equine gastric ulcer syndrome | Horse Racing Free Tips

Anti-inflammatory Supplements Are Supposed To Reduce Need For Drugs, But Do They Carry The Same Ulcer Risk In Horses?

Thoroughbreds receive a plethora of nutritional supplements smattered on their feed making their buckets look like a child's cereal bowl after they're finished adding spoonfuls of sugar. Given how sensitive a Thoroughbred's stomach can be and their propensity to develop equine gastric ulcer syndrome (EGUS), anti-inflammatory supplements must be used with caution.

Louisiana State University researchers in the Equine Health Studies Program (EHSP) recently took a closer look at two anti-inflammatory nutritional supplements commonly given to horses: turmeric and devil's claw. In light of their proven anti-inflammatory properties, both supplements can be used either in lieu of nonsteroidal anti-inflammatory drugs (NSAIDs such as flunixin or phenylbutazone) or to decrease the need for NSAID administration.

“NSAIDs have known adverse effects, such as right dorsal colitis and kidney toxicity,” said Dr. Michael St. Blanc, research intern veterinarian at Louisiana State University's School of Veterinary Medicine. “NSAIDs also inhibit cyclo-oxygenase 1 and prostaglandin synthesis and can therefore contribute to the development of gastric ulcers.”

Prostaglandins play an important role in gastric health. For example, these mediators:

Stimulate bicarbonate secretion, which buffers gastric acid. An excessively acidic stomach environment can irritate and ulcerate the lining of the stomach;
Inhibit hydrochloric acid secretion, which helps maintain an appropriate gastric pH;
Promote microvascular blood flow to the stomach lining, and
Support mucus production that protects the stomach wall.

“Considering the known side effects of NSAIDs, nutritional supplements with anti-inflammatory properties like devil's claw and turmeric are attractive options for the long-term management of inflammatory conditions,” said St. Blanc. “This is of course assuming that devil's claw and turmeric do not contribute to EGUS.”

While neither turmeric nor devil's claw are known to cause diarrhea or negatively affect kidney function, both supplements are required by the National Animal Supplement Council (NASC) to include a statement regarding their possible role as a gastrointestinal irritant. Those statements specifically warn consumers that they should not be used, or used only with caution, in patients either with or at risk of stomach ulcers.

“Despite the industry requirement for these statements, these claims are relatively unsubstantiated by scientific data,” said St. Blanc.

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Considering the popularity of these anti-inflammatory supplements and the fact that almost 100% of racehorses either have or are at risk for EGUS, St. Blanc and the EHSP research team, evaluated the safety of both devil's claw and turmeric in 12 Thoroughbreds. At the start of the study, all horses had an EGUS score greater than 0, meaning that all included Thoroughbreds had pre-existing ulcer disease (as expected in racing Thoroughbreds). Horses were randomly assigned to either the treatment or control groups. Horses in the treatment group were fed 12,000 mg turmeric root powder and 2,500 mg devil's claw extract once daily for 28 days. All horses included in the study were otherwise managed similarly.

At baseline and days 14, 21, and 28, all horses underwent gastroscopy to assign an EGUS score and assess severity of disease. Complete blood work was also performed, and researchers recorded the horses' body weight.

“The key finding of this study was that mean ulcer score did not increase in horses receiving the turmeric root powder and devil's claw extract,” said St. Blanc. “In fact, mean EGUS scores decreased significantly in both groups of horses by days 14 and 21, again showing that the turmeric and devil's claw supplement did not worsen EGUS.”

The study did not detect any significant changes in body weight or blood parameters.

While these supplements are not designed to treat EGUS, an improvement in EGUS scores was noted. St. Blanc said that improvement in EGUS was likely due to lack of feed competition and stress during the study period and not due to supplement administration.

“The doses of turmeric and devil's claw used in this study were clinically well tolerated, and both supplements were palatable,” he concluded. “They therefore both appear to be safe anti-inflammatory modalities in Thoroughbreds, even in the face of EGUS.”

As mentioned above, EGUS affects almost 100% of Thoroughbreds involved in racing and training. Signs of EGUS included poor performance, a dull hair coat, weight loss, and bruxism (grinding teeth). Prevention and treatment of EGUS, which may include minimizing NSAID administration, are essential for optimizing the health, welfare, and performance of Thoroughbreds. Current management strategies for EGUS include minimizing stress (associated with feeding, housing in stalls, and social restrictions) and administering pharmaceuticals such as omeprazole, sucralfate, misoprostol, and ranitidine.

Dr. Stacey Oke is a seasoned freelance writer, veterinarian, and life-long horse lover. When not researching ways for horses to live longer, healthier lives as athletes and human companions, she practices small animal medicine in New York. A busy mom of three, Stacey also finds time for running, hiking, tap dancing, and dog agility training.

