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Gastric Ulcers

by Michael J. Murray, DVM, MS, Dipl. ACVIM

My Arabian gelding was diagnosed with a gastric ulcer after having endoscopy because of recurring colic. He was treated with cimetidine twice a day for nearly two months, and during the first month of treatment, he still had periodic attacks of colic. He was free of symptoms for two months, but then the symptoms began to recur. I had him re-scoped, and the ulcer was more of a "crack" than a hole. We put him back on cimetidine for three weeks, to be followed by two months of Carafate. Is there anything else I can do for this horse, and will I be battling this problem the rest of his life?

Gastric ulcers typically are thought to be a problem of foals, but they are very common in adult horses, as well. It is hard to tell how frequently they cause symptoms, because an owner often will not recognize that there is a problem unless the horse shows overt signs or colic.

Other signs that are associated with ulcers include poor appetite and condition and vague attitude changes. It becomes apparent that these signs are related to ulcers after the horse has endoscopy and treatment permits the ulcers to heal.

Your veterinarian was correct to recommend endoscopy to determine whether your horse had gastric ulcers, but even with an endoscopic diagnosis, the horse's symptoms may not be due to the stomach ulcer.

In fact, the ulcer(s) may be secondary to another abdominal problem. I would be concerned that this is the case with your horse, since he continued to have attacks of colic while treated.

On the other hand, it may be that the horse did not receive enough medication. Cimetidine (Tagamet), like ranitidine (Zantac) and famotidine (Pepcid), are histamine type-2 receptor antagonists (H2 blockers), and these drugs block the secretion of acid by the stomach. In so doing, they permit healing of ulcers. These drugs differ in potency, and in the horse cimetidine is one-half to one-third as potent as ranitidine, which is about one-half as potent as famotidine.

Also, each horse responds differently to H2 blockers, with some horses responding only to high doses. I generally recommend treatment with ranitidine at three mg/pound (three grams per 1,000 pound horse), every eight hours.

In most cases, ulcers heal in two to three weeks, and in all cases in which colic is caused by the ulcers, symptoms resolve in 48 hours. If they do not, I then suspect that there is another, primary abdominal problem.

Regarding Carafate, it is only effective for ulcers in the glandular part of the stomach, and since most ulcers in adult horses are in the non-glandular part of the stomach, its use may not be indicated in your horse. Check with the veterinarian who scoped your horse as to the location of the ulcer.

Finally, will this be a lifelong problem for your horse?
That is difficult to say. Of the horses I have treated that are of similar age and use as your horse, most have not developed serious symptoms (colic) of ulcers again. However, that is not to say they do not develop ulcers again. They probably do!

Some horses, though, do present as a chronic ulcer problem, having recurrence of clinical signs. these horses have required long-term maintenance treatment, usually frequent administration of antacids.

Michael J. Murray, DVM, MS, Dip. ACVIM, is an Associate Professor and Adelaide C. Riggs Chair in Equine Medicine at the Marion duPont Scott Equine Medical Center in Leesburg, Va. The Scott Center is part of the Virginia-Maryland Regional College of Veterinary Medicine.

Reprinted from The Horse: Your Guide to Equine Health Care

From the American Association of Equine Practitioners

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