change the pH and lower the acidity.

I’m pleased to say, that the combination of Sucralfate and Equishure healed Hope’s ulcer in a couple of weeks, and she went back to her normal self. I can now use my right leg without her having any objection, and can brush her entire abdomen without her caring.

I’ve decided to keep Hope on a preventative dose of Equishure, just to help ensure that she doesn’t redevelop hindgut ulcers again. So far, she has been totally fine, and now enjoys her low-starch grain sprinkled with her Equishure, a brilliant product tasting faintly of baking soda.

Have you ever had a horse with ulcers? How did you treat them, and do you do anything to prevent them?

 

 

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