Nutritional management of gastric ulceration

The role of an equine nutritionist in equine health, performance and wellbeing: Ideas stemming from an equine science society symposium workshop

In the United States, there is little clarity on the qualifications and availability of equine nutritionists. Currently, no regulatory body exists for formal credentialing outside of veterinary medicine. Most equine nutritionists are not veterinarians but do have advanced scientific degrees (Master of Science and/or Doctor of Philosophy) in the field of Animal Science. However, not all reporting to be equine nutritionists have formal education in the field of equine nutrition. To discuss this, a workshop was held at the 2023 Equine Science Society (ESS) meeting. The purpose of this discussion was to share ideas among equine nutrition professionals about how best to provide support for the inclusion of the specialty as part of a horse's health team, alongside the veterinarian, farrier and other equine health specialists. In human, small animal and livestock practices, the importance of nutrition as part of an overall health, production (livestock) and well-being plan has been documented. However, surveys of veterinarians, the top source of information for horse owners, reveal a lack of confidence in the area of nutrition after graduating from veterinary school and a lack of available continuing education opportunities to learn more. Further, it appears that many horse owners may unknowingly be obtaining nutrition information from unverified sources (such as the internet). The discussion included formal and informal education of equine nutritionists, as well as avenues to open lines of communication with the veterinary community to provide nutrition resources for horse owners, managers and veterinarians.

Risk Factors for Equine Gastric Ulcer Syndrome Incidence in Adult Icelandic Riding Horses

A high prevalence of both squamous (ESGD) and glandular (EGGD) ulcers was previously found in, mainly young, Icelandic horses coming into training for the first time. This study evaluated risk factors for gastric ulcers in Icelandic riding horses at various ages and stages of training. The horses (n = 211) were gastroscoped from 21 equine establishments across Iceland. A variety of morphometric, clinical, behavioural and management factors were evaluated as potential risk factors for gastroscopically significant (grade ≥ 2/4: found in 27% of horses) or gastroscopically severe (grade 3 or 4/4: found in ~10% of horses) ESGD or gastroscopically significant EGGD (grade ≥ 1/2: found in 46.4%). Body condition score (BCS), cresty neck score (CNS), stable/turnout behaviour, exercise intensity/frequency and age were not significantly associated with ESGD or EGGD ulcer score. However, having come off the pasture into training for 4 weeks or less was a significant risk factor for gastroscopically significant and severe ESGD compared to 5 weeks or more. For both EGGD and ESGD, "region" was important. Gastroscopically significant EGGD and gastroscopically severe ESGD were more prevalent in those showing clinical signs often associated with ulcers. Geldings were more likely to have gastroscopically significant ESGD than both mares and stallions and more EGGD than stallions. Being stabled, but spending >2 h/day out in the paddock, compared with <2 h paddock time or full-time turnout, was protective for gastroscopically significant ESGD as was being fed complementary feed (all fed <1 g non-structural carbohydrate (NSC)/kg/BW/meal). Being at a training establishment for >4 weeks was protective for gastroscopically significant and gastroscopically severe ESGD but not EGGD. This study confirms the relatively low prevalence of ESGD in Icelandic horses being kept in training establishments and fed low NSC diets but highlights the high prevalence of EGGD.

A Survey of Pennsylvania Horse Management: Part One-Nutrition

Various aspects of nutritional management can impact both a horse's gastrointestinal (GI) health and caretaker costs. The objective of this study was to characterize the feeding management and GI issues of horses in Pennsylvania (PA). An online survey was distributed from February 27th to August 31st, 2020. Kruskal-Wallis and Mann-Whitney tests were used to analyze the data. Nonparametric statistics were used when data were not normally distributed. From 470 responses collected, the average horse age was 15.7 ± 7.5 years, and the most common breeds were the Quarter Horse and Thoroughbred. Of the 345 horses who received premixed feed, 81% were fed on a volume basis. Most horses (95%) received hay on a volume basis, and 57% of horses were fed hay on the ground rather than in a feeder. No difference was detected in the number of scoops of premixed feed (median = 2; P = .284) or the flakes of hay per day (median = 5.7; P = .765) between horses in different exercise categories. The frequency of reported GI issues was 10% (46/470). Owner perceived, veterinary perceived, and veterinary diagnosed ulcers were found in 2.3%, 4%, and 2.3% of horses, respectively. No statistical difference was detected in the number of scoops of premixed feed fed per day between horses with or without GI issues (P = .536). Horses were provided the same amount of premixed feed and forage regardless of reported exercise category. Most equine caretakers fed concentrates on volume rather than weight, a common practice despite most feeding requirements being based on feed weights.

