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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.<ref name="Orsini">Orsini, J (2000) Tutorial Article Gastric ulceration in the mature horse: a review. ''Equine Vet Educ'', 12(1):24-27.</ref> In addition, there appears to be a poor correlation between the severity of endoscopic lesions and the clinical presentation.<ref name="Murray 1989">Murray, M.J, Grodinsky, C, Anderson, C.W, Radue, P.F, Schmidt, G.R (1989) Gastric ulcers in horses: a comparison of endoscopic findings in horses with and without clinical signs. ''Equine Vet J Suppl'', 7:68-72.</ref> 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.<ref name="Orsini">Orsini, J (2000) Tutorial Article Gastric ulceration in the mature horse: a review. ''Equine Vet Educ'', 12(1):24-27.</ref> Cases gastric ulceration are often asymptomatic, but signs that have been attributed to these lesions in mature horses include:
The clinical signs associated with gastric ulcers are often very non-sepcific, difficult to document and at times only subjective.<ref name="Orsini">Orsini, J (2000) Tutorial Article Gastric ulceration in the mature horse: a review. ''Equine Vet Educ'', 12(1):24-27.</ref> In addition, there appears to be a poor correlation between the severity of endoscopic lesions and the clinical presentation.<ref name="Murray 1989">Murray, M.J, Grodinsky, C, Anderson, C.W, Radue, P.F, Schmidt, G.R (1989) Gastric ulcers in horses: a comparison of endoscopic findings in horses with and without clinical signs. ''Equine Vet J Suppl'', 7:68-72.</ref> The significance of gastric ulceration in horses thus remains questionable. However, there have been instances where ulcer treatment has preceded an improvement in clinical status and/or racing perfomance, suggesting that in some horses, ulcers are a considerable burden.<ref name="Orsini">Orsini, J (2000) Tutorial Article Gastric ulceration in the mature horse: a review. ''Equine Vet Educ'', 12(1):24-27.</ref> Cases gastric ulceration are often asymptomatic, but signs that have been attributed to these lesions in '''mature horses''' include:
*Poor appetite (particularly decreased consumption of concentrates)<ref name="Sanchez">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>
*Poor appetite (particularly decreased consumption of concentrates)<ref name="Sanchez">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>
**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>
**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>
Clinical signs in foals vary depending on age and severity:
'''Clinical signs in foals vary depending on age and severity:'''
*'''Neonatal foals''': many ulcers are silent, some foals only exhibit signs when ulceration has become severe. Glandular ulcers are considered the most significant<ref name="Sanchez">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>
*'''Neonatal foals''': many ulcers are silent, some foals only exhibit signs when ulceration has become severe. Glandular ulcers are considered the most significant<ref name="Sanchez">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>
**Poor appetite
**Poor appetite
**Dorsal recumbency
**Dorsal recumbency
Signs of gastroduodenal ulcer disease (GDUD)<ref name="Sanchez">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>:
'''Signs of gastroduodenal ulcer disease (GDUD):'''<ref name="Sanchez">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>
*Bruxism
*Bruxism
*Colic
*Colic
*Diarrhoea
*Diarrhoea
In foals with outflow obstruction distal to the common bile duct, marked reflux may be seen even with limited suckling.<ref name="Sanchez">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> GDUD is the primary differentila for ptyalism in foals, other possible diagnoses include oesophageal obstruction and ''Candida'' infection.<ref name="Merck">Merck & Co (2008) The Merck Veterinary Manual (Eighth Edition), Merial</ref>
In foals with outflow obstruction distal to the common bile duct, marked reflux may be seen even with limited nursing.<ref name="Sanchez">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> GDUD is the primary differential for ptyalism in foals, other possible diagnoses include oesophageal obstruction and ''Candida'' infection.<ref name="Merck">Merck & Co (2008) The Merck Veterinary Manual (Eighth Edition), Merial</ref>
==Diagnosis==
==Diagnosis==