OTTBs and Ulcers: Why is this so common?

Everyone has heard about ulcers, and it's typically this catch-all approach to anything "off" about our horse's demeanor or appearance.

The truth is, the equine digestive system is a vast and intricate part of our horse's health and wellbeing. If the gastric system is off, our horse is off. Whether that is ulcers, colic, colitis, leaky gut, or parasites, these affect our WHOLE horse.

A healthy, vibrant horse is indicative of a healthy, vibrant digestive system.

Now, I'm no vet. There is so much to learn regarding the digestive system and how to help our horse's balance internally. I learned about ulcers the hard way. Looking back, I met many horses with ulcers that went untreated due to ignorance or misunderstanding about ulcers by their owners.

Many years of research and experience later, I'd like to share with you what I know about ulcers as I wish there was a "cheat-sheet" for me when I was first learning about them.

Ulcer treatment and prevention can be simple and cost-effective!

[Skip to the bottom for my personal "formula" for cost effective treatment and prevention]

Here is what I've learned about ulcers thus far in their diagnosis, treatment, and prevention.

What are Ulcers

Gastric, or stomach, ulcers are sores that form on the stomach lining. They are especially common in performance horses. Most high-level trainers acknowledge the presence of ulcers and have some ulcer prevention or treatment plan in place for the performance horse's in their barn.

How are Ulcers Formed

Unlike humans, horses are constantly producing stomach acid, as ancestrally they are used to constant access to forage on the wild plains. Modern day horses still have this same digestive track, but we've stuck them in stalls and give them rations of food because it's more cost efficient in our boarding system.

Ulceration of the stomach lining occurs when the acid erodes the lining of the stomach creating sores. Ulcers can vary in location and severity.

Common causes for ulcerations are :

• Consistent environmental stress affecting nervous system regulation

• Long period of time in between access to forage

• Intense exercise

• Large quantity of grain-based diets or dense "meals"

• Consistent use of certain non-steroidal drugs such as bute

Signs and Symptoms of Gastric Ulcers

The signs and symptoms of ulcers vary by horse, typically evidence shows up in their behaviors well as physical appearance.

Some examples are:

• Poor appetite

• Poor hair coat

• Attitude changes and irritability

• Decreased performance and reluctance to train

• Poor body condition or Weight loss

• Low grade colic

• Sensitivity to touch along abdomen

  
  

Your vet can clinically diagnose the presence of ulcers by gastric endoscopy/gastroscopy. This involves placing an endoscope into the stomach and looking at its surface lining for ulcerated tissue.

Treatment of Gastric Ulcers

There is currently only one FDA approved treatment for gastric ulcers and that is omeprazole. Omeprazole is a proton pump inhibitor (PPI) and limits the production of stomach acid allowing for the lining of the stomach to heal.

Omeprazole requires a prescription from your vet and can be given in paste form or compounded into powder form. Compounded omeprazole is less expensive and some argue it is then less effective.

Sucralfate is also an effective treatment for hindgut ulcers. Sucralfate acts as a band-aid over the ulceration and prevents further irritation from acids allowing time for the ulcer to heal itself. Using both medications over a 28 day period provides a holistic approach to healing all ulcerations for your horse.

Misoprostol used to treat gastric ulcers where the licensed medication (omeprazole) is not effective or predicted to not be effective. It is most commonly used in glandular gastric lesions in the horse, where omeprazole is usually ineffective.

Timeline for healing ulcers depends on the type and severity of ulcers. Common ulcers can take 28 days while pyloric ulcers can take months. The good news is you should see signs of improvement behaviorally and physically for your horse within a couple days of starting treatment. This helps to confirm the presence of ulcers and effectiveness of the drug(s).

Administration of these drugs should be directed and monitored by your veterinarian. At the end of treatment, another gastroscopy is also recommended to verify that all ulcerations are healed or provide further insight into the treatment plan.

Prevention of Gastric Ulcers

Once you’ve treated your horse for ulcers, there are a number of different practices that have proven to help prevent ulcer re-occurrence. Working with your veterinarian, here are a couple easy, low cost ways to help reduce the risk of ulcer recurrence:

• Provide consistent access to low quality (but clean) hay, forage, or pasture

• Supplement alfalfa into your horse’s diet (if appropriate)

• Reduce the amount of grain and concentrates your horse is receiving or break them up into multiple small meals a day ( <3lbs a meal)

• Avoid or decrease the consistent use of anti-inflammatory drugs or find one that is less caustic to the stomach.

• Limit stressful situations such as intense training and frequent transporting OR supplement omeprazole during shows and transportation.

• Reduce stressors in environments such as long periods in a stall, inability to see or have contact with other horses, and long periods in between access to forage. Listen to what your horse deems as "stressful".

• Give couple handfuls of hay or alfalfa just prior to exercise to buffer splashing of acids in the stomach.

While there are many claimed remedies and treatments to ulcers (I've even heard feeding papaya), omeprazole is the only tested and approved drug for treatment. With no negative side effects, it’s highly recommended to treat any horse for ulcers to ensure that your horse has a happy, healthy digestive tract.

My "Cheat Sheet" to Ulcer Treatment

Ok. Contrary to the first statement in this blog. I typically treat/check every horse I take in for rebalancing for ulcers. Why? because it's a no brainer and I can do it cost effectively. Since omeprazole shows effectiveness within the first couple days, I'll treat horses from 2 weeks to 1 month depending on what signs/symptoms they show. If they continue to show signs I will bring my vet in for scoping.

If my goal is producing happy, healthy horses then I will always double check I have a happy, healthy digestive system. From their I assess and rebalance the diet, environment, and any other stress triggers that might affect the horse.

NOTE: This is for horses that do not present strong symptoms or behaviors. It's simply a safety check for new horses coming into my program.

I will either use compounded omeprazole/sucralfate through my vet or order Abler (abler.com) sachets. You can order in bulk or pre-measured. Now this product is not FDA approved because it is shipped from overseas and not tested for consistency of omeprazole in each dosing. For me, I've had nothing but positive results from it and the horses are much better eating it mixed in their food then any tube or paste; by day 28 of sticking a tube in their mouth, they're pretty over it. Abler costs me around $179 for a little over a months worth of omeprazole. They also sell sucralfate as well.

LAST NOTE: You CAN over use omeprazole and build up tolerance and ineffectiveness to the drug, as well as alter the homeostasis of your horse's gut biome. Don't leave your horse on it long term. It's meant for acute treatment only.

I allow my horses 24/7 access to slow feeder hay, encourage movement where their water and hay are not right next to each other, and balance their diet with the appropriate fats, vitamins, minerals, and protein.

The horse's body WANTS to be balanced and healthy. It's up to us to figure out what it needs to find that balance again and maintain it.

I hope this ulcer deep-dive is helpful and opens your eyes to the prevalence of ulcers as well as empowers you in their treatment and prevention for a happy, healthy equine partner.

Happy Partnerships!!