Ulcers, specifically gastric or stomach ulcers, are very common in the horse. While ulcers generally impact the horse in training or competition, they do affect horses not in active work, often to the same degree if not worse. Ulcer medications are also heavily used in all horses with suspected or diagnosed gastric ulcers, helping to resolve the immediate crisis in some, but in the long-term, many continue to suffer. Should you use ulcer medications in your horse?
Gastric or stomach ulcers in the horse are really a secondary health condition, not a primary one. What does that mean? It means that they develop as a result of another health problem in the horse, so really, gastric or stomach ulcers are not the ‘main’ problem. Despite this, ulcers are seen as a primary event or problem in most horses and thus are treated or managed as such. Even in the case when stomach ulcers are precipitated by medications, such as non-steroidal anti-inflammatories, the ulcers are secondary, not primary.
For most horse owners, what they see are the clinical symptoms associated with the stomach ulcer, as these are most of the time more readily apparent. The symptoms of the underlying or main problem are lingering in the background, not as obvious, and thus overlooked by most horse owners.
We react to that which we see, and while all of the symptoms or signs are present, we tend to just react to the most obvious.
This generally leads to concern on the horse owner’s end, as they see their horse acting crabby, pawing, kicking, altered appetite, resenting the girth, or even being annoyed at a gentle tummy brushing. Next, the veterinarian is contacted in many instances, which leads to a farm visit or a haul-in appointment for gastric endoscopy, so the stomach lining can be visualized, and ulcers detected.
Okay, now your horse has been ‘scoped’ at the tune of several hundred dollars and a sedative injection, then comes the prescription. The medication of choice for most veterinarians and horse owners is omeprazole, but there are others including cimetidine and sucralfate. How much does this prescription cost you? On average, a 7-day treatment course of omeprazole will run you around $250 or an average of $35 per day. So, a 10-day treatment session could cost you over $350. Keep in mind that some horses are on this medication almost daily.
A pretty costly approach to a problem when you are just managing clinical symptoms and not the primary problem!
Do Medications Resolve Stomach Ulcers in the Horse?
What percent of horses respond to the omeprazole or other medications for the treatment of gastric ulcers? Well in order to answer that question, you have to define the term ‘respond’. If you are talking response in regards to reduction of clinical symptoms, the number is likely around 80%. If you are talking a total healing to the gastric ulcer or lesion, that number can be around 60%. If you are talking complete resolution to the problem, meaning no future stomach ulcers, that number likely drops to around 35-40%, but that may be very gracious.
In my experience, a high number of horses do get more comfortable in regards to stomach discomfort and an improved attitude when on omeprazole, but this is to be expected. The ulcer in the stomach is not really created as a result of increased stomach acid, but more so it is a breakdown in the protective lining of the stomach as a result of medication usage or more likely, stress. Look at it like a wound on your knee, a scrape if you will. If you reduce stomach acid production, you will reduce irritation to that wound, or ulcer. This then allows it to have a chance to heal or mend. Was the stomach acid the cause? Nope. Did the stomach acid irritate and further propel the creation of the stomach ulcer in your horse? Likely, yes, but this does not mean the stomach acid was the ‘devil’ and should be eliminated.
The acid produced within your horse’s stomach is very important for food digestion and therefore nutrient assimilation or absorption. In all likelihood, this stomach acid also plays a vital role in the natural microbiome present within the digestive tract in the horse. If you decrease that stomach acid production, when it is not elevated or excessive in the first place, you stand a good chance of creating more problems in your horse. Indeed, if you look at research regarding the long-term usage of ulcer medications (PPI’s or H2 antagonists), you will find that there are negative impacts on the absorption of certain nutrients, such as magnesium. You will also find that the digestive microbiome is further disrupted.
This is interesting, actually, as if you look closely at most horses that are on long-term or even intermittent doses of ulcer medications, you will find that many have digestive upset problems including colic episodes or loose stools. Many of these owners also have complaints of low magnesium levels, which are then linked to anxiety or odd behaviors in the horse, which are then countered supposedly through the use of magnesium supplement. Makes you rub your chin and go ‘hmmmm’, right? If not, it should.
So, should you use that stomach ulcer medication in Your Horse?
Well, that is dependent upon the situation. As a veterinarian, I have not put my hands on a tube of omeprazole or a pill of cimetidine or sucralfate in likely 10 years. What medication I did have in my office pharmacy expired years ago and it was like tossing money into the trash dumpster.
Most of the horses that I encounter have chronic digestive upset and ulcers, which have been managed, and I use that term very loosely, for many years without a resolution to the problem. So, even if I had the medications, they are obviously not the answer for that horse, so why would I choose them?
I am not against stomach ulcer medications in acute situations. If you have a horse that is painful, even acting colicky to an extent or critical, then by all means, these medications should be used to buffer or reduce that stomach acid. You have to keep in mind that it is a vicious cycle of events. Stress, and the hormonal sequence that plays into the events, are the cause of the stomach ulcers. Once that horse develops an active ulcer and becomes painful, this pain response fuels the stress response, which then leads to more stomach irritation and breakdown in the stomach lining. Most of the time, your horse may also end up with a higher rate of stomach acid secretion, due to this stress response, or the normal acid present may be further propelling your horse in a negative direction. So, yes, if you can use that medication for a short period to grab a hold of the situation and bring about comfort for your horse, by all means…do it!