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Is Your Horse Stressed? Boehringer Ingelheim Has A Special Soundtrack For Them — No, Really

Boehringer Ingelheim is focused on helping keep horses safe and “sound” when it comes to stress with the release of a music track specially designed to help reduce stress in horses. Research shows stress can quickly turn into equine gastric ulcer syndrome (EGUS), with one study showing horses can develop stomach ulcers in as few as five days.

The musical arrangement features soothing music designed with the horse in mind. The track was created by Janet Marlow, sound behaviorist, composer, researcher and founder of Pet Acoustics Inc. Marlow focused on creating rhythms and melodies composed for the listening comfort of the horse, including specific pitch, tone and frequencies. Studies show that playing music can help balance equine behavior because it helps mask outside sounds and vibrations, as well as provide a positive and relaxing effect.

“When Boehringer Ingelheim expressed an interest in doing something to help manage stress in horses, I was extremely interested based on my research in this area,” said Janet Marlow, founder of Pet Acoustics. “It's all about composing music and modifying the decibel and frequency levels of each note for the comfortable hearing range of the animal. Using this process, we have tested music through clinical studies at veterinary hospitals, barns, etc. to see the music elicit a release of physical tensions and stress behaviors.”

To access it, veterinarians and horse owners can visit https://www.youtube.com/channel/UCoekmWDxfuaOGuL1ELoPIGQ/videos. Visitors will be able to play the music track and video, as well as gain access to additional resources on stress, EGUS, and ways to help prevent it.

This includes information on the use of Ulcergard^® (omeprazole), to help reduce the creation of acid in a horse's stomach during times of stress, helping to maintain optimal gastric health. For ulcer prevention, horses should be given ULCERGARD once daily during these stressful periods. ULCERGARD is the only prevention for equine gastric ulcers that is proven to be safe, effective and approved by the FDA.

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What We Know (And What We Don’t) About Equine Gastric Ulcers And The Impact Of Treatment On Bones

Gastric ulcers in horses have been a problem for trainers, owners, and managers for years now, and studies suggest a majority of racehorses and performance horses suffer from them. As a result, they've been a topic of much academic research in the past five years.

Dr. Ben Sykes, assistant professor of equine internal medicine at Massey University, sat down with the Grayson Jockey Club Research Foundation recently to give the public an idea of what we've learned in the past five years and what he and other researchers plan to focus on in the next five.

A complete replay of Sykes's seminar is below. A few key takeaways:

First of all, the term most of us use to describe this issue in horses is a bit outdated. Equine Gastric Ulcer Syndrome (EGUS) is still the common terminology in lots of advertising and lay articles about the topic, but that's actually a holdover from before we knew that there were two distinct types of ulcer-like disorders that could be happening in a horse's stomach.
Technically, there are now two terms in use which are more specific: Equine Squamous Gastric Disease and Equine Glandular Gastric Disease. Squamous gastric disease refers to ulcers in the upper half of the stomach, characterized by ulcers easily viewed on gastroscope. Glandular Gastric Disease refers to lesions [which technically aren't ulcers, but look and behave similarly to true ulcers] in the lower half of the stomach, particularly around the part where the stomach empties into the gut.

Until recently, gastroscopes were only long enough to reach the squamous part of the stomach, so we didn't really know if there could be problems lurking further along. The two terms really only came about in the last several years when the longer gastroscopes became common. Research we have on gastric ulcers in horses prior to 2015 is almost certainly referring to Equine Squamous Gastric Disease. Equine Glandular Gastric Disease is much less understood.
Why does this matter? The two diseases exist independently of each other, with different possible causes and different treatments. For Sykes, squamous ulcers come about as a result of management decisions that increase damage of stomach acid to the top of the stomach. The ulcers are caused by two types of acid – hydrochloric acid, which is reduced by common treatments like omeprazole, and volatile fatty acids, which are not addressed by omeprazole and come about as a way to digest grain. Sykes said researchers think that this acid damage occurs during exercise.
Studies have shown that exercise drops stomach pH, increasing the acidity. This is primarily because the abdominal muscles at a trot or canter squeeze the stomach into an hourglass shape, pushing the acid that was at the bottom of the stomach, where it was being buffered by a lot of fibrous feed material, toward the top, which is more likely to be fairly empty or contain thinner, more watery material. It's quite easy for the acid to splash around at the top of the stomach and cause damage.

