Changes

====Antacids====

====Antacids====

The use of antacids to treat EGUS in the horse has not been critically evaluated<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in  Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref> and some believe they are contraindicated due to potential rebound effects.  Furthermore, the requirement for frequent dosing of large volumes of these products (owing to their poor efficacy) makes them an unattractive, stressful and impractical alternative to omeprazole. (Orsini)

The use of antacids to treat EGUS in the horse has not been critically evaluated<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in  Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref> and some believe they are contraindicated due to potential rebound effects.  Furthermore, the requirement for frequent dosing of large volumes of these products (owing to their poor efficacy) makes them an unattractive, stressful and impractical alternative to omeprazole.<ref name="Orsini">Orsini, J (2000) Tutorial Article Gastric ulceration in the mature horse: a review. ''Equine Vet Educ'', 12(1):24-27.</ref>

====Mucosal protectants====

====Mucosal protectants====

Sucralfate is a complex salt of sucrose and aluminium hydroxide.  It is thought to promote ulcer healing via several mechanisms: adherence to ulcerated mucosa, stimulation of mucus secretion, pepsin inibition, increasing prostgalandin E synthesis and enhancing the local production of epidermal growth factor.<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in  Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref>  It has been used effectively to treat and prevent stress-induced ulcers in man and has been recommended at 10-20mg/kg three times daily for the treatment of glandular ulcers in horses.(murray 1994 in Orsini)  However, the effect of sucralfate on equine squamous gastric ulcers remains inconclusive<ref name="EGUC">The Equine Gastric Ulcer Council (1999) Tutorial Article: Recommendations for the diagnosis and treatment of equine gastric ulcer syndrome (EGUS).  ''Equine Vet Educ'', 11(5):262-272.</ref> and the product may be ineffective in the alkaline conditions created by acid suppression agents.(123-125 in Sanchez)

Sucralfate is a complex salt of sucrose and aluminium hydroxide.  It is thought to promote ulcer healing via several mechanisms: adherence to ulcerated mucosa, stimulation of mucus secretion, pepsin inibition, increasing prostgalandin E synthesis and enhancing the local production of epidermal growth factor.<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in  Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref>  It has been used effectively to treat and prevent stress-induced ulcers in man and has been recommended at 10-20mg/kg three times daily for the treatment of glandular ulcers in horses.<ref>Murray, M.J (1994) Gastric ulcers in adult horses.  ''Comp Cont Educ Pract Vet'', 16:792-794,797.  In: Orsini, J (2000) Tutorial Article Gastric ulceration in the mature horse: a review. ''Equine Vet Educ'', 12(1):24-27.</ref>

  However, the effect of sucralfate on equine squamous gastric ulcers remains inconclusive<ref name="EGUC">The Equine Gastric Ulcer Council (1999) Tutorial Article: Recommendations for the diagnosis and treatment of equine gastric ulcer syndrome (EGUS).  ''Equine Vet Educ'', 11(5):262-272.</ref> and the product may be ineffective in the alkaline conditions created by acid suppression agents.(123-125 in Sanchez)

====Prostaglandin analogues====

====Prostaglandin analogues====

====Management====

====Management====

*'''Diet:''' ideally turnout to good quality grass.(Murray 1994)  Stabled horses should have continuous access to hay and should be offered this before calorifc needs are met by concentrates.(Orsini)  Alfalfa, or another high calcium or high protein forage may be preventative by increasing gastric pH.(Nadeau et al. 2000; Lybbert et al. 2007; Ralston 2007)  Concentrates should be fed at no more than 0.5kg per 100kg body weight and not more frequently than every 6 hours.(Andrews 2006)  Horses prone to, or at risk of, EGUS should be fed the minimum amount of concentrates necessary.(Nadeau 2009)  

*'''Diet:''' ideally turnout to good quality grass.(Murray 1994)  Stabled horses should have continuous access to hay and should be offered this before calorifc needs are met by concentrates.<ref name="Orsini">Orsini, J (2000) Tutorial Article Gastric ulceration in the mature horse: a review. ''Equine Vet Educ'', 12(1):24-27.</ref> Alfalfa, or another high calcium or high protein forage may be preventative by increasing gastric pH.(Nadeau et al. 2000; Lybbert et al. 2007; Ralston 2007)  Concentrates should be fed at no more than 0.5kg per 100kg body weight and not more frequently than every 6 hours.(Andrews 2006)  Horses prone to, or at risk of, EGUS should be fed the minimum amount of concentrates necessary.(Nadeau 2009)  

*'''Stress:''' minimise handling wherever possible, provide company and toys for stabled horses, encourage good feeding habits of foals.

*'''Stress:''' minimise handling wherever possible, provide company and toys for stabled horses, encourage good feeding habits of foals.

Most of these suggestions would be difficult if not impossible to achieve for horses in race training, thus prophylactic medication should be considered.(Orsini)

Most of these suggestions would be difficult if not impossible to achieve for horses in race training, thus prophylactic medication should be considered.<ref name="Orsini">Orsini, J (2000) Tutorial Article Gastric ulceration in the mature horse: a review. ''Equine Vet Educ'', 12(1):24-27.</ref>

====Prophylaxis====

====Prophylaxis====

Omeprazole paste at a lower dose (1-2mg/kg) daily for 3-4 weeks.(100, 107-109 in Sanchez)

Omeprazole paste at a lower dose (1-2mg/kg) daily for 3-4 weeks.(100, 107-109 in Sanchez)

*Prevented ulcers in horses maintained under ulcerogenic conditions (White et al. 2003; McClure et al. 2005a,b,c;White et al. 2007).

*Prevented ulcers in horses maintained under ulcerogenic conditions (White et al. 2003; McClure et al. 2005a,b,c;White et al. 2007).

*Treating ulcers in asymptomatic performance horses may lead to improved performance.(Orsini)

*Treating ulcers in asymptomatic performance horses may lead to improved performance.<ref name="Orsini">Orsini, J (2000) Tutorial Article Gastric ulceration in the mature horse: a review. ''Equine Vet Educ'', 12(1):24-27.</ref>

*Prophylaxis in foals controversial as gastric acidity may be protective against bacterial translocation.<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in  Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref>

*Prophylaxis in foals controversial as gastric acidity may be protective against bacterial translocation.<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in  Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref>

*May benefit foals receiving substantial doses of NSAIDs for orthopaedic pain.<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in  Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref>

*May benefit foals receiving substantial doses of NSAIDs for orthopaedic pain.<ref name="Sanchez">Sanchez, L.C (2010) 'Diseases Of The Stomach' in  Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 15.</ref>