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→Clinical syndrome
==Clinical syndrome==
==Clinical syndrome==
The clinical signs associated with gastric ulcers are often very non-sepcific, difficult to document and at times only subjective.(Orsini) In addition, there appears to be a poor correlation between the severity of endoscopic lesions and the clinical presentation.(Murray et al 1989 in Orsini) The significance of gastric ulceration in horses thus remains questionable. However, there have been instances in which ulcer treatment has preceded an improvement in clinical status and/or racing perfomance, suggesting that in some horses, ulcers are a considerable burden.(Orsini) Horses with gastric ulcers are often asymptomatic, but signs that have been attributed to these lesions include:
*Poor appetite
*Poor appetite
*Poor condition
*Poor condition
*Rough hair coat
*Weight loss
*Weight loss
*Diarrhoea
*Diarrhoea
*Low-grade colic
*Excessive recumbency (EGUC)
*Excessive recumbency
*Mild to severe colic
*Bruxism (in foals only and almost pathognomonic)
**Mild, recurrent colic signs after eating are often reported<ref>Videla, R, Andrews, F.M (2009) New perspectives in equine gastric ulcer syndrome. ''Vet Clin North Am Equine Pract'', 25(2):283-301.</ref>
**In one study, 49% of horses that presented for colic had gastric ulceration and those with duodenitis-proximal jejunitis had a trend towards a higher prevalence of gastric ulceration compared to those with other GI lesions.(Dukti et al. 2006) (Nadeau 2009)
*Changes in attitude (dullness or depression)
*Poor racing performance and reluctanced to train (Murray 1988, 1992; Murray et al. 1989) (Table 2).(Orsini)
**Performance improved in 4 Thoroughbred racehorses after antiulcer treatment(Franklin et al.2008)(Nadeau 2009)
**Gastric ulcers have adversely affected physiological indices of performance in horses.<ref>Nieto, J.E, Snyder, J.R, Vatistas, N.J, Jones, J.H (2009) Effect of gastric ulceration on physiologic responses to exercise in horses. ''Am J Vet Res'', 70(6):787-95.</ref>
(Murray 1992, 1994b; Vatistas et al. 1999a; Sandin e t al. 2000).(Jonssen 2006)
5 syndromes in foals: silent, active with clinical signs, perforated, gastric and duodenal stenosis, general malaise and low grade colic
Foals: cx variable depending on extent of ulceration:
Off suck or partially off suck
Bruxism (almost pathognomonic), excessive salivation (top ddx), chewing straw
Dorsal recumbency
Pain or colic after feeding or tubing
Failure to thrive
Diarrhoea
Foals with outflow obstruction will develop reflux after suckling or marked reflux even with limited to no suckling if the duodenal obstruction is distal to the common bile duct. (Sanchez)
In neonates and some older foals, the following signs have been associated with ulcers:
Intermittent colic
Frequent dorsal recumbency
Intermittent nursing (interruption of feeding,presumably due to discomfort)
Diarrhoea and/or history of diarrhoea
Poor appetite
Bruxism* (grinding of teeth)
Ptyalism (salivation).*
*These extreme signs are often associated with gastric outflow dysfunction as a result of duodenal ulceration.
(EGUC)
Most foals with gastric ulcers do not exhibit clinical signs. Clinical signs become apparent when the ulceration is widespread or severe. The classic clinical signs for gastric ulcers in foals include diarrhea, bruxism, poor nursing, dorsal recumbency, and ptyalism. None of these signs is specific for gastric ulcers. In fact, ptyalism is a sign of esophagitis, which in most foals is secondary to gastric outflow obstruction and gastroesophageal reflux. Other causes, including esophageal obstruction and Candida infection, should be considered. Importantly, when a foal exhibits clinical signs, the ulcers are severe and should be diagnosed and treated immediately. Sudden gastric perforation without prior signs occurs sporadically in foals. Adult horses with ulcers display nonspecific signs that can include abdominal discomfort (colic), poor appetite, mild weight loss, poor body condition, and attitude changes.
Complications related to gastric ulcers are most frequent and severe in foals and include perforation, delayed gastric emptying, gastroesophageal reflux and esophagitis, and megaesophagus secondary to chronic gastroesophageal reflux. Ulcers in the proximal duodenum or at the pylorus can cause fibrosis and stricture. The latter complication is seen in both foals and adult horses. In rare cases, severe gastric ulceration causes fibrosis and contracture of the stomach. (Merck)
==Diagnosis==
==Diagnosis==