On July 9th, we published some images relating to a patient that had been diagnosed with both squamous and glandular stomach ulcers but had not shown any clinical signs whatsoever, highlighting the policy of routine gastric screening in horses. Untreated ulcers, as well as being extremely painful , can lead to perforation of the stomach wall , peritonitis and death, so we take them very seriously!

Thankfully the horse mentioned in the previous blog responded well to treatment with omeprazole (Peptizole) to reduce gastric acid production, coupled with sulcralfate which coats the stomach wall to protect the damaged tissue. He was re-scoped yesterday and the images are seen below:

This image shows the junction of the squamous and glandular regions, now with no ulceration.

As can be seen, this horse has responded well to our normal treatment regime but not all patients do so well. A recent review article in Equine Veterinary Education by B W Sykes, highlighted the fact that around 15 to 30% of squamous cases and up to 75% of glandular ulceration patients fail to respond to normal treatment. It is postulated that there may be marked variation in individual’s uptake of omeprazole and this can be affected by the timing of drug administration and feeding strategies. For instance, we advise generally that ulcer patients have ad lib fibre but Sykes suggests that omeprazole uptake will be more optimal if given after a period of fasting i.e. first thing in the morning when hopefully the horse finished his late in the evening and also around 60-90 minutes before giving sulcralfate which in coating the stomach wall, will affect omeprazole uptake. The slow-release intramuscular omeprazole injection should definitely be considered if oral dosing is proving ineffective. Work is also being done to evaluate an alternative proton pump inhibitor to omeprazole, called esomeprazole. Studies have shown that this new drug produces more pronounced suppression of gastric acid at lower dose rates than omeprazole.