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Li Z, Du S, Wang X, Zhang L, Liu X, Fan Q, Yang H, Gao R. Clinical effects of a combination of phenylbutazone and omeprazole on chronic lameness in Mongolian horses. Equine Vet J 2024; 56:562-572. [PMID: 37337455 DOI: 10.1111/evj.13962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/07/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Phenylbutazone (PBZ) is the most commonly used drug to treat symptoms of lameness in horses; however, it is associated with adverse effects such as gastric ulcer syndrome (EGUS). Interestingly, many practitioners prescribe omeprazole (OME) concurrently with PBZ to prevent the development of EGUS. However, the efficacy and safety of this practice in Mongolian horses with chronic lameness remain unknown. OBJECTIVES To evaluate the clinical effects of a combination of PBZ and OME on chronic lameness in Mongolian horses. STUDY DESIGN Randomised block experimental design. METHODS Eighteen Mongolian horses with lameness score was ≥3 points, were divided into three treatment groups, with six horses in each group: placebo (CON), PBZ (4.4 mg/kg PO q. 24 h), or PBZ plus OME (4 mg/kg PO q. 24 h; PBZ + OME) in a randomised block design based on the initial lameness score. The horses were treated for 15 days. During this period, weekly gastroscopy, and physiological and biochemical tests were performed. RESULTS Both PBZ (median 1.0, interquartile range [IQR]: 0.8-1.3; p = 0.01) and PBZ + OME (median 1.0, IQR: 1.0-1.0; p = 0.01) significantly decreased the lameness score compared with before administration. In addition, PBZ significantly increased the equine glandular gastric disease (EGGD) score (3.0 ± 0.6, p < 0.001), GT-17 content (293.4 ± 21.8 pg/mL, p < 0.001), and pepsinogen-1 (PG1) content (295.3 ± 38.3 ng/mL, p < 0.001) compared with CON or PBZ + OME. However, it significantly reduced the total protein (53.6 ± 1.5 g/L, p < 0.05) and albumin (25.5 ± 1.8 g/L, p < 0.05) contents. Nevertheless, compared with PBZ, PBZ + OME significantly decreased the EGGD score (0.3 ± 0.5, p < 0.001) and significantly increased the gastric fluid pH (7.3 ± 0.5, p < 0.001), total protein content (62.5 ± 4.6 g/L, p = 0.009), and albumin content (29.4 ± 1.1 g/L, p = 0.004). Meanwhile, they significantly diminished the gastrin 17 (GT-17) (162.0 ± 21.0 pg/mL, p < 0.001) and PG1 (182.4 ± 22.5 ng/mL, p < 0.001) contents. MAIN LIMITATIONS Individual differences in horses were larger, but the sample size was small. There was larger interval between observations for each index. CONCLUSIONS Compared with PBZ alone, PBZ + OME had no therapeutic effect on chronic lameness; however, it reduced the occurrence of EGGD in Mongolian horses. Horses may be protected against chronic lameness and PBZ-induced EGGD by increasing the pH value, decreasing serum PG1 and GT-17 content, and preventing the reduction of myeloperoxidase content.
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Affiliation(s)
- Zhengyi Li
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot, China
| | - Shan Du
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot, China
| | - Xiaomin Wang
- Agriculture and Animal Husbandry Bureau, Karaqin Banner, Chifeng, China
| | - Lanxin Zhang
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot, China
| | - Xinyu Liu
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot, China
| | - Quanrong Fan
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot, China
| | - Huidi Yang
- College of Basic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Ruifeng Gao
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot, China
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Shan R, Steel CM, Sykes B. The Impact of Two Recommended Withholding Periods for Omeprazole and the Use of a Nutraceutical Supplement on Recurrence of Equine Gastric Ulcer Syndrome in Thoroughbred Racehorses. Animals (Basel) 2023; 13:1823. [PMID: 37889700 PMCID: PMC10251805 DOI: 10.3390/ani13111823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 10/29/2023] Open
Abstract
The impact of recommended withholding periods (RWPs) for omeprazole on the recurrence of Equine Gastric Ulcer Syndrome (EGUS) is unknown. The study was designed to compare the effect of two RWPs on EGUS recurrence post-omeprazole treatment and to determine if a nutraceutical supplement would reduce EGUS recurrence when administrated during an RWP. The study was a blinded, randomized clinical trial. Part 1: Horses were allocated to an RWP0 or RWP2 and crossed over after 4-weeks. Horses received oral omeprazole once daily, except during the RWPs at the end of the treatment periods. Part 2: Horses received omeprazole for 21 days prior to an RWP2 during which they received a nutraceutical supplement. Gastroscopy was performed on Day 0 and pre- and post- RWP. Part 1: More horses were affected by Equine Squamous Gastric Disease (ESGD) after the '2-clear-days' RWP than the 'not on race-day' RWP (p = 0.012). The prevalence of ESGD post-RWP for '2-clear-days' did not differ from day 0 (p = 0.478). Part 2: The prevalence of ESGD post-RWP was lower than on Day 0 (p = 0.046). A difference in recurrence of ESGD was present between the two common RWPs. The implications of this on the welfare of Thoroughbred racehorses warrant further discussion.
