Ulcers Are They A Sore Point On Your Yard? Louise Radford BVetMed Cert.VR MRCVS of Merial Animal Health Since the first Gastric Ulcer Awareness Month in 2007, it has been well documented that approximately 60 per cent of performance horses are affected by gastric ulcers. And yet, despite this, it is believed that it is still one of the most under-recognised problems in the equine field. The main reason for this lack of diagnosis is likely to be the vague and non-specific nature of the clinical signs, which are often put down to back pain or behavioural issues. One study in which 63% of the performance horses examined had gastric ulcers, found that over three quarters of the owners or riders of these horses had reported poor performance¹. Prior to the study, which included dressage horses, show jumpers and hunters, horses were reported as resisting work and difficult to train, and many were suspected of having recurring back pain. Clinical Signs These vary from one horse to another, and they do not always correspond to the severity of the ulcers some horses appear to be more stoic than others! Symptoms can include some or all of the following; Reluctance to work or jump; dull starey coat; poor or picky appetite; weight loss; mild or recurrent colic; discomfort on girth tightening and salivation, and teeth grinding and diarrhoea in foals. So why are horses so prone to ulcers? Horses have evolved as trickle feeders with free access to light grazing and rest 24/7, so their stomachs are designed to receive a constant supply of food. Because of this, acid is released into the stomach constantly, regardless of whether or not they are eating, however saliva (which neutralizes the acid) is mostly produced when they eat. People on the other hand only produce acid when they eat. 1 of 5
The stabling, feeding and exercise regimes of many performance horses often results in long periods with restricted food intake. So even after a short period of time the acid will begin to overwhelm the lining of the upper part of the stomach, and ulcers can start to form. We also know that training affects gastric acidity, and horses fed the same diet before and during training have higher levels of gastric acid during training². Other factors affecting the development of ulcers include travel, separation from peers and solitary confinement. The horse show environment can also result in interrupted meals and irregular schedules. Treatment and prevention Examination via gastroscopy is the only definitive way to diagnose ulcers, and studies have shown the most effective treatment is the acid inhibitor, omeprazole for the treatment and prevention of equine ulcers. In addition to treatment it is also important to try to put management strategies in place to reduce risk of recurrence. Even small changes to the regime can make a difference. For example, when grazing, horses are constantly on the move, so when they re in the stable or corral, split the forage ration into several nets or piles - you can even provide different contents - for example haylage or chop. This more natural foraging will also help encourage picky eaters and stressy horses to eat. Try not to exercise your horse on an empty stomach they are not like us, they can gallop and jump without any issue with a small amount of food in the stomach. In fact, during exercise forage will form a mat like barrier, protecting the upper part of the stomach from acid splashing in to this vulnerable area where ulcers most commonly form. And if you are travelling your horse on its own, or he/she has to be stabled in new surroundings, try to take a companion. If this is not possible, special equine mirrors have been proven to help reduce stress in these situations. Flying High So what do our top performers do to try to minimise the impact of gastric ulcers? Sophie Wells is a member of the paralympic team and has two horses on the Elite Squad that she is preparing for selection for the games in September. Paralympic team vet Rod Fisher BVSc MRCVS explains the team s approach to gastric ulcers. 2 of 5
Maintaining the best performance is not solely an orthopaedic challenge, all aspects of the horse s health need to be addressed. The British Elite Paralympic Squad has been fortunate to have the services of Internal Medicine Specialists (via sponsorship from Merial) who examine the squad horses via gastroscopy on a regular basis. The first is at the start of the year, and we usually re-scope later in the season to evaluate improvements following treatment. It s also useful to scope the horses before they are exposed to specific risk factors such as prolonged transport. Some might think that the demand on Para Dressage horses is not sufficient for gastric ulcers to be significant, however at the first scoping clinic in 2007, 83% of horses showed some level of ulcers, and over the following years on average ulcers have been found in 77% of the horses. Fluent movement is key to performance, and horses that have girth pain when saddled and ridden are no longer relaxed. Additionally the increase in stride length developed through training and so important in the dressage horse may be reduced in the presence of gastric ulcers. Sophie s Story 22 year old Paralympic team rider Sophie Wells began riding at the age of 7. Born with Amniotic Band Syndrome, a foetal development condition which affected her hands and ankles, Sophie took up able-bodied dressage at the age of 12. At the age of 13 she was re-classified as a Grade IV para rider and selected onto the Lottery funded World Class Start and Potential Para dressage programme. I train with Angela Weiss, and have been doing so for two years, we have a great partnership and she has helped me so much. Angela is also the World Class Start & Potential Para Dressage Squad Coach, alongside Nina Venables. 3 of 5
I have two horses in the squad, Pinocchio (Noki) aged fifteen who I ve ridden for three years, and Valerius (Reece) a ten year old I ve had for five years. I got Noki in January 2009, he is owned by Dr Jackie Walker, and I m very lucky to have the ride on him. My top horse, Touchdown had gone lame in quarantine and had to retire after a keratoma operation. I needed a horse but I had lost all my money in touchdown. Noki is the biggest softy, and a gentle giant, and he d had a lot of experience with his previous rider. Reece is a cheeky, playful horse, and always in trouble! He was scoped last year and nothing major came up. However over Christmas he had a few colicy episodes and went really picky in his eating. He also became a bit grumpier. When he was scoped at squad training in February they found a large quite nasty ulcer. After just a week on treatment with omeprazole he was eating his hard feed so much better and has been working really well since! We will now be looking at ongoing management to reduce the risk of the ulcer recurring once it has cleared. I d had no prior experience of ulcers, but the scoping was well worth doing for Reece and I'm pleased we are getting on top of it now! Team selection is well underway at the moment and at the time of writing we have the winter championships next week. The horses are going well in training at the moment, so my priority is trying to keep them healthy and well. Finally I would just like to say thank you to the team in helping Reece in particular with his treatment and diagnosis! -Ends- Caption for the ulcer image: " Valerius had a grade 2 ulcer located in the antrum of the stomach. This is a glandular area, just before the entrance to the pylorus and the duodenum." 4 of 5
April 2012 References 1. Mitchell RD. Prevalence of gastric ulcers in hunter/jumper and dressage horses evaluated for poor performance. Proceedings of the Association of Equine Sports Medicine Annual Meeting 2001. 2. Lorenzo-Figueras M et al. Effects of exercise on gastric volume and ph in the proximal portion of the stomach of horses. Am J Vet Res (2002) 5 of 5