Treatment strategies

Some people attempt to ‘buffer’ the stomach acid, by using antacids, similar to some human cases. This does not really help the horse, because the stomach adjusts to the temporarily increased pH and secretes more acid to compensate. 

There are two groups of prescription drugs that reduce the secretion of acid in the stomach of the horse. H2‐receptor antagonists are used in humans but rely on maintaining a high concentration in the blood stream, so only have an effect if given at a high enough dose and frequently. In horses, much better results in acid suppression have been achieved by using omeprazole, which permanently disable the acid pumps in the stomach lining, and acid production does not resume until the body has made new pumps.

However, as we have seen above, the reduction of acid is only one part of the story, especially when it comes to glandular ulcers, and this is probably why glandular ulcers don’t heal as well when the horses are only treated with omeprazole.

Depending on the needs of the horse, we may prescribe drugs that enhance coating of the stomach lining, stimulate the secretion of the protective gloopy layer, improve blood flow of the stomach wall, and/or help with the bacterial balance. 

Management strategies and preventing gastric ulcers.

Based on the risk factors and how/why ulcers develop, there are some general recommendations to optimise management for a horse with gastric ulcers. This does not mean that all of this should be applied to all horses, as there may be other health issues, and all must be balanced to manage each horse in an optimal manner:

• Grazing as much as possible, and in direct contact with other horses if their character allows and does not put either horse at risk of injury.
• Always having fibre food available (feed hay or haylage if Lightening gold is not grazing, and if ad lib fibre feeding is not possible then reduce time between fibre feeds to less than 6 hours where possible). If the horse usually has run out of fibre food in the mornings and feeding more or later in the evening is not practical, it might help to feed the last evening fibre meal in a smaller-mazed net or perhaps even feeding some of it hung in the middle of the stable so it cannot be pinned against the wall and eaten quickly in the earlier parts of the night, ensuring they have still have access to fibre in the early mornings before activity at the yard starts for the day.
• Always having access to water, both when stabled and when turned out.
• If feeding hard foods, little and often is better than one or 2 large meals per day. The total starch content should be less than 1 kg per day for a 500kg horse, and less than 500 g per meal. The total amount of grains should not exceed 1% of bodyweight (so approx. 5 kg for a 500kg horse) per day.
• If feeding hard food, ideally the horse should have some fibre food approximately half an hour before that, so that a protective ‘fibre mat’ can form in the stomach before more acid is produced. Eating fibre also enhances saliva production, and this will help buffer the acid in the stomach that will be produced in response to the richer feed when given.
• Similarly, ideally feed fibre food before exercise, but no hard food directly before exercise so that the ‘fibre mat’ can protect the stomach wall from acid splashes.
• The addition of corn oil (50-100ml per day) to the diet may decrease the risk of gastric ulcers and because it is safe (and cheap) to give this is well worth considering. If they are not used to oil in the feed, the horse might go off its food, so we recommend to gradually introduce the oil to feeds.
• Have the same handlers and same horse companions as much as possible.
• Oddly, it has been shown that it can help horses to have gentle music radio (not talk radio) on if they are stabled.
• Avoid stress when possible, although we appreciate this is easier said than done.

Follow-up

Many of the horses we treat show a marked overall change in behaviour and (subjectively) performance, as reported by their owners or riders. If such a good positive response were seen after we found and treated gastric ulcers, it is fair to assume that ulcers were the cause of the problems and have healed now, and no repeat gastroscopy would be required, just measures to prevent recurrence of ulcers if possible, which we will advise you on in the report tailored to your horse.

If we found no ulcers on gastroscopy, then we will discuss with you what further options are available to investigate other causes of the clinical signs you may have encountered.

If we found and are treating ulcers, but the horse does not seem to improve at all or not enough, then it is worth considering a repeat gastroscopy. If we then find the ulcers have healed but there is no improvement in clinical signs, we will discuss further options to investigate other causes for the clinical signs.

There is a small number of horses that do not respond to the treatments initially prescribed, so in those cases we might find on repeat gastroscopy that the ulcers have not or only minimally healed. If that is what we see, we will adjust the treatment plan for your horse, tailored to your situation.