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Affiliation(s)
- Ran Shan
- Department of Veterinary Clinical Services, The Hong Kong Jockey Club, Conghua Racecourse, Guangzhou 510900, China
| | - Catherine M. Steel
- Department of Veterinary Clinical Services, The Hong Kong Jockey Club, Conghua Racecourse, Guangzhou 510900, China
| | - Ben Sykes
- School of Veterinary Sciences, Massey University, Private Bag, 11-222, Palmerston North 4442, New Zealand
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Gough S, Hallowell G, Rendle D. Evaluation of the treatment of equine glandular gastric disease with either long-acting-injectable or oral omeprazole. Vet Med Sci 2022; 8:561-567. [PMID: 35167731 PMCID: PMC8959258 DOI: 10.1002/vms3.728] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Equine glandular gastric disease (EGGD) is common in domesticated horses and can be challenging to treat. Oral omeprazole (ORLO) is used widely but the clinical response is frequently poor. Objectives To compare rates of EGGD healing and improvement between ORLO and a long‐acting injectable omeprazole preparation (LAIO). Study design Retrospective clinical study. Methods The case records and gastroscopy images of horses presenting to masked for peer review over a 12‐month period were reviewed, with images blindly assessed by one of the authors. Treatment responses to 4 mg/kg LAIO administered every 7 days for 2 and 4 weeks were compared with ORLO 4 mg/kg PO q24hrs for 4 weeks. Data were compared using a Mann‐Whitney U test with post‐hoc Dunn's test, Chi‐squared test and a Fisher's exact test. Results Thirty‐three horses that received LAIO and 12 that received ORLO were identified. Nine horses in the LAIO had received other treatments previously. The groups were comparable in signalment and EGGD lesion severity. Long‐acting injectable omeprazole was found to be non‐inferior to ORLO. LAIO was associated with better healing rates than ORLO at 4 weeks (LAIO‐80%; ORLO‐42%; p = 0.02), and reduction in lesion severity at 2 and 4 weeks in the LAIO group but not in the ORLO group at 4 weeks. Eighteen percent of horses in the LAIO group and 50% in the ORLO group did not heal at 4 weeks. There was no association between rate of healing or improvement and resolution or improvement of clinical signs. Six localised and self‐limiting injection site reactions were identified in 4 horses treated with LAIO (6.7%). Main limitations Retrospective design, small numbers and the use of other treatments prior to use of LAIO. Conclusions LAIO was found to be non‐inferior to oral omeprazole for EGGD. Larger blinded randomised clinical trials are justified. Equine glandular gastric disease (EGGD) is common in domesticated horses and can be challenging to treat. Long‐acting injectable omeprazole was found to be non‐inferior to ORLO. LAIO was associated with better healing rates than ORLO at 4 weeks (LAIO‐80%; ORLO‐42%; p = 0.02), and reduction in lesion severity at 2 and 4 weeks in the LAIO group but not in the ORLO group at 4 weeks.
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Affiliation(s)
- Sarah Gough
- Rainbow Equine Hospital, Malton, North Yorkshire, YO17 6SG
| | - Gayle Hallowell
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, United Kingdom
| | - David Rendle
- Rainbow Equine Hospital, Malton, North Yorkshire, YO17 6SG
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Hewetson M, Tallon R. Equine Squamous Gastric Disease: Prevalence, Impact and Management. VETERINARY MEDICINE (AUCKLAND, N.Z.) 2021; 12:381-399. [PMID: 35004264 PMCID: PMC8725839 DOI: 10.2147/vmrr.s235258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022]
Abstract
This narrative review explores the etiopathogenesis, clinical signs, diagnosis and treatment of ESGD (equine squamous gastric disease) and discusses the impact of this commonly encountered condition on the equine industry. ESGD refers specifically to peptic injury of the squamous mucosa of the stomach. Prevalence is highest in performance horses, but the disease has been documented across many breeds and ages, including in feral horses and foals. The pathogenesis of ESGD is well understood. Intensive management and exercise are important factors that contribute to a disruption of the normal stratification of gastric pH. This results in exposure of the vulnerable squamous mucosa to acid, leading to ulceration. Clinical signs are variable and there is little evidence to support a direct association between reported signs and the presence or absence of lesions seen on gastroscopy. Management is aimed at acid suppression and mitigation of known risk factors.
