Treatment
Treatment is based on a combination of pharmaceutical agents, as well as dietary and management changes. Drug therapy
Acid suppression is currently the mainstay of drug therapy and is achieved using omeprazole, a proton pump inhibitor. The resulting increase in stomach pH allows the ulceration to heal. There are three oral formulations of omeprazole licensed in the UK — Gastrogard (Boehringer-Ingelheim), Peptizole (Norbrook) and UlcerGold (Zoetis). An injectable formulation is also available. Given that squamous and glandular ulceration are separate diseases, treatment for the two conditions differs slightly.
Horses with squamous ulceration are generally placed on a 28-day course of oral omeprazole. Ideally, affected patients are rested (at least when treatment begins) to reduce acid splash and thereby maximise ulcer healing. This, however, isn’t always possible. Repeat gastroscopy is recommended following the initial 28-day course to assess the response to treatment. Around 80% of cases show that they have healed and are subsequently weaned off the omeprazole. The remaining 20% require a continuation of medication with repeat gastroscopy following a further four-week course of treatment. Horses with glandular ulceration (with or without concurrent squamous ulceration) are also given a course of oral omeprazole. Sucralfate is often added too. Just over 65% of patients see their problem resolved at repeat gastroscopy following four to six weeks of treatment. Longer treatment courses are therefore generally required compared to squamous ulcerative disease.