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.<ref>Papich, M.G (1993) Anti-ulcer therapy.  ''Vet Clin N Am'', 202:1465-1468.</ref>  '''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 of both 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.<ref>Papich, M.G (1993) Anti-ulcer therapy.  ''Vet Clin N Am'', 202:1465-1468.</ref>  '''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 of both naturally-occurring and NSAID-induced gastric ulcers in horses.<ref name="MacAllister">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><Murray, M.J, Haven, M.L, Eichorn, E.S, ''et al.'' (1997) Effects of omeprazole on healing of naturally-occurring gastric ulcers in thoroughbred racehorses.  ''Equine Vet J'', 29:425-429.  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 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 name="MacAllister">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====