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Affiliation(s)
- Michael Hewetson
- Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Hertfordshire, UK
| | - Rose Tallon
- Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Hertfordshire, UK
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Wise JC, Hughes KJ, Edwards S, Jacobson GA, Narkowicz CK, Raidal SL. Pharmacokinetic and pharmacodynamic effects of 2 registered omeprazole preparations and varying dose rates in horses. J Vet Intern Med 2020; 35:620-631. [PMID: 33340169 PMCID: PMC7848319 DOI: 10.1111/jvim.15971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/02/2020] [Accepted: 11/10/2020] [Indexed: 12/02/2022] Open
Abstract
Background Omeprazole preparations vary in bioavailability in horses. Hypothesis/Objectives To characterize the pharmacokinetics and pharmacodynamics of an existing enteric‐coated oral omeprazole paste (REF) and a novel, in‐feed, enteric‐coated dry granule preparation (NOV). Animals Twelve Standardbred/Thoroughbred mares free from clinical disease. Methods A prospective, blinded randomized interventional study was trial, conducted in 3 parts: (a) bioavailability study, (b) dose titration study, and (c) comparative clinical pharmacodynamic study, each using a blocked crossover design. Results Consistent with the larger dose administered, Cmax (median, 1032 ng/mL; range, 576‐1766) and AUC0‐24 (median, 63.9 μg/mL*min; range, 42.4‐152.4) were greater after single oral administration of NOV than REF (282.7 ng/mL; range, 94.8‐390.2, and 319 23.8 μg/mL*min; range, 8.2‐42.3, respectively; both P = .004). No differences were observed between products for absolute oral bioavailability (NOV 55% range, 15‐88; REF 17% range, 10‐77; P = .25). Treatment with both preparations was associated with reduced gastric squamous ulcer scores and increased pH of gastric fluid. Bioequivalence was demonstrated for pharmacodynamic measures with the exception of % time pH <4, despite differences in dose rate and subsequent plasma omeprazole concentrations. Conclusions and Clinical Importance The findings of this study indicate that the NOV product would be a suitable alternative to the reference product, and confirm that plasma concentrations of omeprazole and omeprazole dose do not predict drug pharmacodynamics in horses.
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Affiliation(s)
- Jessica C Wise
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Kristopher J Hughes
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Scott Edwards
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Glenn A Jacobson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Christian K Narkowicz
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Sharanne L Raidal
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
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Wise JC, Wilkes EJA, Raidal SL, Xie G, Crosby DE, Hale JN, Hughes KJ. Interobserver and intraobserver reliability for 2 grading systems for gastric ulcer syndrome in horses. J Vet Intern Med 2020; 35:571-579. [PMID: 33284465 PMCID: PMC7848314 DOI: 10.1111/jvim.15987] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background Grading of equine gastric ulcer syndrome (EGUS) is undertaken in clinical and research settings, but the reliability of EGUS grading systems is poorly understood. Hypothesis/Objectives Investigate interobserver and intraobserver reliability of an established ordinal grading system and a novel visual analog scale (VAS), and assess the influence of observer experience. Animals Sixty deidentified gastroscopy videos. Methods Six observers (3 specialists and 3 residents) graded videos using the EGUS Council (EGUC) system and VAS. Observers graded the videos three 3 for each system, using a cross‐over design with at least 1 week between each phase. The order of videos was randomized for each phase. Methods Interobserver and intraobserver reliability were estimated using Gwet's agreement coefficient with ordinal weights applied (AC2) for the EGUC system and the intraclass correlation coefficient (ICC) for the VAS. Results Using the EGUC system, interobserver reliability was substantial for squamous (AC2 = 0.69; 95% confidence interval [CI], 0.57‐0.80) and glandular mucosa (AC2 = 0.72; 95% CI, 0.70‐0.75), and intraobserver reliability was substantial for squamous (AC2 = 0.80; 95% CI, 0.71‐0.90) and glandular mucosa (AC2 = 0.80; 95% CI, 0.74‐0.86). Interobserver reliability using the VAS was moderate for squamous (ICC = 0.64; 95% CI, 0.31‐0.96) and poor for glandular mucosa (ICC = 0.35; 95% CI, 0.06‐0.64), and intraobserver reliability was moderate for squamous (ICC = 0.74; 95% CI, 0.62‐0.86) and glandular mucosa (ICC = 0.56; 95% CI, 0.39‐0.72). Conclusions and Clinical Importance The EGUC system had acceptable intraobserver and interobserver reliability and performed well regardless of observer experience. Familiarity and observer experience improved reliability of the VAS.
