Gastric ulcers are startlingly common among performance horses of all kinds, and horses coming off the racetrack are no exception. In a recent virtual education session as part of the Retired Racehorse Project's Thoroughbred Aftercare Summit, three experts gathered to share their thoughts on dealing with this issue in off-track Thoroughbreds.
Drs. Frank Andrews, director of Equine Health Studies at the Louisiana State University's School of Veterinary Medicine, Dr. Rana Bozorgmanesh, associate veterinarian at Hagyard Equine Medical Institute, and Dr. Bill Vandergrift of International Equine Consulting agreed ulcers can be a challenging problem, but there are a few management changes that can help.
A few takeaways:
- There is more than one type of “gastric ulcer” in horses – the stomach may have either squamous or glandular ulcers, depending upon their location. Ulcers are really a type of wound caused by acidic secretions into the tender tissue lining the stomach. Glandular ulcers are those that appear in the first third of the stomach, which in horses is really like an extension of the esophagus; it was previously thought the glandular part of the stomach was resistant to ulcers, but research now indicates that may not be the case. Squamous ulcers occur in the latter two-thirds of the stomach and are considered the most common type. Ulcers may also occur in the esophagus as a result of acid reflux.Ulcers can also occur in the start of the small intestine. While an endoscopy may pick up on glandular or squamous ulcers in the stomach, it likely won't be able to show ulcers that far along in the gastrointestinal tract.
- A case of ulcers doesn't look the same in all horses. Those with ulcers in the intestine may experience intermittent diarrhea, which loses protein and dehydrates the horse, inducing further stress. Of course, stress is one of the potential causes of ulcers.Vandergrift told the story of one owner who noticed a horse was losing weight, so began offering the horse more and more grain until it was taking in nearly 25 pounds per day and still losing weight – likely because of ulcers which were worsened by the addition of more high starch concentrate.
- Infrequent, large meals of high starch grain are believed to increase stomach acid production, which can cause ulcers or make a case of ulcers more painful. All three experts agreed that small, frequent meals of concentrate along with lots of forage are better for an ulcer-prone horse. Vandergrift also recommends hay pellets instead of long-stemmed forage in cases of horses experiencing diarrhea.
- Long-term use of NSAIDs can be a cause of ulcers, but not all risk factors are drug-related. The withdrawal of food prior to competition, the stress of travel and athletic work, and dehydration can all result in increased acid production. Often, owners or managers may struggle to recognize when a horse is stressed by the living environment, daily routine, training load, etc. Assessing behavior can be just as valuable a tool to combat ulcers as diet changes.
- Management changes like an adjustment in feeding schedule are only effective after a horse has completed treatment, including pharmacological intervention, for ulcers. Omeprazole is the obvious candidate for resolving ulcers and is considered safe to use over a period of weeks, depending upon the horse's needs. Bozorgmanesh said she also adds misoprostal in cases of horses battling diarrhea, though that isn't safe to use in pregnant mares.
- If you're going to use supplements or other feed additives to address ulcers, the same logic applies – those are really best for prevention, not cure of existing ulcers.“Some of these nutraceuticals can reduce the incidence or severity, but if you've actually got a horse that is presenting with ulcers, has had a history of ulcers, then I think you've got to get people involved and work with some pharmacological agents and actually treat those ulcers. Yes, there are nutraceuticals that can help but if you're trying to treat ulcers, then treat them.
Owners should seek out research data and published research that backs up the claims of a supplement designed to reduce ulcer risk. Products that don't have this information readily available should be avoided. Also make sure you know what's in them. Many people are fond of using aloe vera as a feed additive to reduce acid; Andrews cautioned that many of those products may be diluted – if you're going to try this, make sure the variety you purchase is at least full strength.
- Ulcers can be the primary cause of symptoms in a horse, or they may be secondary to some other issue.“I look at the stomach as the window to the rest of the GI tract,” said Andrews. “And if there's stress farther down the GI tract, that may manifest itself in ulcers.
- Vandergrift said he's skeptical of the use of probiotics as a solution for ulcers.“I think too much emphasis is placed on probiotics or the actual bacteria themselves,” he said. “Many times I think everyone out there forgets that the vast majority of the innate bacterial, whether it's in the large intestine or the small intestine, are anaerobic. Being anaerobic, you can't make a probiotic out of them. They can't live outside the horse. So, the question remains – how do you establish a healthy microbiome?”
Vandergrift prefers the use of prebiotics, which are a type of saccharide that stimulate the growth of good bacteria, making it easier for them to thrive.
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