The chronic usage of these medications is what I am after in this article, and what I combat often with rehab patients or consultations. Many horses are on an ‘on-off’ type of cycle with these medications, while others are on them daily, as if they were a piece of candy given as a treat. Not a good situation, indeed, for the horse nor the owner. I cannot imagine the cost, both financially and health wise.
Resolving Stomach Ulcers Once and For All in the Horse
Ulcers are very common and we deal with them in many of our rehab horses, even intermittently. The fact of the matter is that these ulcers are created as a result of stress, period. If you just sit back and take some time to observe your horse, you will find this to be true. It is no different than in people. The stress can be a result of many factors from the diet to herd dynamics, weather, training, or transportation. If you look closely at your horse, watching their moods, attitudes and general body language, you will see the stress. Watch their eyes. Watch how they wander the pasture and what they do. Watch them in their stalls or if you can’t watch them in their stall, take a good look at the condition of their stall after a night’s rest.
This stress is what is creating your horse’s dependence upon those costly medications that are really do very little other than putting a band-aid upon the problem. Now, even though we have recognized this stress as a cause, it does not mean you can eliminate it, at least not completely. Some causes of stress can be altered, such as different turnout, a larger stall, more hay provisions, or a different pasture mate. Many others cannot be altered. In fact, some of these stresses are behavioral, like anxiety or even depression, which are the horse’s response to the world. Some horses have a history of abuse, either by an owner or from a pasture mate, thus they are very suspicious and on guard at all times. Really, many are paranoid, plain and simple. I can’t change that and you can’t change that, at least not in the immediate future. It takes time to resolve personality issues, regain trust, and instill confidence in a horse, no different than in a person.
So, what do you do if you can’t resolve the stress issue in your horse? How do you manage those stomach ulcers, especially if they keep coming back over and over?
First, you have to correct what you can, which includes evaluating turnout, forage, and the diet. Eliminate or alter what you can. Don’t forget this also includes finding other sources of stress, which may mean a sore foot, which may be due to a bad shoeing job, an overdue shoeing, or just improperly maintained feet. You have to correct what is correctable! Otherwise, you are spinning your tires in the mud.
Second, if there is still stress present within your horse, out of your control, then address the stress response. You can modify how your horse’s body responds to stress, impacting and helping to balance the hypothalamic-pituitary-adrenal axis (HPA). This is most easily done through the use of primary or secondary adaptogens. There are many adaptogen formulas, but my favorite formulas are:
Both formulas contain adaptogens. The Cur-OST EQ Adapt & Calm is a single adaptogen formula, being a concentrated Ashwaghanda extract, which can be very potent and beneficial for many horses. However, there are some horses that require more or actually don’t respond as well to the Ashwaghanda by itself, for various reasons. Hence, the Cur-OST EQ Adapt & Recover. This is a more balanced blend of adaptogens and impacts not just the stress response, but circulation as well in the horse.
Now, those adaptogens help us to manage the primary event, which is stress, but what about the stomach ulcer in your horse?
In the world of traditional Chinese medicine, many stomach ulcers are believed to be associated with liver Qi stagnation and/or stomach Yin deficiency. Think of the liver Qi stagnation as being pent up emotions, resulting in anger and a blockage of proper energy flow in the body. Think of stomach Yin deficiency as being dryness in the stomach, which is not unlike dry skin and if rubbed enough, wounds can develop.
In order to address the stomach ulcer directly, I take the second approach in most patients, which is to tonify stomach Yin or create moisture within the stomach. Actually, for many, once you tonify the stomach Yin, the energy or Qi in the horse begins to move more freely, so this can benefit both modes of thought. The main formula I use in these cases, which is really ALL cases of stomach ulcers in the horse is:
The Cur-OST EQ Stomach contains very high levels of two potent moisturizing and soothing ingredients, being a concentrated Aloe gel extract and Marshmallow Root. This is entirely different from ‘aloe juice’, so don’t be misled. These two ingredients help to add moisture to the body, including the stomach, which has a soothing effect as a result, like water putting out a fire. In addition, these two ingredient can actually enhance and support the digestive microbiome, which is an added benefit!
Through the use of a Cur-OST Adaptogen formula in combination with the Cur-OST EQ Stomach, most stomach ulcer related problems in our patients are a thing of the past within 48 hours. The therapy is then continued for a full 30-day course or regimen, after which many are good to go, while others may require daily usage or support due to the presence of uncontrolled stress factors.
What’s the Cost? The Most Popular Question!
Cost is relative, in reality. Something could be perceived as being expensive, but when put up against the cost of another therapy or treatment, it then may appear relatively cheap. In most of our equine patients with stomach ulcer symptoms, the cost to those owners is around $100 per month, maybe a little more, which is all dependent on other problems present in that horse. For instance, if a horse has metabolic syndrome, foot pain due to laminitis, and stomach ulcers, if you wish to really help the horse, the above regimen may not be all that is required. But then again, using omeprazole in that same patient at the tune of $35 per day is not going to resolve the EMS issues either. Make sense??
Cost to the horse owner for treatment or management of any health or lameness condition is always a factor and sometimes a limiting factor in their ability to achieve full success. Right now, omeprazole is one of the most prescribed medications in the horse, likely costing horse owners millions of dollars each year. Considering the high cost, $250 for a 7-day period, and the fact that a high percentage of these horses either fail to fully respond or relapse, it just makes sense to take a different road.
For the sake of your horse and their health, choose the higher road when it comes to managing gastric ulcers. The approach is a lot cheaper and may in the end create a much healthier and happier horse!
Author: Tom Schell, D.V.M, CVCH, CHN