News & Reports CONFERENCES
Understanding gastric ulceration in horses WHAT is the clinical relevance of gastric ulcers in horses? This was the question asked by Richard Hepburn, of the B&W Equine Group in Tetbury, in a plenary lecture entitled ‘After 30 years of gastroscopy, what are we really seeing?’, at the 11th International Colic Research Symposium, held in Dublin last month. Mr Hepburn discussed current thinking on gastric ulcers but also looked back at published research to give the subject context. He explained that the first paper that had looked at any reasonable number of horses with gastric ulcers had been published in 1986, by Hammond and Clinical conundrum: not all horses with gastric ulceration will show clinical signs colleagues. Their results suggested that exercise and diet could have an we have to do the same and change away influence on the prevalence of gastric ulcers. from a grading scheme’. While ‘clients love Subsequently, research published by numbers’, was the grading system relevant Murray and others in 1989 compared horses to the clinical picture? with and without clinical signs. Although He also noted that squamous and horses with clinical signs of gastric ulcers had glandular ulcers should be considered as two a higher prevalence of ulcers on endoscopy different problems rather than as a single than those without, almost half the horses syndrome. without clinical signs also had ulcers. This, Mr Hepburn said, highlighted ‘the biggest Squamous ulcers conundrum’ of the problem: ‘What is the For squamous ulcers, the ‘big debate’ was clinical relevance of a lot of what we’re what was really important. Was it, for looking down the endoscope at?’ example, the severity, the extent or the Ten years later, in 1999, the Equine location of the ulcers? Clinical signs were Gastric Ulcer Council published its vague and inconsistent, and included poor recommendations for diagnosing and body condition, dull coat and inappetence, treating equine gastric ulcer syndrome and often did not appear to be related to ulcer (EGUS). The aim was to come to some prevalence. For example, in a study of gastric consensus. ‘The consensus was that gastric ulcers, Vatistas and others (1999) found ulceration was a prevalent and significant that only 39 per cent of horses displayed health problem,’ said Mr Hepburn. clinical signs. It had also been reported that Risk factors, such as intense exercise, some horses, although not showing obvious certain aspects of diet, transportation and clinical signs, would show an improvement concurrent disease, were identified. The in performance and general wellbeing if council recommended that definitive their gastric ulcers were treated, and poor diagnosis had to be by endoscopy, and the performance did seem to be related to the most effective treatment appeared to be presence of gastric ulcers. Despite having omeprazole. However, it also flagged up the previously been identified as a risk factor, inconsistency between what was being seen colic did not appear to be relevant to EGUS. in the gut and the clinical state of the horse. Most of the published data concerned ‘Not a huge amount has changed since 1999 thoroughbred racehorses, but the small in our general consensus,’ Mr Hepburn amount of data on other horses indicated commented. that diet and exercise might indeed be The council also recommended a relevant to the development of ulcers in grading system, but Mr Hepburn questioned other populations of horses. the usefulness of this system. It worked Mr Hepburn considered that trying to relatively well for squamous tissue, he said, control and limit the movement of acid in but was hard to apply to glandular lesions. the stomach, perhaps through feeding small In human medicine a grading system was meals before exercise, might be a way to help not used, and he suggested that ‘maybe manage and reduce the formation of ulcers. 136 | Veterinary Record | August 9, 2014
In people, it had been shown that using and then withdrawing acid suppression medication (proton pump inhibitors) could cause rebound acid hypersecretion, leading to heartburn and dyspepsia. Was it possible that the same could be happening in horses? There was some evidence that this might be the case and, said Mr Hepburn, ‘I think we need to be a little more pragmatic about how we use these drugs and the population we use them in.’
Glandular ulcers
Less was known about glandular disease, Mr Hepburn explained. The prevalence was variable and had been reported to be between 17 and 65 per cent. There was a global distribution, but some countries appeared to have more horses with glandular lesions. Not a great deal had been established regarding possible causes, and there was ‘almost nothing’ published describing the relationship between glandular lesions and clinical signs. At the moment, therefore, he said, ‘We just have no idea. This is an area where . . . we are making individual decisions on a clinical basis.’ Other topics discussed at the symposium, which was hosted by the British Equine Veterinary Association, included the microbiome and physiology of the equine gut, diagnostics, epidemiology, surgical techniques and postoperative management.