Equine Gastric Ulcer Syndrome affects fitness parameters in poorly performing Standardbred racehorses

Introduction

Equine Gastric Ulcer Syndrome (EGUS) is a highly prevalent disorder in horses, which can be classified, based on the localization of the lesions, as Equine Squamous Gastric Disease (ESGD) or Equine Glandular Gastric Disease (EGGD). Although EGUS is recognized as a common cause of poor performance in racehorses, objective investigations about its relation with athletic capacity are lacking. Therefore, the present retrospective study aims to evaluate the associations between EGUS severity and some fitness parameters measured during an incremental treadmill test in Standardbred racehorses in training.

Methods

With this aim, data from 87 Standard bred racehorses which underwent a complete diagnostic evaluation for poor performance was reviewed. During gastroscopic examination, a 0-4 score was assigned to ESGD, while EGGD was evaluated for absence/presence; a total EGUS score was obtained by adding 1 point to ESGD score in horses showing concomitant EGGD. Fitness parameters obtained during incremental treadmill test included speed at a heart rate of 200 bpm (V200), speed and heart rate at a blood lactate of 4 mmol/L (VLa4, HRLa4), peak lactate, lactate and heart rate at 30 minutes post-exercise, maximum speed, minimum pH and maximum hematocrit. The associations between fitness parameters and EGUS and ESGD scores were evaluated by Spearman correlation, while Mann-Whitney test was used to compare them between horses with or without EGGD. Statistical significance was set at p<0.05.

Results

EGUS grade was inversely correlated with V200 (p = 0.0025) and minimum pH (p = 0.0469); ESGD grade was inversely correlated with V200 (p = 0.0025) and VLa4 (p = 0.0363). Although a trend was observed, no significant differences in V200 were observed between horses with or without EGGD (p = 0.073); horses with EGGD reached a lower minimum pH (p = 0.0087).

Discussion

These results show a negative association between aerobic capacity and EGUS, in particular ESGD. Although different hypotheses have been proposed, including abdominal pain and decreased appetite due to lactate accumulation, the underlying mechanisms are still unknown, and it is not clear whether EGUS represents a cause or a consequence of an early lactate accumulation and post-exercise acidosis.

Effects of the Ingestion of Ripe Mangoes on the Squamous Gastric Region in the Horse

Erosions and gastric ulcers may be present in horses at any age and under different conditions of rearing and handling. In tropical regions, horses can feed on fruits rich in soluble carbohydrates, such as mangoes, but little is known about how these foods interact with their digestive systems. To test the hypothesis that the ingestion of ripe mangoes with peels could cause disturbances in the digestive processes of horses, an experiment was developed to monitor animals that had free access to ripe mangoes in their pasture areas. Horses (purebred Arabians, n = 5; ~340 kg, ~13 years) were evaluated by video gastroscopy and blood analysis. A controlled postprandial glucose curve for mango intake was also performed. Gastroscopies were performed at intervals of 15 days, starting in December, just before the beginning of the harvest, until the beginning of February, and days after the end of the harvest. Blood collection was performed on the same day between November and February for blood analysis. The results were submitted to ANOVA and Tukey’s test, with a significance level of p < 0.05. Gastroscopies indicated that four out of five horses had erosions and ulcers in the squamous region between 15 and 30 days after the start of the season. Biochemical tests indicated a reduction in plasma proteins during the harvest period, and the postprandial glucose curve showed concentrations above 200 mg/dL between 30 and 180 min after ingestion of 5.37 kg mangoes. The animals were not treated and recovered after 15 days of harvest and without ripe mangoes on the ground. It is concluded that the indiscriminate ingestion of mangoes favors the appearance of lesions in the gastric squamous region, to varying degrees, and that animals recover naturally after an average of 15 days from the end of the season when the animals return to their regular feeding with hay and grass pasture.

