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Tuesday, 12 February 2019

Equine Gastric Ulcers


For those of you who don't follow us on Instagram, you'll have missed our Thursday vlog story with a bit of an update. It was only a minute or so long, so I've decided to give a much more in detail update on the blog as I'm also really interested in showcasing our story and the progress along the way. So, sit back, whether with a lovely hot cuppa or a glass of chilled wine (depending on the time of the day!), and I hope you enjoy the insight from our experience in this post.

After we came back from a dressage competition at Richmond Equestrian Centre at the end of January, Louie seemed fine. Still into chewing the bobble on your hat, getting hold of all the toggles on your jackets & into every pocket looking for sweeties. Nothing seemed out of the ordinary, and the key to this, is that nothing ever did. Louie enjoyed the next night off, as did I, and as I happily walked up to his stable on the Tuesday, he was in his usual place, snoozing after a day out in the field. He didn't come to the door of the stable, which was odd, but I didn't think too much of it, and popped my saddle on the rack outside his door, open my cupboard and grabbed a couple of sweets. Still no Louie... That is weird, I thought.

Detecting the symptoms of gastric ulcers in horses


I opened the door and went over to him, where he greeted me by twisting towards me, ears flat back and snarling. He never opened his mouth, but it made me stop in my tracks. I tried to use a really soothing voice and give him a pat on his neck, but he just held his head higher than normal still with his ears flat back. This was not like Louie at all.

We all have our bad days, and on cold days or when he's cold, he can be a little grumpier, but nothing like this, just less interested in you. I put a headcollar on him and tied him up in the stable and gave him so hay to munch on. He just stood there looking very angry.  

I went to take his rugs off, and he wasn't happy. He didn't kick or swish his tail, but keeping twisting towards me. I gave him a good check over and a good brush, but nothing else seemed to trigger any reaction. He eventually started to munch on his hay... I thought about not working him, but then also thought it a good diagnostic to figure out if something was really wrong and perhaps where and with what trigger.

I tacked him up, and placing the saddle pad on him made him angry, but I thought to keep going and see a reaction with a saddle and especially the girth. Placing the saddle on his back got no reaction which is bizarre considering the reaction I had from a light saddle pad!! I got the girth and got a reaction from attaching it to the straps, but not when I passed it under his tummy or when I did it up. 

I was really starting to become bamboozled by what on earth was triggering him to be so grump and angry. I thought it was tummy paid, but it was so inconsistent to touching his tummy or sides...

While I popped my boots on, he began munching his hay, and when I went back into do his girth up more and put his bridle on he was ears forward and into what I was up to again. I took him out and across the concrete yard. I could hear he wasn't lame. I got on, no reaction. Did the gates to get into the school, no reactions to my leg or shifting of my weight. Warmed up lovely, did my girth up, again, no reaction. Worked like a dream & I forgot all about it!

I remember though, that he came in from working and as usual, went straight to his hay, had a drink, and was seemingly happy and normal again. The next night was his lunging session and the whole episode was EXACTLY the same.

Something really wasn't right. So I contacted my vet to arrange to speak to him the next morning.

Discussing with a professional as to the possible causes in behavioural change


When I spoke to him he explained many horses at this time of year struggle with their tummies. The chemicals in the grass are odd with such variance in temperature (some nights it's -5, and 8/9 during the day) and that this could be playing a part. He also said that they physically aren't eating as much when it's been so cold overnight, just nibbling at the grass, so their stomach's aren't as full.

We've always discussed Louie's tail swishing under saddle, but seem to find it no worse at any given time and that when he relaxes into his work, it reduces. He has shown no other signs that would cause us to feel the need to complete an equine gastroscopy, but he said that this is what he would recommend given Louie's recent and total changed behaviours.


I didn't hesitate, and I booked him in for as soon as I could. I never gave it much of a second thought, but came to the conclusion that if he didn't have any ulcers, great, but then what was causing this odd and out of character behaviour. And if he did, great too, because then I can treat them and actually the idea of him even being in small discomfort from them, is enough to act on it.