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Affiliation(s)
- Jessica C Wise
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Edwina J A Wilkes
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Sharanne L Raidal
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Gang Xie
- Quantitative Consultant Unit, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Danielle E Crosby
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Josephine N Hale
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Kristopher J Hughes
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
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Ricord M, Andrews FM, Yñiguez FJM, Keowen M, Garza F, Paul L, Chapman A, Banse HE. Impact of concurrent treatment with omeprazole on phenylbutazone-induced equine gastric ulcer syndrome (EGUS). Equine Vet J 2020; 53:356-363. [PMID: 32697849 DOI: 10.1111/evj.13323] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/02/2020] [Accepted: 07/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Phenylbutazone is commonly prescribed for treatment of various painful or inflammatory disorders in horses, but is associated with gastrointestinal (GI) adverse effects. Anecdotally, many practitioners prescribe omeprazole concurrently with phenylbutazone to reduce development of equine gastric ulcer syndrome (EGUS), but the efficacy and safety of this practice remains unknown. OBJECTIVES To evaluate the effect of omeprazole on phenylbutazone-induced equine glandular gastric disease (EGGD) and equine squamous gastric disease (ESGD). STUDY DESIGN Randomised block experimental design. METHODS Twenty-two horses with EGGD and ESGD scores ≤2 were included. Horses were assigned to treatment groups: phenylbutazone (4.4 mg/kg PO q 12 h; PBZ), phenylbutazone plus omeprazole (4 mg/kg PO q. 24 h; PBZ/OME) or placebo (CON) in a randomised block design based upon initial EGGD score. Horses were treated for up to 14 days. Gastroscopy was performed weekly; CBC and biochemistry were performed at Day 0 and study end. Horses were monitored for signs of colic and/or diarrhoea. RESULTS EGGD score increased in PBZ (median change 1, inter-quartile range, [IQR], 0-2) compared to PBZ/OME (median change 0, IQR -1 to 0; P = .05). PBZ/OME (6/8) had more intestinal complications than CON (0/6; difference between proportions = 75%; 95% CI, 23%-93%; P = .03). Plasma protein concentrations decreased in PBZ, compared to CON (mean difference between groups, 14 g/L; 95% CI, 1.04-27; P = .03). Five horses were withdrawn from the study due to intestinal complications (n = 3 PBZ/OME and n = 2 PBZ); one horse (PBZ) was withdrawn due to severe grade 4 EGGD. MAIN LIMITATIONS Small sample size and changes in management for the 2-3 days prior to study initiation; variable treatment duration among groups due to development of complications. CONCLUSIONS Administration of omeprazole ameliorated PBZ-induced EGGD, but was associated with an increase in intestinal complications. Caution should be exercised when co-prescribing NSAIDs and omeprazole in horses, particularly in association with change in management.
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Affiliation(s)
- Megan Ricord
- Equine Health Studies Program, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Frank M Andrews
- Equine Health Studies Program, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Francisco J M Yñiguez
- Equine Health Studies Program, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Michael Keowen
- Equine Health Studies Program, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Frank Garza
- Equine Health Studies Program, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Linda Paul
- Equine Health Studies Program, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Ann Chapman
- Equine Health Studies Program, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Heidi E Banse
- Equine Health Studies Program, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
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Gough S, Hallowell G, Rendle D. A study investigating the treatment of equine squamous gastric disease with long-acting injectable or oral omeprazole. Vet Med Sci 2020; 6:235-241. [PMID: 31945806 PMCID: PMC7196684 DOI: 10.1002/vms3.220] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/03/2019] [Accepted: 10/26/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Equine squamous gastric disease (ESGD) is a highly prevalent disease in horses, particularly in elite athletes. Some horses respond slowly, or fail to respond, to the licensed treatment, oral omeprazole (ORLO). OBJECTIVES To compare rates of ESGD healing and improvement between ORLO and a long-acting injectable omeprazole preparation (LAIO). STUDY DESIGN Retrospective clinical study. METHODS The case records and gastroscopy images of horses presenting to Rainbow Equine Hospital over a 12-month period were reviewed, with images being reviewed blind by one of the authors (David Rendle). Treatment responses were compared between horses that received 2 or 4 injections of 4 mg/kg LAIO at weekly intervals, and horses that received ORLO at 4 mg/kg PO SID for 4 weeks. Data were compared using a Mann-Whitney test with post hoc Dunn's test, chi-squared test or Fisher's exact test. RESULTS Fifty-six horses met the inclusion criteria: 29 received LAIO and 27 received ORLO. Treatment groups were comparable in terms of signalment and ESGD lesions. There was a difference in rate of healing when LAIO and ORLO treatment groups were compared at 28 days (LAIO-97%; ORLO-67%; p = .005; OR = 14(1.8-158)), but no difference between LAIO at 14 days and ORLO at 28 days (LAIO-86%; ORLO-67%; p = .12; OR = 3.1 (0.9-10)). Five localised and self-limiting injection site reactions were identified in 3 horses out of 98 injections (5.1%). MAIN LIMITATIONS The study was limited by its retrospective nature, absence of randomisation and limited numbers. CONCLUSIONS Four weeks of treatment with LAIO resulted in better rates of ESGD healing than 4 weeks of ORLO. Larger more robust studies of LAIO are warranted.