Effect of moving from being extensively managed out in pasture into training on the incidence of equine gastric ulcer syndrome in Icelandic horses

OBJECTIVE

To investigate equine squamous gastric disease (ESGD) and equine glandular gastric disease (EGGD) in Icelandic horses moving from pasture into training.

ANIMALS

81 horses (median age, 3 years; interquartile range, 1 year) from 10 farms representing 4 different Icelandic regions.

PROCEDURES

Initial gastroscopy was undertaken within 2 weeks of moving from pasture into a training establishment. A total of 71 horses underwent endoscopic examination again 8 weeks later. Various management and behavioral factors were assessed through face-to-face questionnaires with the owners or trainers. Multivariable logistic regression was used to determine factors contributing to any change in ESGD and EGGD severity score during the 8-week training period.

RESULTS

Incidence of EGGD and ESGD in this feral population was similar to that found in domesticated horses. ESGD incidence (severity score, ≥ 2; score range, 0 to 4) reduced from an initial 71.6% (58/81) to 25.4% (18/71). On multivariable analysis, sex (ie, being a stallion or a female vs gelding) increased the likelihood of ulcer grade reduction. Being fed preserved forage 3 or more times a day also improved the likelihood of ESGD reduction (odds ratio, 17.95; 95% CI, 1.67 to 193.40; P = .017). Overall, the farm explained 35% of the variance, confirming the importance of management factors. Incidence of EGGD (severity score, ≥ 1; score range, 0 to 2) reduced from 47% (38/81) to 40.8% (29/71) during the same period. No measured variables were associated significantly with EGGD incidence or reduction.

CLINICAL RELEVANCE

Pasture provision (without supplementary feed or forage) does not result automatically in a low incidence of gastric ulcers. Regular provision of preserved forage is a key factor in reducing ESGD incidence.

Effects of a nutraceutical supplement in the management of mild equine squamous gastric disease in endurance horses

INTRODUCTION

Equine squamous gastric disease (ESGD) may require prolonged treatments with acid suppressants; therefore, interest in nutraceutical supplements with anti-ulcerogenic properties has increased. This study aims to investigate the efficacy of Trophogast pellet for the treatment of ESGD in endurance horses.

MATERIAL AND METHODS

Fifteen endurance horses were included based on their gastroscopic examination and randomly assigned to a treatment group, receiving Trophogast pellet for 30 days together with management changes, or to a control group, only subjected to management modifications. At the end of treatment, gastroscopy was repeated. Scores were assigned according to the Equine Gastric Ulcer Council scoring system. All horses were weighed at the beginning and at the end of the study. ESGD grades and weight before and after treatment were compared.

RESULTS

At enrolment, median ESGD score in the treatment group was 2, while in the control group it was 1. After the treatment period, a significant decrease in ESGD grade was observed in the treatment group (median 1, p = 0.0078), while there was no change in the control group (median 2). No significant weight change was observed in either group.

CONCLUSION

Trophogast pellet was effective at promoting healing of mild ESGD in endurance horses.

An Ethical Framework for the Use of Horses in Competitive Sport: Theory and Function

Growing ethical concern about equestrian sport is reflected in publications by regulatory authorities, animal charities, and the lay press; and in government debate and social media. However, attempts by regulators and stakeholders to address ethical issues in equine sport have been discipline specific and ad hoc. Ethical frameworks can help stakeholders to make contextual decisions about what should or should not be done in a particular situation. However, when existing animal welfare frameworks and existing sports ethics frameworks are reviewed in this paper, it becomes clear that none provide us with a suitable or sufficient tool for considering ethical issues which can arise in situations where the athlete is a non-human, non-consenting participant. This paper presents the theoretical development of a novel ethical framework, with the aim of providing stakeholders with a tool which they might apply to the consideration of the ethical questions which inevitably arise in relation to (equestrian) sport. The derivation and limitations of the ethical framework are explained. The use of the framework will serve both to underwrite the continuation of the social license to use horses in sport and also to enable those within equestrian sport to critically assess existing and proposed practices and to make welfare-improving adjustments to practice if/where necessary. The theoretical framework as presented here is currently being practically tested and refined in consultation with industry stakeholders, and that research will be submitted for publication in due course.

