Ask Your Veterinarian Presented By Kentucky Performance Products: What Do We Know About Ulcers? by Paulick Report Staff|07.15.202007.21.2020|2:59pm3:40pm Veterinarians at Rood and Riddle Equine Hospital answer your questions about sales and healthcare of Thoroughbred auction yearlings, weanlings, 2-year-olds and breeding stock. QUESTION: What do we know about the causes and best treatments for ulcers? DR. KATE CHRISTIE: Equine gastric ulcer syndrome is a common condition in the performance horse with upwards of 90% of horses having evidence of gastric ulceration within two to three months of intensive training. Frustratingly, clinical signs vary from horse to horse and gastroscopy remains the only definitive diagnosis for ulcer disease in the adult horse. The majority of gastric ulcers occur in the non-glandular portion of the stomach and are associated with exposure of this area to the acidic contents of the stomach. Some of the most important conditions that increase exposure to stomach acids include long periods between eating and high levels of exercise and training. Ulcers can also be located in the glandular portion of the stomach, specifically in the pylorus or outflow tract of the stomach. Gastric ulcers in this region of the stomach are less completely understood, but may be associated with breakdown of natural protective barriers. Unlike other species, bacterial infection does not seem to play a role in equine gastric ulcer syndrome. Dr. Kate Christie Once a diagnosis of gastric ulcer disease has been reached, treatment and management should be tailored to each individual horse. A combination of pharmaceutical intervention as well as environmental management is often the most successful. Horses that go long periods of time without access to forage, especially those on a high grain diet, are at increased risk of gastric ulcers. Providing constant access to forage is key in the prevention and management of equine gastric ulcers. Adding alfalfa to the diet may also be helpful as it is naturally high in calcium and can act as a buffer for the highly acidic contents of the stomach. Medications used to treat gastric ulcers in horses have the main goal of decreasing the acidity of the stomach. Commonly used medications include omeprazole (GastroGard, UlcerGard) and ranitidine (Zantac). Sucralfate is also commonly administered as a coating agent to help heal ulcerations. GastroGard is the most commonly used medication and is the only medication with FDA approval for the treatment of gastric ulcers in horses. A long-acting injectable omeprazole has shown promise and may offer an alternative to traditional omeprazole therapy although further study is needed. Glandular ulcers can be more difficult to treat and often require longer courses of treatment. In some cases, treatment with a medication called misoprostol may be recommended if these ulcers fail to respond to GastroGard alone. The only way to confirm resolution of gastric ulcers is repeat gastroscopy which is typically recommended after a four-week course of treatment. Dr. Kate Christie grew up in Halifax, Nova Scotia, where she developed her love of horses actively competing in the show hunter world and watching Standardbred racing at the with her grandfather. She received her undergraduate degree in Life Sciences as well as a Master's degree in Pharmacology and Toxicology from Queen's University in Kingston, Ontario where she continued her riding career and further developed a passion for veterinary medicine. Kate graduated from the North Carolina State College of Veterinary Medicine in 2014 and went on to complete a year-long rotating hospital internship at Rood and Riddle Equine Hospital (2014-15) prior to entering a Large Animal Internal Medicine Residency at the University of Georgia. She became boarded in large animal internal medicine in 2018 at the completion of her residency program. Kate remained at the University of Georgia as a clinical associate professor for one year and is excited to be returning to Lexington to join the Rood and Riddle internal medicine team. Her professional interests include gastrointestinal disease, infectious and non-infectious respiratory disease, and equine pharmacology. Outside of work, Kate enjoys spending as much time as possible with her retired show jumper, Skye. When not in the saddle, she enjoys trail-running, hiking, and traveling with her husband.