Management and therapeutic options for equine gastric ulceration — looking beyond omeprazole

摘要

Ulceration of both the squamous and glandular mucosa of the equine stomach is extremely common. The clinical presenting features of each condition overlap and these vary in severity from minor changes in performance to loss of condition and recurrentcolic in severe cases. Within the individual horse there is a poor correlation between the severity of squamous and glandular ulcer scores, and the risk factors for the development of each condition appear to differ. Squamous mucosal ulceration is knownto be caused by imbalance between damaging factors (hydrochloric acid, pepsin and bile acids) and the mucosal protective factors (mucus and saliva). Risk factors which augment squamous damage include inadequate forage intake which increases gastric acidity, and high intensity work, which both reduces mucosal blood flow and causes gastric compression. Omeprazole, a proton pump inhibitor, has been established as the most effective drug for increasing gastric pH when given at the optimum dose and formulation. The correct treatment protocol for glandular ulceration is not so clear as the aetiopathogenesis has not been fully established. Stress factors and elevated plasma Cortisol may predispose to development of glandular ulcers, which in some cases may become colonised by acid resistant bacteria. In addition to reducing gastric acidity by therapeutic and management intervention, oral antibiotics and a variety of additional treatments have been proposed as supplemental treatments in horses with glandularulceration. Further prospective clinical trials are required to determine the efficacy of these different agents in the treatment of equine glandular ulceration.