Coincidentally, the weather on the Friday and weekend was WAY too icy for the horses to get out, but it forced me into an experiment, and was one that Cathy, my flatwork coach, had suggested when I'd updated her on what the vet had said. Keep him in for a few days and monitor his grumpiness. If he continues to be grumpy, you can be fairly confident what ever is going on, isn't from the grass. And if he's back to his usual happy self, you can also be confident that the changes are connected in someway to turnout. 

So Louie staying in all weekend and if you saw my horsey duvet days post, you'll know it actually left us in a really productive & motivational place, whereas in the past, I'd have become stressed and uptight and needing to keep him in. 

The experiment result was a very happy and content Louie! So I now knew it was related in someway to turnout and the cold grass could be triggering something, whether that is basic tummy pain or a lower stomach content exposing an ulcer that wouldn't normally bother him... We would soon find out.

I worked Louie on the Monday evening, again, he worked really well, nothing out of the ordinary. We worked on some lateral movements to try to improve his suppleness, but it was also a good test to see how he responds to the leg being put on to guide him. He was absolute fine, and as he'd had a bucket of Fast Fibre when he came in, he also wasn't especially grumpy when I arrived at the yard.

Diagnosis of Gastric Ulcers in horses


On Tuesday, we took Louie down to Clevedale vets at Upleatham, near Redcar. It's a fair distance, but boasts the fantastic Alistair Love, who's an RCVS Recognised Advanced Practitioner in Equine Practice and has a passion for gastric ulceration cases. Clevedale really have got a strong team of equine specialist vets and when it comes to not the everyday veterinary needs, they are my first go to.

Alistair Love. Clevedale Vets

With a gastroscopy, the horse needs to be starved for a minimum of 8-12 hours before the procedure takes place. So rather than swapping out his lovely straw bed for shavings and doing it at home, I took him down to their practice and stabled him overnight. It made a lot of sense, as they can then keep an eye on him during that long starvation period as well as for a few hours after the gastroscopy has taken place. 


The equine gastroscopy took place on Wednesday morning and unfortunately, due to work commitments, I wasn't able to be there. I was really curious about the whole procedure and being able to watch and hear it all happen. But we headed down early afternoon to collect Louie and speak with the vet. Alistair had already called me after his had finished - he'd done 3 that morning, so it really shows you how common it is to perform!

He updated me on the phone that Louie was found to have grade three ulcers on his lesser curvature, and grade 2 ulcers on the pylorus and wider pyloric antrum. I know right...what does that even mean?

Ulceration on the lesser curvature

As the camera passed through the stomach, it almost comes straight across to the great curvature of the stomach, but it then pushed to come back on itself and on an empty stomach, gives a really clear picture of the lesser curvature. This is where Louie's ulceration can be seen. These are squamous ulcers.


Here you can see Louie's ulcerations. Usually the tissue would look like healthy tissue and be slightly more grey in colour, and you can see that even away from the ulcers that it is more yellow. You can also see the red markings that will be making any acid contact points quite sore for him.



Ulceration of the Pylorus

This is basically the exit of the stomach and a more uncommon place to see ulcers and are glandular ulcers.


They can also be a little bit tougher to say goodbye to so with the treatment that's been prescribed, these may take considerably longer to resolve or improve. Louie's grading on these ulcers is grade 2, and you can identify them in the below image as the small red dots. The rest of the area looks reasonably healthy.


Prescribed treatment of Gastric Ulcers in horses

Please note that the following is specifically designed for Louie's ulcers and what was found, as well as Louie's reaction to taking oral medication and the symptoms that he presents

The squamous ulcers found on Louie's lesser curvature should hopefully improve, if not resolve, within 4-8 weeks of starting treatment, however the glandular ulcers could take considerably longer, with around 10-20% worsening after starting the omeprazole treatment. Symptoms may start to improve within as little as one week of starting treatment which is great to know that it can offer them to begin feeling much more comfortable so soon, but in some cases might not be seen until one month in. As with most things relating to horses, it's a case by case basis.

It is important to remember that treatment is connected to the acid production, so doesn't in any way reflect how well the ulcers are really healing. A second gastroscopy will be carried out 4-5 weeks after the initial treatment has started.