References
EQUINE GASTRIC ULCER COUNCIL (1999) Recommendations for the diagnosis and treatment of equine gastric ulcer syndrome (EGUS). Equine Veterinary Education 11, 262-272 HAMMOND, C. J., MASON, D. K. & WATKINS, K. L. (1986) Gastric ulceration in mature Thoroughbred horses. Equine Veterinary Journal 18, 284-287 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 Veterinary Journal Supplement 7, 68-72 VATISTAS, N. J., SNYDER, J. R., CARLSON, G., JOHNSON, B., ARTHUR, R. M., THURMOND, M., ZHOU, H. & LLOYD, K. L. (1999) Cross-sectional study of gastric ulcers of the squamous mucosa in thoroughbred racehorses. Equine Veterinary Journal Supplement 29, 34-39
Merial Animal Health provided travel and accommodation for Veterinary Record’s attendance at this symposium. doi: 10.1136/vr.g4999
Understanding gastric ulceration in horses WHAT is the clinical relevance of gastric ulcers in horses? This was the question asked by Richard Hepburn, of the B&W Equine Group in Tetbury, in a plenary lecture entitled ‘After 30 years of gastroscopy, what are we really seeing?’, at the 11th International Colic Research Symposium, held in Dublin last month. Mr Hepburn discussed current thinking on gastric ulcers but also looked back at published research to give the subject context. He explained that the first paper that had looked at any reasonable number of horses with gastric ulcers had been published in 1986, by Hammond and Clinical conundrum: not all horses with gastric ulceration will show clinical signs colleagues. Their results suggested that exercise and diet could have an we have to do the same and change away influence on the prevalence of gastric ulcers. from a grading scheme’. While ‘clients love Subsequently, research published by numbers’, was the grading system relevant Murray and others in 1989 compared horses to the clinical picture? with and without clinical signs. Although He also noted that squamous and horses with clinical signs of gastric ulcers had glandular ulcers should be considered as two a higher prevalence of ulcers on endoscopy different problems rather than as a single than those without, almost half the horses syndrome. without clinical signs also had ulcers. This, Mr Hepburn said, highlighted ‘the biggest Squamous ulcers conundrum’ of the problem: ‘What is the For squamous ulcers, the ‘big debate’ was clinical relevance of a lot of what we’re what was really important. Was it, for looking down the endoscope at?’ example, the severity, the extent or the Ten years later, in 1999, the Equine location of the ulcers? Clinical signs were Gastric Ulcer Council published its vague and inconsistent, and included poor recommendations for diagnosing and body condition, dull coat and inappetence, treating equine gastric ulcer syndrome and often did not appear to be related to ulcer (EGUS). The aim was to come to some prevalence. For example, in a study of gastric consensus. ‘The consensus was that gastric ulcers, Vatistas and others (1999) found ulceration was a prevalent and significant that only 39 per cent of horses displayed health problem,’ said Mr Hepburn. clinical signs. It had also been reported that Risk factors, such as intense exercise, some horses, although not showing obvious certain aspects of diet, transportation and clinical signs, would show an improvement concurrent disease, were identified. The in performance and general wellbeing if council recommended that definitive their gastric ulcers were treated, and poor diagnosis had to be by endoscopy, and the performance did seem to be related to the most effective treatment appeared to be presence of gastric ulcers. Despite having omeprazole. However, it also flagged up the previously been identified as a risk factor, inconsistency between what was being seen colic did not appear to be relevant to EGUS. in the gut and the clinical state of the horse. Most of the published data concerned ‘Not a huge amount has changed since 1999 thoroughbred racehorses, but the small in our general consensus,’ Mr Hepburn amount of data on other horses indicated commented. that diet and exercise might indeed be The council also recommended a relevant to the development of ulcers in grading system, but Mr Hepburn questioned other populations of horses. the usefulness of this system. It worked Mr Hepburn considered that trying to relatively well for squamous tissue, he said, control and limit the movement of acid in but was hard to apply to glandular lesions. the stomach, perhaps through feeding small In human medicine a grading system was meals before exercise, might be a way to help not used, and he suggested that ‘maybe manage and reduce the formation of ulcers. 136 | Veterinary Record | August 9, 2014
In people, it had been shown that using and then withdrawing acid suppression medication (proton pump inhibitors) could cause rebound acid hypersecretion, leading to heartburn and dyspepsia. Was it possible that the same could be happening in horses? There was some evidence that this might be the case and, said Mr Hepburn, ‘I think we need to be a little more pragmatic about how we use these drugs and the population we use them in.’
Glandular ulcers
Less was known about glandular disease, Mr Hepburn explained. The prevalence was variable and had been reported to be between 17 and 65 per cent. There was a global distribution, but some countries appeared to have more horses with glandular lesions. Not a great deal had been established regarding possible causes, and there was ‘almost nothing’ published describing the relationship between glandular lesions and clinical signs. At the moment, therefore, he said, ‘We just have no idea. This is an area where . . . we are making individual decisions on a clinical basis.’ Other topics discussed at the symposium, which was hosted by the British Equine Veterinary Association, included the microbiome and physiology of the equine gut, diagnostics, epidemiology, surgical techniques and postoperative management.
References
EQUINE GASTRIC ULCER COUNCIL (1999) Recommendations for the diagnosis and treatment of equine gastric ulcer syndrome (EGUS). Equine Veterinary Education 11, 262-272 HAMMOND, C. J., MASON, D. K. & WATKINS, K. L. (1986) Gastric ulceration in mature Thoroughbred horses. Equine Veterinary Journal 18, 284-287 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 Veterinary Journal Supplement 7, 68-72 VATISTAS, N. J., SNYDER, J. R., CARLSON, G., JOHNSON, B., ARTHUR, R. M., THURMOND, M., ZHOU, H. & LLOYD, K. L. (1999) Cross-sectional study of gastric ulcers of the squamous mucosa in thoroughbred racehorses. Equine Veterinary Journal Supplement 29, 34-39
Merial Animal Health provided travel and accommodation for Veterinary Record’s attendance at this symposium. doi: 10.1136/vr.g4999
