Changes

====Treatment problems====

====Treatment problems====

The prevalence of gastric ulcers in horses remains high regardless of the common use of antiulcer treatments.  This has been attributed to the expense of recommended products encouraging subtherapeutic and curtailed dosing schedules(Orsini et al 2003 in Nadeau 2009).  Omeprazole and ranitidine must be administered for at least 28 days for adequate ulcer healing.(Nadeau 2009) In the USA, compounded omeprazole from bulk powders are used as a cheaper substitute for the FDA approved products. However, these formulations lack efficacy and are not regulated (Nieto et al. 2002; Merritt et al. 2003; Orsini et al. 2003).(Nadeau 2009)  A considerable challenge lies in the management of abdominal pain associated with EGUS, since the commonly used NSAIDs for pain control may worsen and even induce further ulcerative lesions.<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>  Another challenge is the horse in which oral medication is prohibited.  However, Andrews and colleagues (2006) have demonstrated the efficacy of an omeprazole powder, adminstered IV in sterile water, which signifcantly increases the pH of equine gastric contents and may be useful in problem horses.<ref>Andrews, F.M, Frank, N, Sommardahl, C.S, Buchanan, B.R, Elliott, S.B, Allen, V.A (2006) Effects of intravenously administrated omeprazole on gastric juice pH and gastric ulcer scores in adult horses.  ''J Vet Intern Med'', 20(5):1202-6.</ref>  An ongoing point of debate is the use of antiulcer medication in competition horses.  In 2000, the Bureau of the The Fèdèration Equestre Internationale (FEI) permitted the use of cimetidine, ranitidine and omeprazole to prevent and treat gastric ulcers.  This decision was based on evidence that the compounds were not performance enhancing and that EGUS was such a widespread concern. However, these drugs are still listed under prohibited substances in the 2009 Appendices of the American Endurance Ride Conference (AERC) Rules and Regulations.  The argument is that a horse requiring such treatment is not suffciently well to compete and should be withdrawn form competition if it needs preventative medication.  A related concern is that the AERC permits the use of hyperosmolar oral electrolyte pastes which may cause gastric ulcers.(Holbrook et al. 2005)  Without the protection afforded by antiulcer agents, these horses may be at considerable risk for EGUS.(Nadeau 2009)

The prevalence of gastric ulcers in horses remains high regardless of the common use of antiulcer treatments.  This has been attributed to the expense of recommended products encouraging subtherapeutic and curtailed dosing schedules(Orsini et al 2003 in Nadeau 2009).  Omeprazole and ranitidine must be administered for at least 28 days for adequate ulcer healing.<ref name="Nadeau"> In: Nadeau, J.A, Andrews, F.M (2009) ''Science: Overviews'' Equine gastric ulcer syndrome: The continuing conundrum.  ''Equine Vet J'', 41(7):611-615.</ref>  In the USA, compounded omeprazole from bulk powders are used as a cheaper substitute for the FDA approved products. However, these formulations lack efficacy and are not regulated (Nieto et al. 2002; Merritt et al. 2003; Orsini et al. 2003).<ref name="Nadeau"> In: Nadeau, J.A, Andrews, F.M (2009) ''Science: Overviews'' Equine gastric ulcer syndrome: The continuing conundrum.  ''Equine Vet J'', 41(7):611-615.</ref> A considerable challenge lies in the management of abdominal pain associated with EGUS, since the commonly used NSAIDs for pain control may worsen and even induce further ulcerative lesions.<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>  Another challenge is the horse in which oral medication is prohibited.  However, Andrews and colleagues (2006) have demonstrated the efficacy of an omeprazole powder, adminstered IV in sterile water, which signifcantly increases the pH of equine gastric contents and may be useful in problem horses.<ref name="Andrews 2006">Andrews, F.M, Frank, N, Sommardahl, C.S, Buchanan, B.R, Elliott, S.B, Allen, V.A (2006) Effects of intravenously administrated omeprazole on gastric juice pH and gastric ulcer scores in adult horses.  ''J Vet Intern Med'', 20(5):1202-6.</ref>  An ongoing point of debate is the use of antiulcer medication in competition horses.  In 2000, the Bureau of the The Fèdèration Equestre Internationale (FEI) permitted the use of cimetidine, ranitidine and omeprazole to prevent and treat gastric ulcers.  This decision was based on evidence that the compounds were not performance enhancing and that EGUS was such a widespread concern. However, these drugs are still listed under prohibited substances in the 2009 Appendices of the American Endurance Ride Conference (AERC) Rules and Regulations.  The argument is that a horse requiring such treatment is not suffciently well to compete and should be withdrawn form competition if it needs preventative medication.  A related concern is that the AERC permits the use of hyperosmolar oral electrolyte pastes which may cause gastric ulcers.(Holbrook et al. 2005)  Without the protection afforded by antiulcer agents, these horses may be at considerable risk for EGUS.<ref name="Nadeau"> In: Nadeau, J.A, Andrews, F.M (2009) ''Science: Overviews'' Equine gastric ulcer syndrome: The continuing conundrum.  ''Equine Vet J'', 41(7):611-615.</ref>

==Prognosis==

==Prognosis==

====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.<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)  

*'''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..<ref name="Andrews 2006">Andrews, F.M, Frank, N, Sommardahl, C.S, Buchanan, B.R, Elliott, S.B, Allen, V.A (2006) Effects of intravenously administrated omeprazole on gastric juice pH and gastric ulcer scores in adult horses.  ''J Vet Intern Med'', 20(5):1202-6.</ref> Horses prone to, or at risk of, EGUS should be fed the minimum amount of concentrates necessary.<ref name="Nadeau"> In: Nadeau, J.A, Andrews, F.M (2009) ''Science: Overviews'' Equine gastric ulcer syndrome: The continuing conundrum.  ''Equine Vet J'', 41(7):611-615.</ref>

*'''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.