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,<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> 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<ref name="Vatistas">Vatistas, N.J, Snyder, J.R, Nieto, J, Thompson, D, Pollmeier, M, Holstes, J (1999) Acceptability of a paste formulation and efficacy of high dose omeprazole in healing gastric ulcers in horses maintained in race training.  ''Equine Vet J Suppl'', 29:71-76.</ref> 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.<ref>MacAllister, C.G, Sifferman, R.L, McClure, S.R ''et al.'' (1999) Effects of omeprazole paste on healing of spontaneous gastric ulcers in horses and foals: a field trial.  ''Equine Vet J Suppl'', 77-80.  In: 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>  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.<ref name="Vatistas">Vatistas, N.J, Snyder, J.R, Nieto, J, Thompson, D, Pollmeier, M, Holstes, J (1999) Acceptability of a paste formulation and efficacy of high dose omeprazole in healing gastric ulcers in horses maintained in race training.  ''Equine Vet J Suppl'', 29:71-76.</ref>

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,<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> 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<ref name="Vatistas">Vatistas, N.J, Snyder, J.R, Nieto, J, Thompson, D, Pollmeier, M, Holstes, J (1999) Acceptability of a paste formulation and efficacy of high dose omeprazole in healing gastric ulcers in horses maintained in race training.  ''Equine Vet J Suppl'', 29:71-76.</ref> and no adverse effects have been observed.  The paste formulation is easy to administer and is 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.<ref>MacAllister, C.G, Sifferman, R.L, McClure, S.R ''et al.'' (1999) Effects of omeprazole paste on healing of spontaneous gastric ulcers in horses and foals: a field trial.  ''Equine Vet J Suppl'', 77-80.  In: 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>  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.<ref name="Vatistas">Vatistas, N.J, Snyder, J.R, Nieto, J, Thompson, D, Pollmeier, M, Holstes, J (1999) Acceptability of a paste formulation and efficacy of high dose omeprazole in healing gastric ulcers in horses maintained in race training.  ''Equine Vet J Suppl'', 29:71-76.</ref>

====Antacids====

====Antacids====