Dr. Tania Sundra

23 January 2022

“What’s the best treatment for ulcers ?”

We often get asked this question : “What’s the best treatment for gastric ulcers ?” To be honest, we don’t have a “best” treatment or a “standard protocol”….

The reason for this is that every lesion is different as is the horse that they are attached to. As vets, we need to have a range of different options in our toolkit for treating various conditions and gastric disease (the correct term for gastric ulcers) is no exception. Depending on the type of disease that is present (squamous vs glandular or both!), will determine what treatment we prescribe. Depending on how the horse is managed, a particular medication may be more effective than another, whilst others may benefit from combination therapies.

Some mild lesions like Grade 1 squamous disease (yellow-discoloration or small areas of “redness” that develop on the squamous mucosa) may also have nothing to do with your horse’s clinical signs and we may opt to investigate other issues (such as musculoskeletal pain) rather than prescribing an expensive course of treatment that your horse likely doesn’t need. If we did opt for a treatment trial AFTER scoping your horse, then a 14 day course of medication should be enough to determine if these low grade lesions are causing your horse’s clinical signs.

When it comes to management, some treatment options may not be suitable. For instance, many horses may live out in a paddock 24/7 with access to a roundbale of hay. Studies have shown that the presence of food in the stomach greatly impacts the bioavailability of omeprazole paste (a popular treatment for gastric disease). As a result, oral omeprazole needs to be administered once a day, first thing in the morning, an hour before feeding, following an overnight fast.  For some owners, this can be tricky to manage, especially if horses are agisted and they may not be able to get out to them every morning. In these cases, a different type of medication may be more suitable.

The only ‘standard protocol’ we recommend, is :

1. to gastrosope your horse prior to starting treatment and;

2. to re-scope them at the end of the treatment course.

The reason we recommend scoping your horse and don’t recommend “treatment trials” is that we have no idea what medication your horse needs, whether it needs medication in the first place and how long to treat them for without first looking inside their stomach.

Remember, the production of acid in your horse’s stomach is a metabolically “expensive” process. Your horse’s body produces acid for a reason –  it’s the start of the digestive process. If we decide to suppress this acid production with drugs, and alter the normal digestive physiology then we need to be 100% sure we have a reason to do so. Gastroscopy is a simple procedure that we can perform on your property. The actual procedure takes no longer than 8-12 minutes and most horses are back eating within 30-60minutes.

Re-scoping your horse at the end of treatment is also essential to determine whether the treatment has worked or if your horse may need treating longer or with a different medication. There is no reason why a horse should stay on treatment longer than 28 days without determining if the treatment if actually working. Whilst most horses with squamous disease should heal within 14-28 days, glandular disease is much trickier to treat and may require a combination of therapies.

Also remember that regardless of the medication used, management changes need to be addressed to prevent the condition from recurring. This is as important, if not more important than any medication. This is one of the reasons we ask all our owners to complete a pre-gastroscopy questionnaire so we can best tailor a management program for each horse to address their individual risk factors.

The only way to tell IF your horse has gastric disease and what TYPE of disease it has, is to gastroscope your horse. We offer a mobile gastroscopy service, allowing us to scope your horse on your property.
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For more information, please don’t hesitate to contact us on 0427 072 095 or email info@avonridgeequine.com.au