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Affiliation(s)
- Sarah Gough
- Rainbow Equine HospitalMaltonNorth YorkshireUnited Kingdom
| | - Gayle Hallowell
- School of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUnited Kingdom
| | - David Rendle
- Rainbow Equine HospitalMaltonNorth YorkshireUnited Kingdom
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Banse HE, Andrews FM. Equine glandular gastric disease: prevalence, impact and management strategies. VETERINARY MEDICINE (AUCKLAND, N.Z.) 2019; 10:69-76. [PMID: 31406687 PMCID: PMC6642651 DOI: 10.2147/vmrr.s174427] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/26/2019] [Indexed: 12/13/2022]
Abstract
Equine glandular gastric disease (EGGD) is an increasingly recognized disease of the glandular mucosa of the equine stomach. Diagnosis is confirmed by gastric endoscopy and scored based upon one of several different endoscopic scoring systems. Prevalence appears to be variable, depending upon breed and discipline. Primary identified risk factors include exercise frequency, and stress; therefore, management strategies are focused on reducing exercise and stress. Limiting grain intake and increasing pasture turnout may also be helpful preventative measures. Pharmacologic treatment consists primarily of an approved omeprazole product with or without misoprostol or sucralfate. Further research into the pathophysiology of EGGD may allow for identification of other targeted treatments.
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Affiliation(s)
- Heidi E Banse
- Equine Health Studies Program, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton RougeLA, USA
| | - Frank M Andrews
- Equine Health Studies Program, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton RougeLA, USA
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10
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Varley G, Bowen IM, Habershon‐Butcher JL, Nicholls V, Hallowell GD. Misoprostol is superior to combined omeprazole‐sucralfate for the treatment of equine gastric glandular disease. Equine Vet J 2019; 51:575-580. [DOI: 10.1111/evj.13087] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 02/23/2019] [Indexed: 12/20/2022]
Affiliation(s)
| | - I. M. Bowen
- School of Veterinary Medicine and Science University of Nottingham Loughborough UK
| | | | - V. Nicholls
- School of Veterinary Science University of Liverpool Leahurst UK
| | - G. D. Hallowell
- School of Veterinary Medicine and Science University of Nottingham Loughborough UK
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11
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Sykes BW. Courses for horses: Rethinking the use of proton pump inhibitors in the treatment of equine gastric ulcer syndrome. EQUINE VET EDUC 2018. [DOI: 10.1111/eve.12894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- B. W. Sykes
- School of Veterinary Sciences The University of Queensland Gatton Queensland Australia
- Bova Compounding Caringbah New South Wales Australia
- Luoda Pharma Pty Ltd Caringbah New South Wales Australia
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Bush J, van den Boom R, Franklin S. Comparison of aloe vera and omeprazole in the treatment of equine gastric ulcer syndrome. Equine Vet J 2017; 50:34-40. [DOI: 10.1111/evj.12706] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/16/2017] [Indexed: 11/30/2022]
Affiliation(s)
- J. Bush
- School of Animal and Veterinary Science; Adelaide South Australia Australia
| | - R. van den Boom
- School of Animal and Veterinary Science; Adelaide South Australia Australia
| | - S. Franklin
- School of Animal and Veterinary Science; Adelaide South Australia Australia
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Raidal SL, Andrews FM, Nielsen SG, Trope G. Pharmacokinetic and pharmacodynamic effects of two omeprazole formulations on stomach pH and gastric ulcer scores. Equine Vet J 2017; 49:802-809. [DOI: 10.1111/evj.12691] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 04/11/2017] [Indexed: 11/30/2022]
Affiliation(s)
- S. L. Raidal
- School of Animal and Veterinary Sciences; Veterinary Clinical Centre; Charles Sturt University; Wagga Wagga New South Wales Australia
| | - F. M. Andrews
- Equine Health Studies Program; Department of Veterinary Clinical Sciences; School of Veterinary Medicine; Louisiana State University; Baton Rouge Louisiana USA
| | - S. G. Nielsen
- School of Animal and Veterinary Sciences; Veterinary Clinical Centre; Charles Sturt University; Wagga Wagga New South Wales Australia
| | - G. Trope
