Gastric Ulceration causing poor performance in a horse!!

A 12 year-old event horse presented for poor performance that was best described as unwilling to "go forward". The gelding was evaluated for lameness and was described as sound. The gelding maintained a good appetite and there were no signs of colic behavior reported. A gastroscopy was scheduled and the owner was instructed to fast the horse for 18 hours. When the gastroscope was passed into the stomach a large volume of fluid was present mixed with feed material. Approximately 3 liters of fluid was removed from the stomach in order to visualize the non-glandular compartment. The remaining fluid was filled with feed material and was not removed. However, a clear pattern of non-glandular ulceration was noted throughout the exposed stomach wall (Figures 1-3).

 

 

Figure 1

 These ulcers appear full thickness thru the layer coating the inside of the stomach and are evenly spread through out the stomach. We were not able to visualize the glandular stomach or the pyloric region which may be abnormal in this horse. The fact that the gelding's stomach was filled with fluid and some feed after 18 hrs of fasting would suggest a delay in gastric emptying which may be associated with inflammation of the pyloric region. As such, this gelding will be treated with omeprazole for the appropriate period of time. In addition, the horse will be treated with a stomach coating medicine for the first 48 hrs to alleviate any immediate discomfort due to the ulcerations.

Figure 2

 This case presents yet another example of the types of clinical signs that may be associated with gastric ulcers. Classically we consider horses that have sings of colic, weight loss, poor appetite or failure to thrive. However, in my expereince, horses with gastric ulcers may present in many ways and this condition should be considered on our lists of differentials!!

Figure 3

Gastric Ulcers in a horse

The endoscopic images below are from a teenage gelding that presented for a complaint of aggressive  behavior while grooming. The gelding was not displaying any classic signs of colic nor was there a decline in food intake or a report of weight loss. When the stomach was examined, several bleeding ulcers were noted surrounding the pyloric sphincter. This region of the stomach includes the passage from the stomach into the small intestine. The gelding was treated with 45 days of Gastrogard and returned to normal behavior.

 The important message from this case is that gastric ulcers in horses can present like most anything! Classically, they present as low grade colic associated with feeding plus or minus weight loss. However, in my experience clinical signs associated with gastric ulcers have included poor performance, dull hair coat, excessive water intake, sour behavior under saddle, aggressive behavior while being groomed, colic, parking out, frequent posturing to urinate, teeth grinding, and weight loss.

I strongly recommend a gastric exam which includes visualization of the pyloris to determine if gastric ulcers are the source of the clinical complaint. This involves 24 hrs of fasting and a trained clinician with a 3 meter gastroscope. If ulcers are discovered, the only treatment proved to be effective is Gastrogard medication for at least 30 days! I typical recommend 30 days of a full dose followed by 2 weeks of a half dose.