Changes

==Treatment==

==Treatment==

Acid suppression

Acid suppression

Foal tx (see medicine notes)

Foal tx (see medicine notes)

 

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)

The administration of medications to horses prior to and during competition has been a source of controversy in the equine world.  The administration of antiulcer medications was once forbidden by regulatory authorities during competitions, as it was thought to be a performance enhancing drug. However, in 2000, because of the high prevalence of gastric ulcers in horses and recent information that antiulcer drugs were not performance enhancing (McKeever et al. 2006), the Bureau of the The Federation Equestre Internationale (FEI) with the advice of its Veterinary Committee and Medication Sub-Committee allowed 3 drugs to prevent and treat gastric ulceration: cimetidine, ranitidine and omeprazole. This decision is subject to annual review. However, not all organisations allow the use of antiulcer medications during competition. Although the prevalence of gastric ulcers was found to be 67% in horses competing in endurance rides (Nieto et al. 2004), the Board of the American Endurance Ride Conference (AERC) requested “a variance for the discipline of Endurance Riding to the recently passed FEI Rule allowing the anti-ulcer medication during competition” since they wanted endurance to remain a “no foreign substance category sport” (Higgins 2004). FEI rules supersede national rules for competition so this did create a problem. The view of the AERC is that any horse that needs gastric ulcer medication is too ill to compete and that if a horse needs the drug used as a preventative, it should be withdrawn from competition. These drugs are still listed under prohibited substances in the 2009 Appendices of the AERC Rules and Regulations. Many endurance horses are given concentrated electrolyte paste orally, which are not considered medications by the AERC.

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 that cannot take oral medication. 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.

An ongoing point of debate is the use of antiulcer medication in competition horses. In 2000, the (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 . Many endurance horses are given concentrated electrolyte paste orally, which are not considered medications by the AERC.

However, a recent study showed that these concentrated pastes may cause gastric ulcers due to their hyperosmolality (Holbrook et al. 2005). Thus, allowing the administration of concentrated electrolyte pastes and not allowing the use of antiulcer medications may put horses competing in endurance rides at risk for EGUS.(Nadeau 2009)

However, a recent study showed that these concentrated pastes may cause gastric ulcers due to their hyperosmolality (Holbrook et al. 2005). Thus, allowing the administration of concentrated electrolyte pastes and not allowing the use of antiulcer medications may put horses competing in endurance rides at risk for EGUS.(Nadeau 2009)