How to know if your horse is suffering from an ulcer

Equine ulcers, often referred to as gastric ulcers, are a common but often overlooked ailment in horses.

These sores or lesions on the stomach lining can impact any horse, regardless of age or discipline.

I wanted to shed some light on ulcers in horses, because I’ve seen so many horses get labelled as “naughty” or “disobedient” when they were actually in pain.

Ulcer issues often show up when saddling or riding, as your horse begins to show greater signs of distress while working under saddle.

One lady who had a penchant for thoroughbreds, had to put down three horses in about as many years because it turned out they all had ulcers and no treatments worked, in large part because the issue had become chronic.

She’d had them checked out otherwise at the vet, and had changed saddles (and saddle fitters) several times to try and work out what the problem was.

Finally, when the horses got scoped by the vet, it was confirmed that each horse did indeed have ulcers and began treatment. (To do this with three horses in three years was a lot!)

During those few years, she had three horses that were unrideable for several years in a row, and the medical costs kept mounting as treatment after treatment wasn’t enough to fix the problem.

Horses have very sensitive guts and damage like that is hard or impossible to recover from, especially when it’s become chronic.

The best thing is to catch them early.

What are ulcers in horses?

Equine ulcers are lesions that form on the lining of the stomach or the beginning of the small intestine.

They range in severity from superficial irritations to deep, penetrating sores.

The stomach environment, with its acid production, can be harsh, and any disruption in the protective lining can lead to ulcerations.

Equine gastric ulcers are a prevalent issue, particularly in performance horses. They can cause significant discomfort and lead to various clinical signs, from poor performance to colic.

Ulcers in horses, specifically gastric ulcers, are a common health concern and can be attributed to a variety of factors. The main causes include:

1. Diet and feeding practices: Horses have evolved to be continuous grazers. When they are fed large meals infrequently, as opposed to having constant access to forage, it can lead to increased acid production in the stomach. This acid can damage the stomach lining, leading to ulcers. Also, diets high in grains and low in roughage can contribute to ulcer formation.
2. Stress: Just like in humans, stress can be a significant factor in ulcer development in horses. Factors like frequent travelling, intense training, competition, or changes in environment can contribute to stress.
3. Medications: Prolonged use of certain medications, especially non-steroidal anti-inflammatory drugs (NSAIDs) like phenylbutazone, can increase the risk of ulcers in horses. These medications can reduce the production of the protective mucus layer in the stomach, making the stomach lining more susceptible to damage from acid.
4. Exercise: Intense exercise can increase stomach acid production and decrease blood flow to the stomach, making the stomach lining more susceptible to injury.
5. Limited turnout: Horses that are kept in stalls without regular turnout may experience more stress and have less opportunity to graze, both of which can contribute to ulcer development.
6. Other illnesses: Diseases that cause pain or stress can also be a contributing factor. For instance, a horse with a painful condition like laminitis may be more prone to developing ulcers.
7. Fasting: Even short periods of fasting can increase the risk of ulcers in horses. This is because the stomach continues to produce acid even when empty.
8. Coexisting diseases: Some diseases, like Cushing’s disease or liver disease, can increase the risk of ulcers.
9. Management changes: Abrupt changes in management, diet, or routine can be stressful for horses and may contribute to the development of ulcers.
10. Stall confinement: Limited movement and social interaction is a stress factor for many horses, and can lead to ulcers.

Prevention and management strategies can help reduce the risk of ulcers in horses.

If a horse is suspected to have ulcers, it’s essential to consult with a veterinarian for proper diagnosis and treatment.

How to detect ulcers in horses.

Detecting ulcers in horses can be challenging because the signs can be subtle or easily confused with other health issues.

Early detection is crucial for the best possible outcome.

Here are some methods and signs to help detect ulcers in horses:

Clinical signs that can point to ulcers in your horse:

1. A horse with ulcers might become more irritable, aggressive, or anxious.
2. Horses may show a reduced interest in grain, hay, or both. They might start and stop eating multiple times.
3. Unexplained or sudden weight loss can be a sign.
4. A dull or rough-looking coat.
5. Recurrent mild colic or signs of abdominal discomfort.
6. Especially in performance horses, they may be less willing to work, show reduced stamina, or buck under saddle.
7. Teeth grinding, known as “bruxism,” can be a sign of discomfort.
8. Some horses might drool more than usual.
9. Though not as common, some horses might have diarrhoea or softer stools.

Diagnostic methods to determine if your horse has an ulcer:

1. Gastroscopy: This is the gold standard for diagnosing gastric ulcers. A long endoscope is passed through the horse’s nostril and into the stomach to visualise the stomach lining directly.
2. Response to treatment: Sometimes, if gastroscopy is not available or feasible, veterinarians might treat the horse for ulcers and monitor the response. If the horse shows improvement, it might indicate the presence of ulcers.
3. Faecal blood tests: These tests detect the presence of blood or blood proteins in the faeces, which might suggest ulcers. However, they’re not as specific as gastroscopy.
4. Blood work: While not specific for ulcers, changes in blood parameters (like increased pepsinogen levels) can sometimes provide supportive evidence.

Prevention and Management:

If you suspect your horse has ulcers, it’s essential to consult a veterinarian as soon as possible.

They can provide a definitive diagnosis and guide appropriate treatment.

