Equis ISSN 2398-2977

Stomach: gastric ulceration

Synonym(s): GDU, Equine gastric ulcer syndrome (EGUS

Contributor(s): Madeleine L H Campbell, Rachel Murray, Prof Jonathon Naylor, Vetstream Ltd

Introduction

  • Minor cause of foal mortality; often a complication of systemic or orthopedic disease; symptomatic ulcers usually located in gastric glandular mucosa, non-symptomatic in non-glandular portion of stomach near margo plicatus.
  • Common endoscopic finding in well foals and horses - 51% ulcers are asymptomatic.
  • Cause: non-steroidal anti-inflammatories (NSAIDs); stress, infection, eg rotavirus, diet, delayed gastric emptying, parasites; foreign bodies also implicated.
  • Signs: bruxism, ptyalism, intermittent colic; shock, peritonitis (if perforated).
  • Diagnosis: nasogastric intubation and reflux, radiography, endoscopy.
  • Treatment: H2 receptor antagonists, proton pump inhibitor, cytoprotectants, eg sucralfate, prostaglandin analogs, antacids; supportive fluids; surgery if stricture.
  • Prognosis: good to guarded; depends if ulcer perforates.
Print off the Owner factsheet on Equine gastric ulcer syndrome to give to you clients.

Pathogenesis

Etiology

  • Only NSAIDs, eg phenylbutazone   Phenylbutazone  , flunixin meglumine   Flunixin meglumine  known causes of ulcers.
  • Suggested factors:
    • Stress, eg transport, temperament, weather, parturition (birth hypoxia), weaning, low plasma antibody, orthopedic surgery, exsanguination.
    • Infections, eg rotavirus   Rotavirus  ,Campylobacter  Campylobacter spp  ,Helicobacter,Escherischia coli  Escherichia coli  ,Clostridia  Clostridia spp  ,Candida  Candida albicans  ,Salmonella  Salmonella spp  .
    • Diet, eg high corn, low fiber, high fiber, depraved appetite, infrequent feeding.
    • Parasities, eg migratingGasterophiluslarvae   Gasterophilus  ,Habronema megastoma  Habronema spp  .
    • Other, eg foreign body, corticosteriods (endogenous and exogenous), sex hormones, delayed gastric empyting, congenital, corrosive substances, exercise.

Predisposing factors

General
  • Age.
  • Stress.
  • Exercise intensity.
  • Diet.

Specific

  • Low gastric pH.