I was dreading the diagnosis of ulcers because of Louie's reaction to any pastes by mouth - worming four times a year is a trauma that requires him to be twitched! So daily... I really wasn't not only looking forward to but also I was concerned whether I'd actually get any paste into him at all!

Despite being administered plenty of sedation for his procedure, Alistair could still see he was fuss about his mouth and having things done within his mouth. So put forward a strong case as to why he would recommend a non-paste based treatment.

Thankfully there is a solution, but it is off license so I needed to sign a consent form to be prescribed it. So what is it?

It's injections. They are once a week and are given straight into the muscle so I can even do them for myself! Unfortunately, they aren't in stock though, so I have to wait until a little later into the month for them to arrive and start. I'm going to get the vets to come to me for the first one so I can learn how to do it properly. I've never given an injection before, so I want to make sure I do it right.

In the meantime and throughout is treatment, Louie has been given a new supplement too - Gastric Defence. It's in pellet form and you give 33g three times a day or 50g twice a day. We've opted for the twice a day as it fits with his current feeding regime.

Feeding a horse with gastric ulcers

The great news is that Louie already has a fairly simple diet - Fast Fibre, handful of Alpha A oil, cup of TopSpec balancer and a mini scoop of calmer. We don't need to change a thing as low starch, high fibre diets are recommended. All that's added is his new supplement!


However, Alistair did recommend feeding un-molassed fibre feed 30 minutes before exercising to protect the squamous ulcers on the lesser curvature from the acid splash when riding. For this, we've now got a bag of Dengie's basic Alpha chaff that's un-molassed. We won't swap it into his feed, but will use it before he is worked or travelled.

Alfalfa is really great to absorb the acid and assist with splash inside their stomach, so we'll be sticking to the great range of Dengie products, but it's worth a good read as their Original and Lite do have a molasses coating which is a no-go.

Prognosis going forward with Gastric Ulcers

Again, this is specific for Louie.

No one can predict the future. There is no way to tell what causes the ulcers specifically, and there is no way to know how long they have been there.

However, there is no real reason that Louie cannot make a good recovery from these ulcers and for me to always consider their management in the future.

We are fairly lucky in the sense that there are no changes under saddle, and while we do see the tail swishing present, it certainly didn't worsen when he was worked on those awful evenings he was super grumpy!

I will always now consider the tip on feeding Alpha A before working or travelling, as it can really help comfort levels if there is some irritation and inflammation there. I'm not yet sure whether Louie will be taking his new Gastric Defence supplement for just a month or so, or whether it will be longer term. Time will tell.

And, overall, I am actually really chilled out about it. I feel I've been given some really great advice and a good treatment plan, as well as feeling comfortable that I can reach out to any of my support team should I need to ask anything further or have any concerns. 

Have you considered an equine gastroscopy?

If you've have asked me a few months ago about this, I'd have been terrified of what was to come. I had no knowledge on the subject area, and they were these big dramatic "things" that were difficult to managed and spoilt a horse forever more.

That is not true.

Sure, some horses have far worse ulcers than Louie and will need constant monitoring, treatment and management, but others are a one time case. You find them, treatment, pick up a couple of management tips for preventing them coming back, and may never see them again. Fingers crossed we are in this bracket!

But now I know what I'm dealing with, I wish I'd done it year ago. Hindsight is wonderful thing as it's very easy to say that now, but the reason I haven't scoped him before, is he's never really had enough to show for it. If the vet said 'now's the time' as he did recently, I'd have had it done in a flash, but Louie has never carried enough symptoms for it to be a real concern.

If you have even a momentary thought they may have ulcers, even if like Louie, it was 15 minutes maximum on a few days, take the step and organise a gastroscopy.



4 comments:

  1. Very interesting post! Thanks for sharing this information.

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  2. Ulcers are a nightmare! Since Scottie raced i am very careful to make sure he always has access to forage. But he is such a fatty I have to get a bit creative sometimes!

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    Replies
    1. Thankfully I don't think they have been caused from lack of forage, but more than perhaps this time of year there is less grass on his tummy, so could be exposing something that isn't usually there! :)

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