20 Answers to Your Questions
About Equine Gastric Ulcers

The more I learn about equine gastric ulcers, the more I realize what I don’t know. For example, did you know horses can produce up to 16 gallons of acidic gastric juice each day?! That’s equivalent to:

• The gas tank of an average car
• Three 5-gallon water buckets
• Half of an average bathtub

I feel like I need a Tums just thinking about those facts! (Seriously, I tend to get an acidic stomach when I don’t eat at predictable hours, so I have major empathy for horses!)

This blog post Q&A is based on your twenty questions! Thank you to Boehringer-Ingelheim for sponsoring this post. This post contains affiliate links. 

A few weeks ago I posted on social media I was going to have the chance to interview a veterinarian who specializes in equine gastric ulcers and asked, “What questions would you like me to ask?” And the questions began rolling in. Thank you to those of you who participated.

Dr. Hoyt Cheramie, Senior Equine Professional Service Veterinarian, Boehringer Ingelheim (formerly Merial),  fielded all of the questions. Dr. Cheramie has a long and impressive veterinary background. He went to Louisiana State University for undergrad and vet school, did a large animal internship at the University of Tennessee, a surgical residency at Virginia Tech, and has practiced veterinary medicine in Kentucky, Atlanta, Chicago, and Louisiana.

Over the years Dr. Cheramie treated all kinds of equines from racehorses to English and Western performance horses. As he diagnosed them he realized the true negative effects ulcers had on the horses such as not moving right, or being fine at home but not when away.

At the start of our conversation Dr. Cheramie stated that the human equivalent of equine gastric ulcers is acid reflux or GERD. We only produce acid when we eat. Horses produce acid continually, and therein lies the struggle.

The Good News About Equine Gastric Ulcers

The fact is that ulcers are fairly easy to rule out through endoscopy, and once the ulcers are discovered and treated, the afflicted horse will have a remarkable difference in behavior and attitude.

Disclaimer: During our conversation, my call recorder app did not activate, so most of Dr. Cheramie’s answers are paraphrased based on my notes. 

Background Info About This Ulcer Q&A

1. I’ve had horses over the span of most of my life, with a brief hiatus, but why is it that I hadn’t heard about ulcers until recently with my current horse? (This was my question.)

Twenty years ago ulcers were not as easily diagnosed as the endoscopy equipment was generally only available at large equine hospitals at universities. As the technology has become more widespread, diagnosis has been more accessible to horse owners. That, in turn, has increased awareness.

2. Why should horse owners care about ulcers in the first place?

Equine gastric ulcers negatively impact health. Some of clinical signs might include intermittent colic, weight loss, poor coat, not eating well, and not being able to gain weight in the face of eating well.

Ulcers negatively affect a horse’s performance. There’s tons of anecdotal evidence and research that prove this. UC-Davis did a study and there is a physical performance difference between horses with and without ulcers. For example, horses with gastric ulcers had shorter stride length. If a horse’s abdominal girdle is contracted due to pain, his stride can’t be as long. Swapping leads could be due to ulcers.

(Dr. Cheramie said there are several lay articles that refer back to this UC study.)

3. Can a horse develop ulcers from the stress of not having food and water in the hours leading up to being scoped for ulcers? (I asked this question for a friend–named Knight.)

No, not from a single food withhold period. Ulcers can happen relatively quickly and one study showed they can happen in as little as five days. If you are concerned about your horse during the fasting period, you can administer a dose of Ulcergard® before.

4. What’s your view on feeding Tums for short term gut soothing?

Using an antacid can be beneficial for horses for short periods for the same reason as it is in people. It’s better to take Tums before eating pizza if you know you might have a reaction. Exercise can increase acid production. So giving your horse 8-12 Tums 15-30 minutes before exercise might help some. Using antacids to treat ulcers, however have failed (there are studies to back this up).