Preventative measures include:

1. Regular feeding: Ensure the horse has regular access to forage to reduce acid build-up in the stomach.
2. Reduce stress: Minimise changes in routine, provide regular turnout, and ensure the horse has social interactions.
3. Medication: There are several medications, like omeprazole, that can treat and prevent ulcers. Always consult with a veterinarian before administering any medication.
4. Limit NSAIDs: If possible, avoid or limit the use of non-steroidal anti-inflammatory drugs.

Monitoring your horse’s behaviour, appetite, and overall condition can help in early detection and intervention.

Typical treatments for equine ulcers.

1. Proton Pump Inhibitors (PPIs):
   • Omeprazole: This is the most commonly prescribed medication for treating gastric ulcers in horses. It works by inhibiting the proton pump, which reduces stomach acid production. There are both brand-name and generic formulations available. It’s essential to use an equine-specific formulation to ensure effectiveness.
2. H2 blockers:
   • These medications reduce stomach acid production by blocking histamine receptors in the stomach lining.
   • Ranitidine and Cimetidine are examples. While they can be effective, they often require more frequent dosing than omeprazole and might not be as potent.
3. Mucosal protective agents:
   • Sucralfate: This medication adheres to ulcerated areas, creating a protective barrier that promotes healing. It’s often used in combination with acid-reducing medications.
   • Pectin-Lechitin Complex: This is another protective agent that can form a barrier over the ulcer surface, protecting it from further acid injury.
4. Antacids:
   • Products like MgOH (magnesium hydroxide) or AlOH (aluminium hydroxide) can help neutralise stomach acid. They often provide quick, short-term relief but require frequent dosing.
5. Dietary changes:
   • Increasing forage intake can help buffer stomach acid naturally and reduce the time the stomach remains empty.
   • Reducing high-grain diets, which can increase acid production, and providing smaller, more frequent meals.
   • Some people also feed alfalfa hay or chaff, as it has a natural buffering capacity.
6. Supplements:
   • Prebiotics and Probiotics: As discussed, these can help maintain a healthy gut environment, although they’re not primary treatments for ulcers.
   • L-glutamine and Sea Buckthorn: Some studies suggest these might help in promoting gut health and healing, although more research is needed.
7. Management changes:
   • Reducing stress by ensuring regular turnout, providing companionship, and maintaining a consistent routine.
   • Avoiding or limiting the use of non-steroidal anti-inflammatory drugs (NSAIDs), which can exacerbate ulcers.
8. Herbal remedies:
   • Some horse owners turn to herbal remedies, like slippery elm or aloe vera juice, believing they can soothe the stomach lining. While anecdotal reports suggest benefits, scientific evidence is limited.
9. Regular monitoring:
   • After completing a course of treatment, a repeat gastroscopy can be done to check the healing status of the ulcers.

It’s essential to consult with a veterinarian for a definitive diagnosis and a tailored treatment plan.

Each horse is unique, and what works best for one might not be ideal for another.

Regular check-ups and monitoring are crucial to ensure the best outcome.

Can pre- and probiotics help with ulcers in horses?

Equine prebiotics and probiotics are often discussed in the context of digestive health and gut flora balance, and there’s growing interest in their potential benefits for horses with ulcers. It’s essential to understand their roles and the current evidence supporting their use.

Prebiotics are non-digestible fibres that stimulate the growth and activity of beneficial bacteria in the horse’s gut. Examples include fructooligosaccharides (FOS) and mannanoligosaccharides (MOS).

Potential benefits for ulcers:

• Prebiotics might help in maintaining a healthy balance of gut microflora. A balanced microflora might provide a more favourable environment for ulcer healing.
• By promoting beneficial bacteria, prebiotics can potentially reduce the colonisation of harmful bacteria that might exacerbate ulcer conditions.

Probiotics are live beneficial bacteria that, when ingested in adequate amounts, can provide health benefits to the host. Common probiotics include strains of Lactobacillus and Bifidobacterium.

Potential benefits for ulcers:

• Probiotics can help in re-establishing a balanced gut flora, especially if there’s been a disruption due to factors like medication use.
• Some probiotics might produce substances that can help in reducing inflammation and promoting healing.
• By competing with harmful bacteria, probiotics might reduce the risk of secondary complications associated with ulcers.

While there’s growing interest and some anecdotal evidence suggesting benefits, scientific research specifically linking prebiotics and probiotics to equine ulcer healing is limited.

There have been studies in humans and other animals showing benefits of prebiotics and probiotics in ulcer management. However, the equine digestive system is different, so results can’t be directly extrapolated.

Some studies have shown that certain probiotics can help in improving gut health in horses, but direct evidence linking them to ulcer healing is still limited.

If considering prebiotics or probiotics as a complementary approach, it’s essential to:

• Consult with a veterinarian to ensure it’s appropriate for the individual horse.
• Choose high-quality products with research backing their efficacy in horses.
• Monitor the horse closely for any changes in behaviour, appetite, or health.

Remember, while these supplements can be beneficial for overall gut health, they are not a replacement for proven ulcer treatments.

Equine ulcers are a prevalent concern, but with early detection and appropriate intervention, they can be effectively managed.

Be vigilant for signs of ulcers and prioritise regular veterinary check-ups.

A holistic approach, considering diet, environment, and medical treatments, will ensure the well-being of your horse.