- School of Animal and Veterinary Sciences; Veterinary Clinical Centre; Charles Sturt University; Wagga Wagga New South Wales Australia
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Sykes BW, Kathawala K, Song Y, Garg S, Page SW, Underwood C, Mills PC. Preliminary investigations into a novel, long-acting, injectable, intramuscular formulation of omeprazole in the horse. Equine Vet J 2017; 49:795-801. [DOI: 10.1111/evj.12688] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/04/2017] [Indexed: 12/11/2022]
Affiliation(s)
- B. W. Sykes
- School of Veterinary Science; University of Queensland; Gatton Queensland Australia
- Luoda Pharma Pty Ltd; Caringbah New South Wales Australia
| | - K. Kathawala
- Centre for Pharmaceutical Innovation and Development; University of South Australia; Adelaide South Australia Australia
| | - Y. Song
- Centre for Pharmaceutical Innovation and Development; University of South Australia; Adelaide South Australia Australia
| | - S. Garg
- Centre for Pharmaceutical Innovation and Development; University of South Australia; Adelaide South Australia Australia
| | - S. W. Page
- Luoda Pharma Pty Ltd; Caringbah New South Wales Australia
| | - C. Underwood
- School of Veterinary Science; University of Queensland; Gatton Queensland Australia
| | - P. C. Mills
- School of Veterinary Science; University of Queensland; Gatton Queensland Australia
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15
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Sykes BW, Underwood C, Greer R, McGowan CM, Mills PC. The effects of dose and diet on the pharmacodynamics of omeprazole in the horse. Equine Vet J 2016; 49:525-531. [DOI: 10.1111/evj.12630] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 08/19/2016] [Indexed: 12/13/2022]
Affiliation(s)
- B. W. Sykes
- School of Veterinary Science; The University of Queensland; Gatton Australia
| | - C. Underwood
- School of Veterinary Science; The University of Queensland; Gatton Australia
| | - R. Greer
- School of Veterinary Science; The University of Queensland; Gatton Australia
| | - C. M. McGowan
- Institute of Ageing and Chronic Disease; University of Liverpool; Liverpool UK
| | - P. C. Mills
- School of Veterinary Science; The University of Queensland; Gatton Australia
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16
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Sykes BW, Hewetson M, Hepburn RJ, Luthersson N, Tamzali Y. European College of Equine Internal Medicine Consensus Statement--Equine Gastric Ulcer Syndrome in Adult Horses. J Vet Intern Med 2016; 29:1288-99. [PMID: 26340142 PMCID: PMC4858038 DOI: 10.1111/jvim.13578] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/19/2015] [Accepted: 06/10/2015] [Indexed: 12/01/2022] Open
Affiliation(s)
- B W Sykes
- BW Sykes Consultancy, Upper Orara, NSW, Australia.,School of Veterinary Sciences, The University of Queensland, Gatton, QLD, Australia
| | - M Hewetson
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
| | - R J Hepburn
- B&W Equine Hospital, Breadstone, Berkeley, Gloucestershire, UK
| | | | - Y Tamzali
- Equine Internal Medicine, Université de Toulouse, Toulouse, France
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17
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A Comparison Between Omeprazole and a Dietary Supplement for the Management of Squamous Gastric Ulceration in Horses. J Equine Vet Sci 2016. [DOI: 10.1016/j.jevs.2016.02.228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Affiliation(s)
- F. M. Andrews
- Equine Health Studies Program; Department of Veterinary Clinical Sciences; School of Veterinary Medicine; Louisiana State University; Baton Rouge USA
| | - C. Larson
- Zinpro Corporation; Eden Prairie Minnesota USA
| | - P. Harris
- WALTHAM Centre for Pet Nutrition; Waltham-on-the-Wolds; Leicestershire UK
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19
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Andrews FM. Gastric juice pH measurement in horses: Three-quarters of a century of history! EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- F. M. Andrews
- Department of Veterinary Clinical Sciences; School of Veterinary Medicine; Equine Health Studies Program; Louisiana State University; Baton Rouge Louisiana USA
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20
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Sykes BW, Jokisalo JM. Rethinking equine gastric ulcer syndrome: Part 2 - Equine squamous gastric ulcer syndrome (ESGUS). EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12277] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- B. W. Sykes
- BW Sykes Consultancy; Upper Orara New South Wales Australia
