Did you know that stomach ulcers that occur in the upper region of the stomach (squamous epithelium – i.e. the part not protected from stomach acid) are now considered a separate disease from glandular ulcers that occur in the lower portion of the stomach (glandular region – i.e. the part where acid is produced)?
Why does this matter? Because when we talk about ulcers, they are often lumped together in terms of signs and symptoms and perhaps more importantly, treatment and prevention. So it’s kind of like, having a viral infection, and wondering why antibiotics don’t help – glandular ulcers need to be approached differently to squamous ulcers… what works for the goose doesn’t necessarily work for the gander… and can in fact make the gander sicker (see our previous post).
However, the main issue that we face as horse owners dealing with glandular ulcers, is that even scientists working on the front line of ulcer research, don’t fully understand anywhere near as much about what causes them and how to treat them, as we do with ulcers in the upper half of the stomach. Here is a summary of some of what researchers know so far:
- The two types of ulcers often co-exist, but one is not an indicator or requirement of the other
- Glandular ulcers appear to develop due to a breakdown in the natural defense mechanisms of the stomach lining to acid.
- Glandular ulcers are associated with reduced levels of performance, and are particularly prevalent in warmblood horses.
- Stress appears to play a possible role, because horses with glandular ulcers release more stress hormones when faced with internal stimulation of their stress pathways and novel situations
- There is a possible relationship to non-steroidal anti-inflammatories (e.g. bute) and incidence of colic, but the evidence and nature of that relationship is still somewhat unclear.
- Treatment strategies typically involve acid suppression, based on the ‘no acid, no ulcer’ dogma, but often involve different drugs (or administration methods) than those used to treat squamous ulcers. Healing rates are also much less predictable, and lesions can take several months to heal.
So, what do we need to take from all of this? Firstly, if you suspect your horse is suffering from ulcers, get them scoped, so that your veterinarian can determine what type of ulcers you are dealing with, and develop an appropriate treatment plan. Secondly, as unpleasant as the scoping process might be, get your horse scoped after treatment to determine if the treatment has actually worked (healing rates from pharmacological treatment of glandular ulcers can range from an average of 9% to over 70%, depending on treatment approach). Finally, prevention is far better than having to deal with this painful, debilitating and frustrating condition for both you and your horse. So, while it is impossible to provide foolproof advice on prevention of a condition that is still so poorly understood, it makes sense that maintenance of a healthy digestive tract, reduction in stress, and protection of the stomach during work and travel, are sensible strategies to support our horses, particularly during the competition season.
References
Hewetson, M (2021), Managing glandular gastric disease in horses, In Practice; https://doi.org/10.1002/inpr.40
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