Changes

===Proton-pump inhibitors (PPIs)===

===Proton-pump inhibitors (PPIs)===

PPIs irreversibly bind to the H+K+-ATPase proton pump of the parietal cell and block the secretion of hydrogen ions.  These agents are more effective than H2 antagonsists as their action is receptor-independent,(EGUC) blocking the final pathway of acid secretion and they have a prolonged effect allowing for once-daily dosing.((Brown and Rees 1994). Papich 1993, Sanchez)  '''Omeprazole (Gastroguard)''', a subsituted benzimidazole, is currently licensed for use in horses.  At a dose rate of 4mg/kg per day omeprazole has proven effective in reducing the severity of gastric ulcers in Thoroughbred horses in active race training (Vatistas 1999) and no adverse effects have been observed.

PPIs irreversibly bind to the H+K+-ATPase proton pump of the parietal cell and block the secretion of hydrogen ions.  These agents are more effective than H2 antagonsists as their action is receptor-independent,(EGUC) blocking the final pathway of acid secretion and they have a prolonged effect allowing for once-daily dosing.((Brown and Rees 1994). Papich 1993, Sanchez)  '''Omeprazole (Gastroguard™)''', a subsituted benzimidazole, is currently the only PPI licensed for use in horses.  At a dose rate of 4mg/kg per day omeprazole has proven effective in reducing the severity of gastric ulcers in Thoroughbred horses in active race training (Vatistas 1999) and no adverse effects have been observed. The paste formulation is easy to administer and generally well accepted by horses. Omeprazole has demonstrated efficacy in the resolution ofboth naturally-occurring and NSAID-induced gastric ulcers in horses.(103.104 in Sanchez) A single dose has also produced an increase in gastric pH in clinically ill neonatal foals<ref>Javsicas, L.H, Sanchez, L.C (2008) The effect of omeprazole paste on intragastric pH in clinically ill neonatal foals. ''Equine Vet J'', 40(1):41-4.</ref> and has contributed to ulcer healing in neonates.(103 in Sanchez)  A potential concern is that altering gastric pH may encourage bacterial overgrowth. Thus further work is needed to evaluate the long-term safety of omeprazole in horses and particularly, foals.(Vatistas 1999)

 

 

  one potential problem may be that increasing gastric pH may allow bacterial overgrowth in the small intestine by preventing the entry of organisms normally inhibited by gastric acidity. Consequently, further studies are required to determine the long-term efficacy and safety of omeprazole in horses.

Acceptability of omeprazole as a paste was, in general, excellent.  Further studies are required to determine the optimal dosage and long-term safety of omeprazole in horses. (Vatistas 1999)

 

Equine Vet J. 2008 Jan;40(1):41-4.

The effect of omeprazole paste on intragastric pH in clinically ill neonatal foals.

Javsicas LH, Sanchez LC.

Omeprazole paste effectively increases intragastric pH in clinically ill neonatal foals after one dose at 4 mg/kg bwt orally.

===Antacids===

===Antacids===