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21
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Sykes BW, Underwood C, McGowan CM, Mills PC. Pharmacokinetics of intravenous, plain oral and enteric-coated oral omeprazole in the horse. J Vet Pharmacol Ther 2014; 38:130-6. [PMID: 25271390 DOI: 10.1111/jvp.12169] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/18/2014] [Indexed: 12/14/2022]
Abstract
The objectives were to document the pharmacokinetics of intravenous, enteric-coated oral and plain oral omeprazole in fasted horses and to investigate the impact of feeding on the bioavailability of an enteric-coated omeprazole. Twelve horses received four treatments: intravenous omeprazole (0.5 mg/kg) in the fasted state (IV-Fasted), enteric-coated omeprazole (4 mg/kg) orally in the fasted state (ECO-Fasted), enteric-coated omeprazole (4 mg/kg) orally in the fed state (ECO-Fed) and plain omeprazole (4 mg/kg) orally in the fasted state (PL-Fasted). Plasma omeprazole concentrations were determined by UHPLC-MS. Bioavailability was higher (P = 0.038) in the ECO-Fasted group (21.5 [9.0-27.7]%) than the PL-Fasted group (10.1 [7.7-13.3]%). Similarly, AUC0-∞ was higher in the ECO-Fasted group than the PL-Fasted group (P = 0.027). No significant differences were present between the ECO-Fasted and ECO-Fed groups with regards to bioavailability, Cmax , Tmax or AUC0-∞ . When the half-life data from the oral formulations was pooled, it was longer than that observed in the IV-Fasted group (100 [73-118] min) and 35 [34-39] min, respectively; P < 0.0001). Bioavailability of enteric-coated omeprazole was higher than previously reported and feeding had minimal impact. Bioavailability of plain omeprazole was approximately half that of enteric-coated omeprazole. The longer half-life observed following oral administration was consistent with the flip-flop effect and has not previously been described for omeprazole in the horse.
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Affiliation(s)
- B W Sykes
- School of Veterinary Sciences, The University of Queensland, Gatton, Qld, Australia
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22
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Woodward MC, Huff NK, Garza F, Keowen ML, Kearney MT, Andrews FM. Effect of pectin, lecithin, and antacid feed supplements (Egusin®) on gastric ulcer scores, gastric fluid pH and blood gas values in horses. BMC Vet Res 2014; 10 Suppl 1:S4. [PMID: 25238454 PMCID: PMC4123152 DOI: 10.1186/1746-6148-10-s1-s4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The objectives of this study were to evaluate the effects of two commercial feed supplements, Egusin 250® [E-250] and Egusin SLH® [E-SLH], on gastric ulcer scores, gastric fluid pH, and blood gas values in stall-confined horses undergoing feed-deprivation. Methods Nine Thoroughbred horses were used in a three-period crossover study. For the three treatment groups, sweet feed was mixed with E-250, E-SLH, or nothing (control group) and fed twice daily. Horses were treated for 21 days, then an additional 7 days while on an alternating feed-deprivation model to induce or worsen ulcers (period one). In periods two and three, horses (n=6) were treated for an additional 7 days after feed-deprivation. Gastroscopies were performed on day -1 (n=9), day 21 (n=9), day 28 (n=9) and day 35 (n=6). Gastric juice pH was measured and gastric ulcer scores were assigned. Venous blood gas values were also measured. Results Gastric ulcers in control horses significantly decreased after 21 days, but there was no difference in ulcer scores when compared to the Egusin® treated horses. NG gastric ulcer scores significantly increased in E-250 and control horses on day 28 compared to day 21 as a result of intermittent feed-deprivation, but no treatment effect was observed. NG ulcer scores remained high in the control group but significantly decreased in the E-SLH- and E-250-treated horses by day 35. Gastric juice pH values were low and variable and no treatment effect was observed. Mean blood pCO2 values were significantly increased two hours after feeding in treated horses compared to controls, whereas mean blood TCO2 values increased in the 24 hour sample, but did not exceed 38 mmol/l. Conclusions The feed-deprivation model increased NG gastric ulcer severity in the horses. However, by day 35, Egusin® treated horses had less severe NG gastric ulcers compared to untreated control horses. After 35 days, Egusin® products tested here ameliorate the severity of gastric ulcers in stall-confined horses after feed stress.