Recommendations for Ensuring Good Welfare of Horses Used for Industrial Blood, Serum, or Urine Production

Simple Summary

Because of their large size, blood, serum, or other substances are often collected from horses for production of biologics and therapeutics used in humans and other animals. There are few international guidelines that provide recommendations for caring for horses kept for these purposes. In this paper, general guidelines are provided to ensure well-being of horses kept for production of biologics.

Abstract

Various pharmaceutical products have been derived from horse blood and urine for over a century. Production of biologics and therapeutics from these samples is a niche industry and often occurs in regions with little regulation or veterinary oversight. To ensure good welfare of horses maintained for these purposes, guidance has been developed to support the industry.

How Can Nutrition Help with Gastrointestinal Tract-Based Issues?

Many horses are fed differently than their wild ancestors. They often have limited access to pasture and are fed conserved forage and concentrates rich in starch and sugars, in only 2 meals per day. Feeding practices in contrast to natural feeding behavior can lead to gastrointestinal issues. Standard nutritional evaluation is warranted because of its important role in prevention and in treatment and management of diseases. When medical and nutritional treatments are combined, success rates are higher. New techniques to characterize equine microbiota have been used, allowing for microbiota manipulation to prevent and treat intestinal diseases.

High intake of sugars and starch, low number of meals and low roughage intake are associated with Equine Gastric Ulcer Syndrome in a Belgian cohort

Equine gastric ulcer syndrome (EGUS) is a pathological condition affecting the glandular and squamous regions of the stomach. It is characterized by non-specific clinical signs, behavioural changes or can also be found without any overt clinical manifestations. Nutritional factors such as intermittent feeding, high sugars and starch intake, large amounts of straw as forage and prolonged time without access to forage have all been associated with an increased risk of equine squamous gastric disease (ESGD). The aim of this study was to investigate which nutritional practices are commonly seen in clinical ESGD cases in Belgium. Medical records of 27 horses referred to the equine nutritional service at Ghent University (2013-2018) due to equine gastric ulcer lesions were reviewed. Twenty-one healthy horses referred for dietary evaluation during the same period were selected as control cases (CC). Dietary evaluation was performed on an individual basis. Forage/concentrate ratio on dry matter basis, forage content in the diet, total dietary sugars and starch intake per day and per meal were analysed. Retrospective descriptive and statistical analyses were performed. Significantly, higher amounts of forage intake (%DM per BW) in the CC vs. ESGD group were noted (p ≤ .05) with average values of 1.39 (SD ± 0.27) and 1.27 (SD ± 0.70) respectively. There were no significant differences for sugars and starch intake in g/kg BW/day (p = .18). However, the sugars and starch intake per meal (g/kg BW/meal) in the CC group (average value 1.06, SD ± 0.56) was significantly (p < .001) lower than in the EGUS group (average value 1.85 SD ± 0.78). Forage intake below the recommended absolute minimum value as well as high sugars and starch intake were most commonly associated with EGUS in the present case series. An adequate diet formulation taking into account these main nutritional factors is therefore essential to avoid gastric problems in horses.

Chronic severe pyloric lesions in horses: 47 cases

BACKGROUND

The clinical findings and outcome associated with chronic severe equine pyloric lesions have not been well described previously.

OBJECTIVES

To describe the history, clinical signs, endoscopic and ultrasound results, laboratory data, treatment, pathological findings and survival of horses with chronic severe pyloric lesions.

STUDY DESIGN

Retrospective case series.

METHODS

Medical records from horses treated at clinics in Czech Republic and Germany in which chronic severe pyloric lesions were confirmed endoscopically and/or on post-mortem examination were reviewed.

RESULTS

Forty-seven horses were identified, median age 3 years (range 0.8-16 years). There were 3 geldings, 23 mares and 19 stallions and the majority were Warmbloods (60%). The most common presenting signs were poor body condition (40; 87%), slow eating (39; 83%), recurrent colic (35; 74%) and selective appetite (30; 64%). The most consistent laboratory abnormality was hypoalbuminaemia (10; 36%). Slow gastric emptying was confirmed in 29 individuals during gastroscopy and/or ultrasonography. Endoscopy revealed distal oesophagitis in 9 of 47 horses, and severe equine squamous gastric disease in all cases. Pyloric lesions were depressed, flat or raised fibrinosuppurative pyloric ulcers and were seen in 45 (2 pylori were not seen endoscopically). Thirty-two cases were treated, with 28 responding well initially. All treated cases received anti-ulcer medication and four underwent gastrojejunostomy. Clinical signs recurred after medical treatment in at least 11 cases. Only 18 of 44 cases (41%) survived long term (3 were lost to follow-up). Horses diagnosed at 3 years of age or younger were significantly less likely to survive more than 6 months than older horses (27.8% vs. 72.2%, P<0.001).

