Gastric Ulcers

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Gastric ulcers are not a problem exclusive to race and performance horses; many leisure horses have also be found to suffer from Equine Gastric Ulcer Syndrome (EGUS).

Gastric Anatomy

To understand why ulcers occur, it is necessary to be familiar with the simple anatomy of the stomach. It can be divided into two regions; the bottom half is referred to as the glandular region and the top half is the squamous region. The glandular region is where hydrochloric acid and enzymes are secreted to break down food. It also produces mucus as a protection system to stop the acid from damaging the stomach lining.

The squamous region acts as a reservoir for food as it makes its way down to the bottom of the stomach and has no built-in protection system. Instead, it relies on the almost continuous supply of grass and other fibrous material trickling into the stomach, to defend it against acid attack.

Fibre has two important functions; firstly it acts as a physical barrier mopping up the acid and literally stopping it from coming into contact with the stomach lining. Secondly, chewing produces saliva which contains bicarbonate that helps to neutralise the acid in the stomach. As a horse only produces saliva when it chews, the more a horse eats, the more saliva is produced so eating grass/forage almost continuously would produce an almost constant supply of neutralising saliva.

What goes wrong?

Ulceration of the stomach lining can occur in both regions of the stomach but are due to very different causes.  Ulcers in the glandular region (Equine Glandular Gastric Disease (EGGD) are due to a break down in the mechanism that would normally protect this area from acid attack.  The cause is not yet fully understood but is thought to include stress, working more than 5 days a week and long term use of NSAIDs, like Bute.

Ulceration to the squamous region (Equine Squamous Gastric Disease (ESGD)) is more likely to be due to prolonged periods without forage, leaving the area prone to acid attack, particularly during exercise.

The Effects of Exercise

It has been found that there is increased pressure, when a horse exercises at high intensity, leading to compression of the stomach, which pushes the acidic contents of the glandular region up into the squamous region. The longer the horse exercises/trains for, the increased time the squamous region is exposed to the acid, and the greater the potential for ulcers to occur. 

Are all horses at risk?

The racehorse is clearly at greatest risk because they work at greater speeds and are typically fed very little fibre. The link between exercise and ulcers however, suggests that all horses that are worked regularly are at risk, from performance horses to leisure horses.

How would I know if my horse has ulcers?

The only way to make a definitive diagnosis is via a gastroscopic examination. The symptoms that would lead you to request an examination include poor appetite, weight loss, grumpy behaviour, dull coat and possibly poor performance. Obviously many of these symptoms could be indicative of several other problems but, if they are all occurring together, then ulcers could be the culprit.

Treatment

Following gastroscopic diagnosis, there are a number of medications which can be recommended by your vet, most commonly, omeprazole, a proton pump inhibitor which suppresses the production of stomach acid.  Misoprostol, a synthetic prostaglandin, may be prescribed for EGGD, as it supresses acid production and supports the healing of the stomach lining. 

Mucosal protectants, like Sucralfate, are also prescribed for treatment of glandular ulcers and, alongside medical treatment, management and diet are instrumental for recovery and prevention of recurrence. Anu underlying causes of stress, pain or discomfort must also be addressed.

Supplements

A growing variety of supplements are available with some now  also being included in feeds as well.  These may help support a treatment and management regime and aid in the prevention or recurrence of ulcers. 

Key ingredients include:

-       Antacids: Help buffer gastric acid and neutralise stomach pH

-     Soluble fibres: These include pectins and beta-glucans, which can help protect the stomach lining, as well as improving the           digestion of starch and sugar within the foregut

-       Pre- and pro- biotics: Support the population of beneficial bacteria throughout the digestive tract

Feeding and Management

Feeding management should include the provision of ad lib forage, while concentrate feed should be kept as low in starch as possible, to help keep acidity levels in the digestive tract under control, and meals should be kept small and frequent. BETA’s feed approval mark is designed to help horse owners identify which feeds are suitable for horses prone to gastric ulcers. 

This means that their starch and sugar contents are low enough that, when fed according to recommendations, the horse will receive less than 1g/1kg of bodyweight in starch and sugar per meal and less than 2g/2kg of bodyweight of starch and sugar per day, parameters which have been identified by specific research.

The horse should not be exercised on an empty stomach, so it is wise to ensure that some forage has been consumed. A small feed containing alfalfa (known to have natural acid-buffering properties) could also be given before exercise.

High Calorie Requirements

Ease & Excel was one of the first feeds to be awarded the BETA feed approval mark, meaning that the ingredients have been examined and the starch and sugar levels (at 8% and 6%, respectively) have been deemed low enough to be suitable for horses with gastric ulcers.

Being high in fibre and oil, Ease & Excel is great for horses in high levels of work or for those requiring extra calories for condition. It is fully balanced and also contains a bespoke In-Feed Formula, from Protexin, which provides a number of benefits to support the health of the gastric and intestinal lining as well as digestive efficiency.

Ease & Excel Cubes bring the same low starch benefits as Ease & Excel and may be preferable for the particularly fussy horse as they eliminate the risk of selective feeding, which can occur when horses pick out only the bits they like from a coarse mix or blend.  Ease & Excel Cubes contain extracts of flavours of essential oils to further enhance palatability, and can be easily soaked to a tasty mash, if preferred.

Added extras:

• As well as increasing the fibre and protein contribution of the concentrate feed, alfalfa is high in calcium so can have a buffering capacity. It provides digestible fibre calories as well as indigestible fibres, such as lignin, which can protect the stomach lining. Alfalfa Plus Oil provides the great benefits of alfalfa along with extra slow-release calories through the addition of soya oil.
• Unmolassed beet pulp naturally has a good acid binding capacity and is high in pectins. These are beneficial in that their structure alters to one that is similar to mucus when in an acidic environment, consequently acting as further protection for the stomach.  Speedi-Beet or Fibre-Beet (containing alfalfa) are quick-soak beet-based products, ideal for increasing calorie content to complement a balanced diet.
• Outshine high oil supplement is a great way to provide additional low starch calories in a safe and concentrated form.

Lower calorie requirements

The recommended amount of a balancer will provide your horse with their full complement of vitamins, minerals and protein without unwanted calories and with mini­mal starch and sugar. Lo-Cal Balancer is ideal for horses at rest or in light work, while Performance Balancer is formulated for horses working up to the highest levels.

Added extras:

• Alfalfa Blend provides the buffering capacity of alfalfa but without as many calories as Alfalfa Plus Oil. For an even lower calorie option, Light Chaff is ideal.
• Although beet pulp can be quite conditioning, when fed in smaller amounts it can be beneficial for good-doers or those who are less partial to chaffs. As a guideline, one mug of Speedi-Beet will soak to approximately a Stubbs scoop in wet volume. This makes it great as a low calorie and low starch fibrous ‘bulk’ to the feed for horses with ulcers.
• Soaked Natural Meadow Cobs are also ideal as a low calorie, high fibre option, which are low in starch and sugar

Moderate calorie requirements

For those in between, Keep Calm Mash is a fully balanced soaked feed, which contains highly digestible superfibres from beet pulp, alongside essential nutrients, and is useful for maintaining condition while supporting up to moderate work levels. Meadow Sweet with Turmeric is also low in starch and suitable for those in up to moderate work.

Much of the management of ulcers should aim to promote a natural lifestyle and reduce stress where possible. This should include ensuring that the horse has plenty of turnout and a high fibre intake, with extra forage provided at times of stress, such as when travelling. A low starch and sugar diet, combined with ad lib forage and a constant supply of clean, fresh drinking water will help to reduce the risk, as well as being essential in the successful treatment and management of gastric ulcers.