5. Why are Thoroughbreds prone to ulcers?

Most breeds have same potential for getting ulcers based on management and how they’re fed. Some horses less, and that may have to do with temperament. For example, a Quarter Horse might be less prone. Some disciplines might have a higher percent of horses with ulcers. In racehorses 85-99% have gastric ulcers if not being effectively managed.

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6. What are the less common warning signs of equine gastric ulcers?

Some might be common and some might be individual, meaning not all horses show the same signs. Sometimes it’s a report of a change in behavior or performance. A horse could be resistant, but it’s not saddle fit, nor lameness. Sometimes it’s a swishing tail. Some horses don’t like being touched in a certain place s around the girth/chest. When a horse starts doing things not normal for that horse, it could be a sign of gastric ulcers.

7. Can I feed sugar free beet pulp (is that the best complete feed for horse prone to ulcers)?

(I am not aware of sugar free beet pulp. The lowest sugar content is 95% sugar free.) It can be beneficial in managing a horse with ulcers. As a basis for the ration, it’s better than feed based on cracked corn, oats, and molasses. Design a nutrition plan that will provide adequate calories, not excess. The horse should have roughage all the time (but not free choice if its hay).

8. What about alternative therapies for ulcers? Massage, acupuncture, holistic methods, for example?

There are lots of purported treatments for ulcers but most of them make claims without scientific study and proof including supplements and homeopathy. A couple of supplements have been shown to be beneficial over placebo but not as effective as the pharmaceutical treatments.

I am not aware of direct reported effects of massage and acupuncture however there is some thought their use may be beneficial in diagnosis or at least indication of the stomach as a problem.

9. What is the shot for Gastrogard that I read about online?

There is word of a product being developed for treatment of equine gastric ulcers. It is not currently available in the U.S. or any other country. It might be available as an added medication in future. The FDA approval process here in the U.S. is very stringent (for the safety and protection of horses and their owners), and drugs approved or available in other countries may not always become available in the U.S.

10. Does salivary gland function have anything to do with a horse being more susceptible to ulcers?

In the long run yes. If a horse isn’t eating or chewing as much throughout the day, there is less saliva production. Saliva has bi-carbonate in it, the natural buffer to all that acid produced by the horse’s stomach. If a horse has decreased saliva production, there’s a decrease in the buffering effects on the stomach.

11. Why does grass mess them up so much? [Not sure the context for this question.]

Access to grass is a recommendation for horses with ulcers. Certain grasses at certain times of the year may predispose some horses to problems if they have underlying metabolic/endocrine disorders. A simplistic answer is grasses today in the U.S. were mainly developed for  feeding cattle, not horses.

12. If ulcer treatment doesn’t work, what then? 

There may be very few horses that cannot respond to omeprazole. If an appropriate course of treatment has been prescribed and owner compliance has been assured, increasing the dose or prolonging the treatment has been effective in most cases that I have come across. If the ulcers are in the glandular area, then prolonged treatment and addition of other medications is often necessary. Rarely, we may add antibiotics if secondary infection of the ulcer wound is suspected. Remember, the medication raises the pH of the stomach fluid, but the horse has to heal the ulcer wound itself.

13. If horse has been treated successfully, when injured, how is it best to administer Bute or other anti-inflammatory without aggravating the stomach? Is there a stomach-friendly anti-inflammatory or what can be fed with it?

Anti-inflammatories reduce the natural compound that helps reduce acid production. Horses are fairly resistant, but we do see it occasionally as a problem. EQUIOXX might be beneficial for the stomach and intestines. Most horses can take a 2-3 week course of Bute without a problem. Some horses might need  ulcer prevention during treatment with anti-inflammatories, but these decisions are best to make with your veterinarian.

14. Are horses okay to stay on omeprazole indefinitely?

This would be considered an extra-label use and is best discussed with your veterinarian. Concern about long term use arises from information about human long term use (generally greater than 3 years of continuous use) of proton pump inhibitors being associated with osteoporosis or kidney problems. Although no long term studies in horses have been done, reports of similar issues have not come up.

