Your horse has been feeling cranky recently and off her feed. She’s picking at her food and doesn’t want you to touch her. You suspect ulcers and call the vet. The vet’s office schedules the appointment for a late afternoon. They tell you to withhold feed after dinner the night before. They also tell you to withdraw the water bucket at noon. They want the stomach to be as empty as possible for the endoscopy.
They perform the endoscopy and find that your horse does have ulcers. They prescribe omeprazole for 28 days. You give your horse the full treatment, then stop, just as the vet ordered. Days later, your horse is exhibiting the same signs again.
After a second course of omeprazole, the vet suggests that you keep your horse on a low dose of omeprazole.
This is a common scenario filled with potential pitfalls.
◆︎ Can you diagnose ulcers without using an endoscope?
There are many schools of thought that ulcers can be diagnosed through acupuncture meridian points. However, the most accurate and reliable method to make a diagnosis is through an endoscopic exam. Because ulcers are so common in horses, some vets will make a diagnosis based on clinical signs and prescribe treatment. In some cases, the cost of the diagnostics could exceed the cost of the treatment.
◆︎ Are risks associated with a gastroscopic exam?
Yes.
➡ Risks associated with sedation. Although the risk associated with sedation is low, it still exists. The horse may have a reaction to the sedation. Alternatively, the horse may become unsteady on his/her feet and injure him/herself.
➡ To perform a gastroscopic exam, the horse’s stomach should have as little food as possible in it. To withhold food for an extended period of time could potentially make the ulcers worse.
◆︎ Ending omeprazole treatment cold-turkey.
Stopping omeprazole “cold-turkey” may cause a rebound effect of increased acid secretion in the stomach. This rebound may cause the ulcers to return, or at least delay continued healing.
◆︎ Potential side effects of omeprazole.
◆︎ Reduced calcium absorption.
In the last several years, it has come to light that calcium absorption is reduced up to 20% for a horse that is treated with omeprazole. While this does not pose a significant problem for a short-term treatment plan, it could potentially affect a horse that is treated for a longer period of time.
If you have your hay balanced with a custom balance, be sure to notify your equine nutritionist that your horse is on omeprazole. The calcium/phosphorus/magnesium ratio may need to be adjusted to account for the lower absorption of calcium.
◆︎ Potential loss of bone density.
In humans, it has been shown that bone density may be reduced with omeprazole usage. Although not confirmed in the horse, this may also occur, possibly due to the reduced calcium absorption. For active young horses, this may not be an issue, due to high bone turnover.
However, for some horses, this could warrant additional caution. This may include horses that are
» sedentary
» older
» have compromised hooves
» chronic inflammation, or
» laminitis
Bone density is dependent on movement. Any horse that lacks sufficient movement is at risk for loss of bone density.
It could also be a concern if your horse is on other medications that can affect bone metabolism, such as thyroid medication, furosemide (Lasix®), phenylbutazone (bute), or bisphosphonates (Osphos® or Tildren®).
◆︎ Action plan.
➡ Work with your vet for the treatment of ulcers. Your vet can advise you as to the most appropriate course of action for treatment.
➡ If your horse is on omeprazole for treatment of ulcers, be sure to ask your vet about tapering off to mitigate the chance of rebound
acid production.
➡ If your horse is on maintenance omeprazole, be sure to notify your equine nutritionist who balances your hay. The balancing supplement may need to be modified.
➡ For positive gut health, consider Equine Ulcer Support, which is beta glucan and high molecular weight hyaluronic acid. Both of these ingredients have been shown in a peer reviewed research article to be beneficial in equine gastric ulcer syndrome. These ingredients do not have the same potential side effects that you may have with omeprazole.
We do the best that we can do for our horses. Understanding various ulcer treatments is a part of that.
Disclaimer: Statements regarding dietary supplements have not been evaluated by the FDA and are not intended to diagnose, treat, cure, or prevent any disease or health condition.