UL­CER DI­AG­NO­SIS AND TREAT­MENT

EQUUS - - Eq Tack& Gear -

Ul­cer di­ag­no­sis can be fairly straight­for­ward: In an en­do­scopic exam a small, flex­i­ble tube with a cam­era in the end is passed through a horse’s esoph­a­gus to his stom­ach and re­lays real-time im­ages to a screen. But even if ul­cers are found, it’s hard to de­ter­mine whether they are the cause of health or per­for­mance prob­lems. In­stead, the re­sults of the en­do­scopic exam are one piece of the larger puz­zle, of­ten serv­ing as a base­line to chart the ef­fec­tive­ness of treat­ment.

In many cases, treat­ment it­self helps in con­firm­ing an ul­cer di­ag­no­sis. A vet­eri­nar­ian may sug­gest start­ing a horse on ul­cer med­i­ca­tion to see if he im­proves.

The gold stan­dard for treat­ing ul­cers in horses is the drug omepra­zole, sold as Gas­troGard. It works by de­creas­ing the acid pro­duc­tion in the stom­ach and is ex­tremely safe, so much so that many vet­eri­nar­i­ans would rather use a course of treat­ment as a di­ag­nos­tic test than sub­ject a horse to an en­do­scopic exam.

The dosage for pre­sumed ul­cers is the same for that of con­firmed ul­cers: Daily treat­ment of 4 mg/kg of Gas­troGard. The drug will reach its peak af­ter about five days, and most horses feel bet­ter af­ter about two weeks. If the horse im­proves, ul­cers are con­sid­ered to have been the cause of his prob­lem and the treat­ment con­tin­ues for an ad­di­tional two weeks.

Omepra­zole can also be used as a pre­ven­tive med­i­ca­tion. The same for­mu­la­tion, sold as Ul­cerGard, is given daily at a lower dose, 1 mg/kg, dur­ing stress­ful times, such as hos­pi­tal­iza­tion or a multi-day show away from home.

Gas­troGard is the only drug approved by the Food and Drug Ad­min­is­tra­tion to treat equine ul­cers, but the cost can send own­ers look­ing for al­ter­na­tive med­i­ca­tions. Some are avail­able, but they have sig­nif­i­cant draw­backs. The hu­man antacid ran­i­ti­dine has shown lim­ited ef­fi­cacy in clin­i­cal tri­als with horses, and su­cral­fate, a mu­cosal ad­her­ent that pro­tects the stom­ach lin­ing from acid, can limit the ab­sorp­tion of other med­i­ca­tions so must be used ju­di­ciously.

Oral sup­ple­ments and herbal prod­ucts for­mu­lated to pre­vent ul­cers are also avail­able but are not re­quired by law to be tested as ex­ten­sively as med­i­ca­tions be­fore be­ing mar­keted. As a re­sult, there is a sig­nif­i­cantly smaller body of data to ex­am­ine. How­ever, stud­ies on some prod­ucts show prom­ise. A sup­ple­ment made with berries of the sea buck­thorn shrub, for in­stance, has been shown to pre­vent ul­cers caused by a phe­nom­e­non known as re­bound acid hy­per­secre­tion, the dra­matic in­crease in acid se­cre­tion af­ter a course of omepra­zole. Horses who were given the sup­ple­ment dur­ing and af­ter suc­cess­ful omepra­zole treat­ment were less likely to have re­cur­rence of ul­cers af­ter the med­i­ca­tion was stopped than were those who did not re­ceive the sup­ple­ment.

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