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Birkmann K, Junge HK, Maischberger E, Wehrli Eser M, Schwarzwald CC. Efficacy of omeprazole powder paste or enteric-coated formulation in healing of gastric ulcers in horses. J Vet Intern Med 2014; 28:925-33. [PMID: 24628650 PMCID: PMC4895457 DOI: 10.1111/jvim.12341] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 12/22/2013] [Accepted: 01/30/2014] [Indexed: 11/29/2022] Open
Abstract
Background GastroGard, an omeprazole powder paste formulation, is considered the standard treatment for gastric ulcers in horses and is highly effective. Gastrozol, an enteric‐coated omeprazole formulation for horses, has recently become available, but efficacy data are controversial and sparse. Objectives To investigate the efficacy of GastroGard and Gastrozol at labeled doses (4 and 1 mg of omeprazole per kg bwt, respectively, PO q24h) in healing of gastric ulcers. Animals 40 horses; 9.5 ± 4.6 years; 491 ± 135 kg. Methods Prospective, randomized, blinded study. Horses with an ulcer score ≥1 (Equine Gastric Ulcer Council) were randomly divided into 2 groups and treated for 2 weeks each with GastroGard followed by Gastrozol (A) or vice versa (B). After 2 and 4 weeks, scoring was repeated and compared with baseline. Plasma omeprazole concentrations were measured on the first day of treatment after administration of GastroGard (n = 5) or Gastrozol (n = 5). Results Compared with baseline (squamous score (A) 1.65 ± 0.11, (B) 1.98 ± 0.11), ulcer scores at 2 weeks ((A) 0.89 ± 0.11, (B) 1.01 ± 0.11) and 4 weeks ((A) 1.10 ± 0.12, (B) 0.80 ± 0.12) had significantly decreased in both groups (P < .001), independent of treatment (P = .7). Plasma omeprazole concentrations were significantly higher after GastroGard compared with Gastrozol administration (AUCGG = 2856 (1405‐4576) ng/mL × h, AUCGZ = 604 (430‐1609) ng/mL × h; P = .03). The bioavailability for Gastrozol was 1.26 (95% CI 0.56–2.81) times higher than for GastroGard. Conclusions and Clinical Importance Both Gastrozol and GastroGard, combined with appropriate environmental changes, promote healing of gastric ulcers in horses. However, despite enteric coating of Gastrozol, plasma omeprazole concentrations after single labeled doses were significantly higher with GastroGard.
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Affiliation(s)
- K Birkmann
- Equine Department, Vetsuisse Faculty, Clinic for Equine Internal Medicine, University of Zurich, Zurich, Switzerland
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Hellings IR, Larsen S. ImproWin® in the treatment of gastric ulceration of the squamous mucosa in trotting racehorses. Acta Vet Scand 2014; 56:13. [PMID: 24625291 PMCID: PMC4008370 DOI: 10.1186/1751-0147-56-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 02/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastric ulceration is highly prevalent in horses, and there is a large commercial market for feed-additives and non-licenced products that claim effect for prevention and treatment of gastric ulceration. ImproWin® has been used as a feed additive in horses with anecdotal evidence that it may have some positive effects on gastric ulceration.The aim of this study was to investigate the effect of ImproWin® treatment on spontaneously occurring gastric ulcers of the squamous mucosa in Standardbred and Coldblooded trotting racehorses. The study was performed as a randomised, double-blinded, single centre study with stratified semi cross-over design with breed as stratification factors. The horses were clinically and endoscopically examined prior to start and after three weeks of treatment. The ulcerations were scored in accordance with Equine Gastric Ulcer Council (EGUC) recommendations on a 5 point scale and on a 10 cm Visual Analogue Scale (VAS). The patients were responder-classified after 3 weeks. Responders in need of ulcer treatment were randomly allocated to 2 or 4 weeks of additional treatment. Non-responders to placebo were crossed to ImproWin®. RESULTS The 5-point EGUC score and VAS recorded score was significantly reduced (P ≤ 0.01) in both groups after 3 weeks of treatment. From 3 weeks to the end of treatment the score was further significantly reduced in the ImproWin® group (P ≤ 0.05). At the end of treatment, 78% in the ImproWin® group and 54.8% in the placebo group were classified as responders. The difference was significant (P = 0.04). CONCLUSIONS ImproWin® may aid the healing process of ulcers of the gastric squamous mucosa of trotters.
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