Wednesday 15 April 2015

Equine Ulcers: A Suitable Case for Treatment? Part 1: Causes and Diagnosis

Throughout this jumps season, the subject of equine ulcers has been much discussed, not least by OfO owners, since we have treated Shantou Magic, Wilde Oak, Primo Capitano, He’s A Bully, Bilbrook Blaze and Quick Decisson. It has already paid off with Shantou Magic, who bounced back from a poor run at Doncaster to win, hard held, at Bangor-on-Dee. Having said that, while there can sometimes be a dramatic improvement in the condition and performance of treated horses, there most certainly isn’t a guarantee; indeed, horses with ulcers can run well, and horses without them can run badly.

Because of the interest in the subject, Part 1 of this blog looks at the causes and diagnosis of ulcers while Part 2 on 1st May will look at treatment and the implications for stable management. I would particularly like to thank two of our vets, Kevin Bishop (who treated Shantou Magic, as well as Silviniaco Conti, Al Ferof and Irving at Paul Nicholls’ yard) and Tim Brazil (who treated Primo Capitano). They were tremendously helpful, shared lots of ideas and even tolerated my attending the gastroscopy. As one of them joked, £100 for the scope and £900 for the interrogation!

What causes equine stomach ulcers?

A key point is that with humans ulcers are essentially bacterial (caused by heliobacter pylorum) whereas with racehorses it is the stable management and training regime that triggers them. The horse is essentially a grazing animal who, when allowed to be out in the paddocks, will eat for up to 16 hours a day and sleep for eight. Happily munching away, the horse will chew between 50,000 and 60,000 times a day, generating over 50 litres of saliva which, together with the grass, is absorbed into the stomach. All of this keeps the stomach acids in balance and, for most horses, ulceration is minimal.

But once we bring the horse into training, that natural process is severely curtailed, with feeding usually twice a day and regular exercise often on an empty stomach. With no natural foraging the saliva production declines dramatically and the natural acidity in the stomach increases. Furthermore, and particularly when the racehorse is galloping, the increasing amounts of acid slosh around the linings of the stomach and it doesn’t take long for ulceration to begin. Research suggests that this can happen within a fortnight. One of our vets believes that the effect of ulcers is to produce a severe heartburn up the sides of the horse around the stomach and heart. He believes that is what can stop them performing well on the racetrack.

What are the clinical signs?
This is not always clear at all. Really well, gleaming horses can have very bad ulcers and equally those who look dull in their coats, have lost appetite and may indeed have minor colic do not necessarily have ulcers. A number of trainers are firmly of the view that if the horse looks and eats well, and is galloping strongly, then there is not necessarily a need to go looking for a problem which then requires treatment. Other trainers – examples being John Gosden and Godolphin – now assume that their horses have ulcers and treat them throughout the season.

How are ulcers diagnosed?
With the much more common use now of the endoscope (a tiny video camera on the end of a flexible tube), this is relatively straightforward. The horse is given a low dose sedative, the tube is inserted through the mouth and down into the stomach, and then the vet views the various parts of the stomach, looking for lesions. They are normally found in 90% of all racehorses in training. What matters is their severity. Current practice is to grade them on a scale of 0 to 4:

  • Grade 0: the stomach lining is intact and there is no reddening;
  • Grade 1: the stomach lining is intact, but there are some areas of reddening;
  • Grade 2: the stomach has single or multiple ulcers, but they are relatively minor;
  • Grade 3: the stomach has large single or multiple ulcers which need treating;
  • Grade 4: the stomach has extensive ulcers, often merging to give deep areas of ulceration.
So if after the diagnosis the horse is deemed to have ulcers at Grade 3 or 4, then treatment is required. We’ll look at this, and the implications, in the next blog.

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