MAIN LIMITATIONS

The study is retrospective, some records were incomplete and case identification was subjective.

CONCLUSIONS

Chronic severe pyloric lesions can be associated with delayed gastric emptying identified with ultrasonography and/or endoscopy. The prognosis is poor in young horses.

Effect of Changing Diet on Gastric Ulceration in Exercising Horses and Ponies After Cessation of Omeprazole Treatment

Diet is an accepted risk factor for equine squamous gastric disease (ESGD), but there is little published evidence for the benefit of dietary change (DC). This study evaluated the effect of DC with or without initial omeprazole medication. Twelve pairs of exercising horses with ESGD Grade 2/4 (EM) and 17 pairs with ESGD Grade ≥3/4 (ES), were monitored. Paired horses had similar management, feeding times, workloads, and initially feed or forage. One of each pair was randomly assigned, postgastroscopy (Scope1), to a specified restricted starch ration; the other remained on their original diet. Omeprazole (4 mg/kg per os SID) was given to all ES pairs for 4 weeks. Gastroscopies were scored, without dietary knowledge, after 4 and 10 weeks (Scopes 2 and 3). Workloads remained similar throughout. McNemar's tests identified any changes in ESGD grade. Within the EM group, DC had no additional effect. For the ES group remaining on their original diet, there was significant improvement in ESGD grade from Scopes 1 to 2 (P < .001) but a worsening between Scopes 2 and 3 (P = .005), with Scope 3 being no different from Scope 1 (P = .08) reflecting no apparent long-term medication benefit. For the DC group, there was significant improvement in ESGD grade from Scopes 1 to 2 (P < .001) and between Scopes 1 and 3 (P = .003); In addition, there was no significant difference between Scopes 2 and 3 (P = .32). Although limited by the small number of pairs evaluated, this study provides evidence that appropriate DCs can be a beneficial management strategy for ESGD.

DESCRIPTION OF GASTRIC ULCERS AND OF THEIR SUSPECTED, ASSOCIATED RISK FACTORS IN DECEASED WILD EQUIDS AT THE RÉSERVE AFRICAINE DE SIGEAN, FRANCE (2010-2016)

Gastric ulcers are common in domestic horses and foals, affecting at least 90% of unmedicated racehorses in active training. Despite these high prevalences in domestic horses, literature about this condition in wild equids is almost nonexistent. The presence of gastric ulcers was evaluated at necropsy in six species of wild equids that died at the Réserve Africane de Sigean, a safari park in the south of France from 2010 to 2016. Among the 55 individuals that died during that period, a description of the gastric mucosa was available in 82% (45/55) of cases. Considering the cases for which a description of the gastric mucosa was available, the prevalence of gastric ulcers was 64% (29/45). The highest prevalences were noted in Grant's zebra (Equus quagga boehmi) and Hartmann's mountain zebra (Equus zebra hartmannae) at 83% and 100%, respectively. In contrast to what is reported in domestic foals, gastric ulcerations were only diagnosed in one foal (out of 11 foals necropsied). The higher prevalence was noted in young individuals (3-36 mo old) at 93% (14/15); the lesions observed consisted mainly of single to multiple, superficial lesions, of which, only the mucosa was missing; these superficial lesions are often considered not clinically significant. The prevalence was lower for adults (74%; 14/19), but lesions were deeper or with a hyperemic or inflammatory appearance. All the lesions observed were located in the gastric, nonglandular, stratified squamous mucosa, along the margo plicatus. No statistical correlation could be found between the development of gastric ulcers and an ongoing, chronic pathologic process or a digestive tract pathology. The detection of gastric ulcers was, therefore, significantly greater in wild equids isolated in smaller enclosures. Nevertheless, additional larger-scale research is needed to point out predisposing factors in equids under human care.