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January 21, 2011

Your Horse Ulcer-Free Pt 5: Equine Ulcer Treatments

There’s a lot of conventional wisdom out there about diagnosing and treating ulcers – yet ulcers continue to be a prevalent problem for horses. The “Your Horse Ulcer Free” series will equip you with the knowledge to recognize, treat, and ultimately prevent equine ulcers in a better, more lasting way.

Be sure to check out the other articles in the series for an overview of equine ulcers, gastric ulcers, colonic ulcers, and diagnosing equine ulcers. Today we’re talking about treating ulcers once your horse has been diagnosed.

So your horse has been diagnosed with ulcers. Now what?

Equine ulcer treatments vary depending on the location and nature of the lesion in the digestive tract. As a result, it’s worthwhile to understand more about the different ulcer remedies available. These include drug therapies, nutritional supplements and techniques in care and feeding.

Be aware that many treatments, especially drug-based therapies, have risks and potential side effects. As a result, you should always consult with your veterinarian to ensure a complete and accurate diagnosis, and to determine the best course of action for your horse’s particular case.

Drug Treatments for Equine Ulcers

Drugs or pharmaceuticals generally work by modifying the biological and/or chemical processes in the gut to aid in healing. Drugs may require the prescription of a veterinarian, but many “over the counter” drug products are also available.

All drugs require the approval of the U.S. Food and Drug Administration (FDA) to be produced and marketed legally. Technically, all drugs should be FDA-approved for the specific application and species – such as for the treatment of ulcers in horses. All drug labels should also indicate the “intended use” of that product. Depending on the circumstances, including availability, efficacy, or cost, a veterinarian may prescribe a drug that is not labeled specifically for treating ulcers in horses. However, the practice of using “off label” drugs should be limited to cases where an FDA-approved treatment is not readily available.

There is only one FDA-approved drug for the treatment of ulcers of any kind in horses: Gastrogard®, specifically for treatment of gastric ulcers in horses. There are no FDA-approved drug remedies for colonic ulcers in horses.

Equine Gastric Ulcer Drug Treatments

While there is only one FDA-approved drug product available for treating gastric ulcers in horses, there are a number of pharmaceutical remedies commonly used. They all generally fall into three categories:

  • Antisecretory agents shut down acid production in the stomach to allow healing to occur. Drugs in this category include omeprazole, ranitidine and cimetidine. Omeprazole is the active ingredient in Gastrogard®, and is also sold in generic forms, often at a lower price. (Be aware that FDA approval requires meeting standards of quality and manufacturing. As such, generic forms of omeprazole may not provide the same effectiveness as Gastrogard®.)
  • Neutralizing agents buffer acids and/or coat the stomach lining to protect the stomach and reduce the corrosive effect of acid. Antacids or bismol products are common drugs in this category. The actual effectiveness of antacids and coatings has generally been minimal.
  • Antibiotics treat bacteria in the ulcer bed that can inhibit healing. While not used in every case, antibiotics can be helpful if gastric ulcers are taking longer than normal to heal because the ulcers are inflamed from bacterial infection.

Colonic Ulcer Drug Treatments for Horses

Because of a relative lack of awareness and understanding of colonic ulcers, there are fewer treatments available. Here are two types of drug products often used or considered for situations where ulcers in the hindgut are likely, though neither are FDA-approved for treating colonic ulcers in horses:

  • Sucralfate, a complex of aluminum and sugar, adheres to ulcers to coat and protect the site of ulcers. FDA-approved for the treatment of duodenal ulcers in humans, it has been used in horses with mixed results.
  • Antibiotics are used in certain hindgut ulcer cases, particularly where infectious colitis is diagnosed. The goal is to eliminate the infection so healing can occur.

It is important to understand, as a horse owner, that drug use, even under the guidance of a caring and experienced veterinarian, has its risks. Also, drug treatments rarely address underlying causes of ulcers, so they are likely to reoccur.

Knowledge is your best defense. So understanding what ulcers are, knowing the difference between foregut and hindgut conditions, and being aware of how different treatments work can help you make better choices.

Dietary and Management Treatments for Equine Ulcers

It is our belief that many digestive ailments we see today, including ulcers and even colic, are induced conditions. They are a consequence of modern equine husbandry, including feeding processed feeds a couple times a day, confinement in stalls, training regimens, travel and other aspects of the performance lifestyle. Because horses’ digestive systems are designed to support a more sedentary lifestyle with a diet of high fiber grass consumed continuously, the care and feeding approaches common today lead to digestive health problems like ulcers.

As a result, we also believe that the best course of action for treating ulcers is to address the root causes. This means changing the way we feed and care for horses, removing the external stresses that lead to the problem in the first place. You may have heard the old idea of calling “Dr. Green” – turning the horse out on pasture to graze, relax and recover.

Of course, we also understand that this is the real world. Horses need to perform, and grain is needed to provide the energy for training and performance. Stalling is necessary, especially in more urban areas where turnout is limited. Still, there are things you can do to modify the feed, or to supplement the diet that may help treat ulcers, and ultimately keep them from returning.

Start by reducing grain/processed feeds, increasing forage, and feeding in multiple small meals throughout the day.

Reducing processed feed and increasing forage helps reduce colonic ulcers by ensuring that the complex carbohydrates are digested in the foregut where they belong, instead of reaching the hindgut where they raise the acidity and cause (or complicate) problems.

Multiple small meals high in forage helps heal gastric ulcers by producing a constant trickle of forage and saliva (from chewing) to buffer the stomach acids. Increasing grass and/or hay are obvious ways to add forage to the diet. In addition, you can maximize forage by adding chaff (or chopped hay) or soaked beet pulp to the diet.

Feed Supplements to Address Ulcers

In addition to modifying your feeding program, there are a number of digestive supplements on the market, from old home remedies to packaged products labeled for digestive health.

One simple and commonly used method is to add corn or flax seed oil to the feed. This helps to supply Omega 3 fatty acids, which can help with weight management while the hindgut is compromised and may promote healing.

Another dietary product used in caring for the hindgut is Psyllium Mucilloid. This is a natural dietary fiber that works as a bulk laxative. It is used particularly to help remove ingested sand from the colon, which may cause ulcers (through the abrasive effects of the sand particles) or lead to sand colic.

Beyond this, the tack store shelves and catalogs are filled with an assortment of products making all kinds of claims for digestive health or ulcer support. But what really works?

Rather than attempt to review all of the different products out there, let’s offer some sound, practical advice: be aware that most of these products don’t live up to the claims, so read labels carefully, research ingredients and their effects, and discuss options with your veterinarian.

Next Step: Reducing the Risk for Ulcers in Your Horse

With so many of today’s horses at risk for gastric and colonic ulcers, it’s important to know what steps you can take to prevent them. Read what you can do to reduce your horse’s risk for ulcers in Pt 6: preventing ulcers in horses.


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