ULCER DIAGNOSIS AND TREATMENT
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.