Gastric (stomach) ulcers in horses are a common problem we encounter on a daily basis at our hospital. Gastric ulcers develop primarily via peptic secretions (hydro chloric acid, pepsin) which cause damage to the stomach. The highly competitive nature of the performance business combined with the advancement of diagnostics has increased awareness of (EGUS) Equine Gastric Ulcer Syndrome. I can remember showing horses in high school and college when we had limited feed choices and very few supplements. Presently there are numerous feed choices, exercise regimes and more opportunities to travel to events. The equine patient must be managed more like an athlete these days due to the highly competitive nature of the business. In most cases gastric ulcers in horses can be diagnosed easily. Stomach ulcers, in my opinion, are an issue we must address in order to keep our horses healthy and maintain that competitive edge.

     We have a tendency to encounter EGUS somewhat more this time of year due to the fact that during spring and summer we utilize our horses a little more than in fall and winter. There are two things that have always amazed me about EGUS, the various different clinical signs the patient exhibits, and the high percentage of horses that are affected. Clinical signs include weight loss, decreases appetite, colic, changes in attitude, sub optimal performance, dull hair coats, and diarrhea, or a combination of all of these. Percentages of horses affected are also striking. Retama Equine Hospital takes in a large number of emergency colics. 5-10% of the colics we take in will have primary EGUS. This is amazing to me because a lot of these colics are non responsive to medical treatment. Pretty painful for only having stomach ulcers! 70% of the horses that we perform Gastroscopy on will have some degree of stomach ulceration.

     The only way to diagnose stomach ulcers is with gastroscopy, (endoscopic evaluation of the esophagus and stomach). This procedure is much more advanced now due to better endoscopic equipment available for veterinary use. There are two different types of endoscopes available for gastroscopy, the fiber optic endoscope which uses a glass fiber bundle to transmit light directly back to an eye piece from which your veterinarian can view the stomach. The video endoscope also uses glass fiber bundles to deliver images but has a chip which can transmit these images to a screen which can be visualized by the client and anyone participating with the exam. The endoscopes used for gastroscopy are about 3m long and 10mm in diameter which is about the same size as the normal equine stomach tubes.

     How is the procedure performed? How safe is the procedure? We must remember that in order to visualize the stomach it must be completely empty of all contents at the time of examination. The patient must be fasted for about sixteen hours.  It is preferred to schedule the gatroscopy around 9:00am. The day prior to the exam I will have my client remove all hay and grain at 5:00pm, and then at 10:00pm I will have them remove the water. The stall also needs to be free of hay that may be left behind from previous feedings. At the time of the gastroscopys, the patient is placed in the stocks, sedated and the endoscope is passed up one nostril into the esophagus and eventually advanced to the stomach much in the same fashion as passing a stomach tube. There is no aftercare needed and the patient can resume their normal feed ration about one hour after the examination. The patient can resume his training routine that same afternoon. The procedure takes about thirty to forty minutes to perform and is relatively non-invasive.

     The lining of the equine stomach is divided into two parts, one part that is lined with squamous tissue and a second part that is covered with glandular tissue. The division between the two parts is called the margo plicatus. The glandular portion contains the glands responsible for the gastric secretions. Although I have noted ulcerations on all parts of the stomach, the majority of the ulcers are located on the squamous portion of the stomach in close proximity to the margo plicatus.  Typically, I will grade the degree of ulceration from 1-4, one being mild and four being severe.  In most cases the degree of ulceration will dictate the treatment protocol.  Although this grading system works well for me, I have had those patients that graded one yet showed the more severe clinical signs of grade 3.  This is due to the fact that some horses tolerate ulcers better than others. 

     At this time there are several different treatment options available to the horse owner.  The things that must be considered before prescribing a treatment regimen are the cost, management, and the severity of the ulceration in each individual patient. I would recommend that all these factors be reviewed by the veterinarian and horse owner in order to decide on which regimen is best for each individual case.

     EGUS is a very common disease of the equine athlete.  With the high level of performance that is expected from these horses, along with an increase in strenuous training regimens, higher energy diets, and increased travel, a greater incidence of stomach ulcers are definitely seen.  It would be safe to say that 70% of all equine athletes are affected with stomach ulcers, yet may not show any outward clinical symptoms. I do however feel that EGUS affects their training, appetite, and temperament and should be considered present in all of our horses.  Talk to your veterinarian about symptoms, diagnosis, and treatment options.