8/ JUNE 2024 THE RIDER The Different Types of Gastric Ulcers In the stomach, the ulcers are clas-


sified depending on their location. Equine squamous gastric ulcers (ESGUs) are ulcers that are in the non- glandular, or squamous portion of the stomach. The non-glandular portion of the stomach is the upper region. Equine glandular gastric ulcers


An Equine Nutrition Series by Madeline Boast,


MSc. Equine Nutrition Gastric ulcers are sores that form


on the stomach lining in the horse. Re- search has estimated that the prevalence may be up to 90% in some demograph- ics. Working horses tend to be more at risk of developing this disease due to the intensive management they are often ex- posed to. When equine gastric ulcers are dis-


cussed, it is not frequently clarified ex- actly which type the horse has which is problematic as prevention and treatment strategies differ depending on the type of ulcer. With more research being pub- lished on the disease, it has become ap- parent that there are critical differences between the various types which need to be taken into consideration when curat- ing a treatment plan.


(EGGUs) are ulcers that are in the glan- dular portion of the stomach. This is the lower region where hydrochloric acid is continuously secreted. When we refer to equine gastric ulcer syndrome (EGUS) this encompasses both the squamous and glandular. Now, there can also be ulcers that develop in the hindgut of the horse. These ulcers are referred to as colonic ulcers. They are less common than gastric ulcers, but still have a high prevalence. A 2005 necropsy study evaluated


over 500 horses, the first group of horses examined showed that 55% were found to have gastric ulcers, and 44% had colonic ulcers. The second group that was evaluated was performance horses, and in this group 87% had gastric ulcers and 63% had colonic ulcers. The risk factors for ulcer develop-


ment differ depending on the location in the gastrointestinal tract. If we start with the squamous ulcers (in the top portion of the stomach), it is known that the risk for development increases with the in- tensity of management. This includes factors such as inadequate forage access, large carbohydrate meals and increased workload. The top portion of the stom- ach (the squamous mucosa) does not have the same protective mechanisms that the glandular portion has. There- fore, we need to limit the acid exposure. The changes in management factors that we see in working horses increases the acid exposure and increases the risk of


ulcer development. They are essentially a chemical burn on the unprotected mu- cosa in the stomach. If we shift our focus to the glandu-


lar ulcers, which are in the lower portion of the stomach, the risk factors change. Research has not determined that the de- velopment of glandular ulcers is directly related to management intensity. For ex- ample, this type of ulcer tends to be more prevalent in Warmblood sport horses than in endurance or racehorses (which have a higher prevalence of the squamous ulcers). We do not have the science to fully elucidate the causes of glandular ulcers in horses. As of right now, it is thought that the development of glandular ulcers is related to behav- ioural stress and the lack of rest days for exercising horses. Treatment also differs between


squamous and glandular stomach ulcers. Omeprazole is used for squamous dis- ease with a high rate of success. For glandular disease, often a combination of omeprazole, sucralfate, and misopros- tol are used. If you suspect that your horse has gastric ulcers, you should con- tact your veterinarian regarding medical treatment. As a nutritionist, I am most fre-


quently asked about prevention, because of course if you suspect ulcers, you need medical treatment. Once your veterinar- ian has evaluated the type of ulcer and prescribed treatment, we can chat about management and dietary changes to pre- vent reoccurrence. When creating a plan to prevent the


recurrence of squamous gastric ulcers, the focus is always on adequate forage, reducing carbohydrates and the timing of exercise – for example, not working the horse on an empty stomach. As dis- cussed, glandular ulcers differ from


squamous, therefore, for prevention of this type of gastric ulcer there is a focus on environmental optimization, this refers to having horses housed together and in an environment that allows for free movement and trickle feeding to re- duce stress. The implementation of ade- quate rest days is also thought to be an important factor in prevention. When it comes to colonic ulcers,


those that are not in the stomach, but in- stead in the hindgut of the horse, they are thought to be caused by stress, the use of non-steroidal anti-inflammatory medications, a high parasite load and/or hindgut acidosis. Both squamous and glandular gastric ulcers can be viewed via gastroscopy. However, these scopes are unable to reach the hindgut of the horse.


Therefore, the diagnosis of colonic


ulcers, also referred to as right dorsal co- litis (RDC) relies on clinical symptoms, blood work, and abdominal ultrasound. Some of the common symptoms are re- curring colic, reduced appetite, poor haircoat health, etc. Of course, these symptoms are not specific and can be due to a variety of health issues which is why it is critical that you contact your veterinarian immediately for any health concerns. The treatment of colonic ul- cers is often a combination of medical management, nutritional changes, and alteration in management. Overall, equine gastric ulcers and


colonic ulcers are unfortunately all too common. However, if your horse has had ulcers, or you suspect that they might have ulcers – understanding the risk factors and the type of ulcer your veterinarian diagnoses can make a dif- ference in how prevention is ap- proached.


References: Andrews, F. M. (2009). Overview of gastric and colonic ulcers. Advances in Equine Nutrition IV, 347. Pellegrini, F. L. (2005). Results of a large-scale necroscopic study of equine colonic ulcers. Journal of equine veteri- nary science, 25(3), 113-117. Rendle, D., Bowen, M., Brazil, T., Con- well, R., Hallowell, G., Hepburn, R., ... & Sykes, B. (2018). Recommendations for the management of equine glandular gastric disease. UK-Vet Equine, 2(Sup1), 2-11. Sykes, B. W., Bowen, M.,


Habershon-Butcher, J. L., Green, M., & Hallowell, G. D. (2019). Management factors and clinical implications of glan- dular and squamous gastric disease in horses. Journal of veterinary internal medicine, 33(1), 233-240. Vokes, J., Lovett, A., & Sykes, B. (2023). Equine gastric ulcer syndrome: an update on current knowledge. Ani- mals, 13(7), 1261.


By: Madeline Boast, MSc. Equine Nu- trition About the author: Madeline


Boast completed her master’s in Equine Nutrition at the University of Guelph and started an independent nutrition company known as Balanced Bay. She has worked with a variety of equids – from miniature ponies to competing thoroughbreds. Through Balanced Bay she designs customized balanced nutri- tion plans that prioritize equine well- being. This includes diets for optimal performance as well as solving complex nutritional issues and everything in be- tween. For additional information see www.balancedbay.ca


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