High carbohydrate diets can be a problem for horses with this disorder since they require more volatile fatty acids to break down the structure of the carbs. That doesn't mean you can't feed an ulcery horse grain, Sykes said – you just have to do it in moderation. A balanced commercially processed feed provides a lot of important nutrients to working horses. Low carb, high fat and high fiber diets are good choices for keeping a horse fed without increasing ulcer risk.
Equine Glandular Gastric Disease on the other hand, occurs in the lower part of the stomach where the environment is commonly pretty acidic. Sykes said he thinks the disease occurs because the natural defense mechanisms of the stomach lining there have been compromised for some reason.
There's no evidence diet impacts Equine Glandular Gastric Disease, but workload might. Studies have shown that long stretches of work without days off make a horse more likely to exhibit signs of Equine Glandular Gastric Disease, and behavioral stress may be a factor as well. Horses with glandular ulcers have been shown to produce higher levels of cortisol in stressful situations than horses without glandular ulcers, though we don't know whether stress caused the ulcers or the ulcers worsened the horses' stress reaction.
A few discoveries from recent data: Perhaps surprisingly, omeprazole, the go-to treatment for gastric ulcers, does its best work on a relatively empty stomach. One study compared the acidity of horse's stomachs when they were fed free choice hay round the clock versus the usual racehorse schedule of two big meals with some hay offered in between. Researchers found that the drug worked best when the horse had an empty stomach first thing in the morning.
It seems misoprostal may be a better treatment for glandular ulcers than omeprazole, which works well on squamous ulcers. Both options improved horses' symptoms, but the misoprostal showed more healing of lesions on gastroscopy.
A new form of omeprazole available via intramuscular injection may show promise for horses with both types of ulcers. The drug isn't accessible in most of the United States yet, but one peer-reviewed study showed 100% healing of squamous ulcers and 75% healing of glandular ulcers after two doses.
For a long time, veterinarians have suspected a connection between prolonged use of non-steroidal anti-inflammatories like phenylbutazone and ulcers, so for a while they suggested giving omeprazole along with bute as a preventative. Sykes pointed to one peer-reviewed study from 2020 that showed that may not be a good idea. In the study, horses were examined after being given a course of drugs — either bute alone or bute given alongside omeprazole. The bute group did show signs of ulceration while the other group didn't, but there was a high rate of serious intestinal issues among the group receiving bute with omeprazole. In two cases, those intestinal problems proved fatal.
One of the big questions Sykes hopes to answer in the coming years is the potential side effects of long-term omeprazole use in horses – particularly whether or not it increases fracture risk by changing calcium and magnesium absorption. Initially, long-term use of certain types of ulcer drugs in humans was thought to increase fracture risk only in geriatric patients but a recent study in pediatric patients showed that short term treatment of very young children resulted in a 13 percent increase of fracture by age 12 or 13.
We don't have any data to show whether or not the same thing occurs in horses, and part of the reason is that it's difficult to exclude other risk factors for a fracture. The human data does have Sykes worried – not only about the intersection of ulcer treatments and fatal fracture risk, but also about whether ulcer treatments could predispose a horse to bucked shins or other bone maladaptive disorders.

Sykes said thanks to Grayson Jockey Club Research Foundation, he and others are currently constructing studies to look at the impacts of common ulcer drugs on mineral absorption in horses. With any luck, we should know more about the issue in the coming years.

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Study: Omeprazole And Bute Not Necessarily A Good Combination

Omeprazole is often prescribed to horses that are receiving phenylbutazone in an effort to reduce the chances of a horse developing equine gastric ulcer syndrome (EGUS), though it isn't clear how safe or effective this treatment is.

Drs. Megan Ricord, Frank Andrews, Francisco Yñiguez, Michael Keowen, Frank Garza Jr., Linda Paul, Ann Chapman and Heidi Banse created a study to evaluate the effect of omeprazole on adult horses with EGUS caused by phenylbutazone.

The research team used 22 horses that had equine glandular gastric disease (EGGD) and equine squamous gastric disease (ESGD), each horse had a score of a 2 or higher when tested for the disease. The horses were divided into three groups: one group (eight horses) received 4.4 mg/kg of oral phenylbutazone every 12 hours; the second group (eight horses) received the same phenylbutazone dose plus 4 mg/kg of oral omeprazole every 24 hours. The control group (six horses) received neither phenylbutazone or omeprazole.

The horses were treated for 14 days and had their stomachs scoped at days seven and 14. Blood tests were done at the beginning and end of the study period. Five of the horses did not complete the study because of intestinal issues (two in the phenylbutazone-only group and three in the phenylbutazone/omeprazole group).

The scientists found that the EGGD score increased in the study group that received the phenylbutazone only when compared to the horses that also received omeprazole. They found no difference in the ESGD scores between the two groups. Strikingly, six of the eight horses in the phenylbutazone/omeprazole group developed intestinal complications—two of which were fatal. Only two of the horses in the phenylbutazone-only group had intestinal complications, and neither of them died.

The team concluded that using omeprazole reduced the severity of EGGD, but that caution should be exercized when using the two concurrently, especially when this takes place at the same time as a management change.

Read the study here.