Pathophysiology

  • NSAIDs +/- stress   →   disruption of gastric mucosal barrier   →   hydrogen ions and pepsin diffuse into mucosa   →   auto-digestion and ulcer formation.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Sanz M Get al(2014)Efficacy of a pectin-lecithin complex for treatment and prevention of gastric ulcers in horses.Vet Rec175(6), 147PubMed.
  • Sutton D (2014)Equine gastric ulceration syndrome: treatment and prevention.Vet Rec175(6), 145-146 PubMed.
  • Sykes B W, Sykes K & Hallowell G D (2014)Comparison of th effect of two doses of omeprazole on the squamous gastric mucosa in thoroughbred racehorses.Vet Rec175(10), 249 PubMed.
  • Sykes B W, Sykes K M & Hallowell G D (2014)A comparison of two doses of omeprazole in the treatment of equine gastric ulcer syndrome: A blinded, randomised, clinical trial.Equine Vet J46(4), 416-421 PubMed.
  • Sykes B W, Sykes K M & Hallowell G D (2014)A comparison between pre- and post exercise administration of omeprazole in the treatment of equine gastric ulcer syndrome: A blinded, randomised, clinical trial.Equine Vet J46(4), 422-426 PubMed.
  • Hepburn R (2011) Gastric ulceration in horses.In Pract33(3), 116-124 VetMedResource.
  • Tamzali Yet al(2011)Prevalence of gastric ulcer syndrome in high-level endurance horses.Equine Vet J43(2), 141-144 PubMed.
  • Fennell L C & Franklin R P (2009)Do non-steroidal anti-inflammatory drugs administered at therapeutic dosages induce gastric ulcers in horses?Equine Vet Educ21(12), 660-662 VetMedResource.
  • Luthersson Net al(2009)The prevalence and anatomical distribution of equine gastric ulceration syndrome (EGUS) in 201 horses in Denmark.Equine Vet J41(7), 619-624 PubMed.
  • Luthersson Net al(2009)Risk factors associated with equine gastric ulceration syndrome (EGUS) in 201 horses in Denmark.Equine Vet J41(7), 625-630 PubMed.
  • Martineau H, Thompson H & Taylor D (2009)Pathology of gastritis and gastric ulceration in the horse. Part 1: Range of lesions present in 21 mature indiviuduals.Equine Vet J41(7), 638-644 PubMed
  • Martineau H, Thompson H & Taylor D (2009)Pathology of gastritis and gastric ulceration in the horse. Part 2: A scoring system.Equine Vet J41(7), 646-651 PubMed.
  • Nadeau J A & Andrews F M (2009)Equine gastric ulcer syndrome: The continuing conundrum.Equine Vet J41(7), 611-615 PubMed.
  • Franklin S H, Brazil T J & Allen K J (2008)Poor performance associated with equine gastric ulceration syndrome in four Thoroughbred racehorses.Equine Vet Educ20(3), 119-124 VetMedResource.
  • Dukti S Aet al(2006)Prevalence of gastric squamous ulceration in horses with abdominal pain.Equine Vet J38(4), 347-349 PubMed.
  • Jonsson H & Egenvall A (2006)Prevalence of gastric ulceration in Swedish Standardbreds in race training.Equine Vet J38(3), 209-213 PubMed.
  • McClure S Ret al(2005)Efficacy of omeprazole paste for prevention of gastric ulcers in horses in race training.JAVMA226(10), 1681-1684 PubMed.
  • McClure S Ret al(2005)Efficacy of omeprazole paste for prevention of recurrence of gastric ulcers in horses in race training.JAVMA226(10), 1685-1688 PubMed.
  • Hartmann A M & Frankeny R L (2004)A preliminary investigation into the association between competition and gastric ulcer formation in non-racing performance horses.J Equine Vet Sci23(12), 560-561 J Equine Vet.
  • Forbes A (2003)Equine gastric ulcer syndrome.UK Vet8(1), 13.
  • Sandin A, Skidell J, Haggstrom J & Nilsson G (2000)Postmortem findings of gastric ulcers in Swedish horses older than age one year.Equine Vet J32(1), 36-42 PubMed.
  • The Equine Gastric Ulcer Council (1999)Recommendations for the diagnosis and treatment of equine gastric ulcer syndrome (EGUS).Equine Vet Educ11(5), 262-272 VetMedResource.
  • Murray M J (1999)Gastroduodenal ulceration in foals.Equine Vet Educ18(4), 307-312 PubMed.
  • Cummings C A, Copedge K E & Confer A W (1997)Equine gastric impaction, ulceration and perforating due to persimmon (Diopyros virginiana) ingestion.J Vet Disgn Invest9(3), 311-313 PubMed.
  • Proudman C J, Baker S J (1994)Gastric disease in the adult horse - a clinical perspective.Equine Vet Educ6(4), 178-184 VetMedResource.
  • Furr M O, Murray M J & Ferguson D C (1992)The effects of stress on gastric ulceration, T3, T4, reverse T3 and cortisol in neonatal foals.Equine Vet J24, 37-40 PubMed.
  • Murray M J (1992)Gastric ulceration in horses - 91 cases.JAVMA210(1), 117-120 PubMed.
  • Baker S (1991)Equine gastroduodenal ulceration - a poorly understood disease.Equine Vet Educ3(2), 60-62 VetMedResource.
  • Sweeney H J (1991)Gastroduodenal ulceration in foals.Equine Vet Educ3(2), 80-85 VetMedResource.

Other sources of information

  • Archer D C, Edwards G B, Kelly D F & Proudman C J (2004)Small Intestinal Obstruction Associated with Idiopathic Focal Eosinophilic Enteritis: 12 cases.In:Proc 43rd BEVA Congress. Equine Vet J Ltd, Newmarket. pp 192.
  • Merritt A M (2003)The Equine Stomach: A Personal Perspective (1963-2003). In:Proc 49th AAEP Convention. pp 75-102.
  • White G W, McClure S R, Sifferman R L et al(2003)Prevention of Occurrence and Recurrence of Gastric Ulcers in Horses by Treatment with Omeprazole at 1 mg/kg/day.In:Proc 49th AAEP Convention.pp 220-221.
  • O'Coner M S, Steiner J M, Roussel A J  et al(2003)Sucrose Permeability Testing as an Indicator of Gastric Ulceration in Horses.In:Proc 49th AAEP Convention.pp 222-223.


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