Another concern is that decreasing the acid production will affect digestion. There is no evidence that this is the case in adult horses as horse actually need very little acid for their digestive processes compared to other species. However, it is always recommended to use as little medication as needed in any case and utilize management and feeding changes as the primary tools for battling gastric ulcers in horses when possible.

15. Why do vets always recommend to do full dose of meds like Gastrogard, then full stop so ulcers come back? Wouldn’t it be better to wean them off and reduce dose slowly?

The label indication does not include a weaning dose. Weaning doses do not keep ulcers from returning once the treatment is discontinued. Management and feeding changes and prevention doses of medication during stressful periods are beneficial. After stopping a full dose treatment there may be a rebound effect of excess acid production and associated signs that may be seen in some horses. In most cases, the ulcers would not return but the horse may show signs of “heartburn.” Talk to your veterinarian about appropriate ways to stop treatment.

Prevention of the return of ulcers is completely different and part of all recommended ulcer management plans. In most cases, management and feeding changes along with appropriate intermittent low dose medication during stressful events will be effective in preventing recurrence. In very few cases other than racehorses, continued low dose medication is required to keep the ulcers from returning. Every horse is different – talk to your veterinarian about how to keep the ulcers from returning.

16. What should you feed a broodmare prone to ulcers if she starts losing condition (over winter)? She’s out 24/7 with only extra forage when needed and is looking great.

If loss of condition is a concern, adding additional calories in from a low ulcerogenic feedstuff can be utilized. Ulcer therapies are not approved for use in broodmares so if needed, that is a decision best made by the veterinarian and owner regarding using an extra-label therapy

17. If a horse gets ulcers once, will they forever be prone to them or can it be a one off experience?

Two thirds of all non-racing performance horses all doing the same thing will have ulcers. If you treat them and don’t change anything about the horse’s lifestyle and feeding or institute effective prevention protocols, they will be susceptible to develop ulcers again.

18. What are the most common reasons regular ulcer therapies fail? [This person treated her horse with omeprazole but the horse still has ulcers/they keep coming back.]

Horse still having ulcers and they keep coming back are two entirely different things. Failure of treatment is most commonly due to ineffective medication choices, poor compliance, inadequate dosing (horse weighs more than dosed for), inadequate treatment medications or time (particularly for glandular ulcers).

Not all omeprazole is the same–omeprazole must be protected from destruction by the acid in the stomach in order to make it into the bloodstream to have its effect of decreasing acid production. That is the benefit of the only FDA approved medications for treating and preventing equine gastric ulcers, Gastrogard® and Ulcergard® brand omeprazole. The omeprazole is in a specially formulated paste to protect the omeprazole so if can have its anticipated effect.

If ulcers keep coming back, that is related to management/stress and feeding. Treatment of ulcers is not a prevention of future occurrence.

19. What lifestyle changes can horse owners make to promote gut health for their horses?

Changes such as feeding more frequently in smaller amounts, allowing for more turn out, using haynets with the tiny holes, and giving a half flake of alfalfa prior to exercise can be helpful. As is a dose or doses of Ulcergard a few days prior to and during a stressful situation such as a long trailer ride or even a weekend fun show, but particularly for longer shows.

20. What are the best resources for the layperson to stay updated on equine gastric ulcer research?

Several equine magazines such as The Horse magazine (they have a medical section online), Equus magazine, AQHA Journal and many others routinely have articles about GI health and cover scientific/medical advancements as well. Boehringer Ingelheim has info for horse owners at ulcergard.com. There are several pages and videos. Although it may seem biased [since BI is the maker of Ulcergard], everything on the website is based on research–it can’t be false info since it’s regulated by the FDA. Also The Chronicle of the Horse and AQHA.com.

Thank you to Dr. Cheramie and Boehringer Ingelheim for the great info and sponsoring our Ulcergard Giveaway!

Your Turn to Comment: Which question would you have asked or do you have a question still unanswered regarding equine gastric ulcers?

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