Equine ulcers, from the problem to the solution

What are ulcers?

Ulcers are little (or LARGE) breaks in the lining of the stomach or intestines. These are essentially open wounds in the digestive tract (not always the stomach). Equine ulcers can be extremely painful. On top of there already being a wound there, these ulcers are constantly bathed in stomach acid.

How do I know if my horse has ulcers?

We are usually attempting to diagnose ulcers in horses that have either one or many of the “signs” of ulcers.

• Negative changes in behavior
  • Cinchiness
  • Bucking
  • Refusing their job
  • Sensitivity to petting or brushing
• Poor body condition
• Poor or decreased performance
• Poor haircoat
• Colic (abdominal pain)

The only way to definitively diagnose ulcers is to visualize them with a scope. I don’t have a scope in my practice but many do. I can always point you in the direction of someone that does.

Another way that I am familiar with diagnosing ulcers in horses is to use a handy little test made to measure different proteins in the manure. The Succeed fecal test measures those proteins that will come out (eventually) in the manure. They are able to usually differentiate between the hindgut and the stomach ulcers, this is a pretty neat feature. Again, not as definitive as visualizing the ulcers, but a pretty close second.

Another way to “diagnose” ulcers is based on acupoints, or referred pain points paired with the horse’s reaction.

What are the causes of the different ulcers?

So, I have bad news, ALL horses are susceptible to ulcers. There are SO many “causes” of ulcers in horses. We typically think of the performance horse as the one that gets them, however I have diagnosed (presumptively – unless they went to get scoped) ulcers in many horses that are not performing. This is due largely in part to both the physiology of the horse, but also our intensive management systems that we keep horses in.

Some of the causes I can think of off hand –

• Feed
  • Concentrate (grains) – these are high in very inflammatory ingredients, not to mention they will further acidify the pH of the stomach contents
  • Frequency – only feeding 2 meals a day to an animal that produces stomach acid 24/7
  • Volume – feeding 2 large meals to a “small stomached” animal can cause overeating-
• Housing – keeping horses in small pens can contribute a couple of ways, one is increased stress (potentially) and the other is decreased/ stagnant circulation
• Training
  • Decreased circulation to the intestines (sometimes after or before a meal) because muscles need that circulation for function and recovery during exercise
  • Potential for stress increases
• Stresses – there is some debate about the exact mechanism (pathophysiology) behind how stress causes equine ulcers, but I think we all agree that there is a higher incidence of ulcers in stressed animals than in those thought to be “stress-free”
  • This can get very technical (related to stress hormones and induced chemicals ect.)
• Medications
  • NSAIDS
    • Phenylbutazone (“Bute”)
    • Flunixin meglumine (“Banamine”)
    • Acetomenophen
    • Firocoxib / Equioxx
• Hauling
  • Again we are back at the stress/ not eating/ sloshing of stomach acid
• Last but not least! CONCURRENT INFLAMMATORY DISEASE
  • Many times horses that have an underlying disease will present with ulcers.
    • Cushings disease
    • EPM (equine protozoal myeloencephalitis)
    • Arthritis
    • Laminitis
    • Inflammatory bowel disease
    • Inflammatory airway disease

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What are the conventional western medicine treatments for equine ulcers?

Omeprazole – Omeprazole is a proton pump inhibitor (PPI). It works by decreasing the amount of acid produced by the stomach.

This medicine is available both over-the-counter (Ulcergard and Prilosec)  and prescription (Gastrogard and compounded Omeprazole)

Cimetidine – An H2 blocker this medication also reduces the amount of acid produced in the stomach. This medication also has prescription and OTC versions.

Misoprostol – a synthetic prostaglandin that acts as a cell protectant and helps to decrease local inflammation in the gut

Sucralfate – Sucralfate forms a barrier over ulcers physically protecting them from the acidic environment of the stomach or intestines

What are the natural remedies for equine ulcers?

Oh so many options!

Treatment is so individual, for the horse and the owner. If I know a horse has bleeding ulcers, I will quickly run to my pharmaceuticals for quick relief. BUT! I do not like to stay there.  My favorite solution is the Immubiome combination of the Lean Muscle (obviously a multi use supplement) and G-Tract.  

If you use my code LVS you will get a small discount

I always recommend folks call and chat with Chris from Immubiome, He is extremely knowledgeable. There is also a SUPER handy chart on their website that can point people in the right direction. The names of the supplements do not always indicate their only use, because many mushrooms have multiple uses/ actions.

Colostrum & Probiotics – super healing combination while repopulating the intestines with good commensal bacteria

Slippery elm, measowsweet, tumeric, licorice – Herbs that form a viscous mucilage when they come into contact with moisture that forms a barrier similar to how sucralfate acts. Some also act as acid normalizers, helping to reset the stomach pH.

There are so many other herbs that also act to aid in the healing of stomach ulcers in horses. I will maybe do small write ups on herbs in another article.

Aloe vera juice – reduced inflammation promotes healing of ulcers *A word of caution, too much aloe juice can cause diarrhea*

Diet change

Feeding less, more often

Reducing or eliminating grain

How can I prevent my horse from getting ulcers?

Diet – like I discussed previously some management changes may be all that is needed

When you think of a horse, or see a random horse, what are they doing? EATING. Even if they aren’t actually eating, they are searching for food. This is the way they were designed, to eat CONSTANTLY. Sometimes all that is needed is to keep feed in front of the horse.

Underlying/ concurrent disease – find out if ulcers are the primary disease, or merely just a symptom of another disease

Preventative maintenance supplements – THERE ARE SOOO MANY OPTIONS HERE!!!

• If you are hauling or know that your horse will be in a stressful situation you may want to use a acid neutralizer ahead of time, for a short period of time
  • Redmond clay is a great ulcer healer/ preventative
  • I really like Zesterra for quick burst preventatives or even treating a horse in a current episode
    • Usually can be found at your local farm and ranch store or from another dealer (I also have found on Amazon – Zesterra)
• A really easy daily preventative is the Daily Gold from Redmond
• Of course the Immubiome G tract and Lean muscle are excellent
• GUT from Uckele is also a great option

Other resources to dive deeper:

UC Davis School of Vet Med

Immubiome website

MadBarn has a great article that is very comprehensive