equine diagnsotics gastroscopyGastroscopy is used to assess the stomach of horses to diagnose disorders such as equine gastric ulcer syndrome. At Oakham Veterinary Hospital, we have the latest mobile video endoscopes that are 3.5metres in length meaning our vets can assess the oesophagus (gullet), the stomach and the first part of the small intestine (duodenum) to undertake a complete assessment of your horse.

 

Equine Gastric Ulcer Syndrome 

Equine Gastric Ulcer Syndrome (EGUS) is a complex condition, of which our medicine specialists are at the cutting edge of research. A list of some of their published work is shown at the bottom of this page. We now know that EGUS represents multiple different conditions causing different signs in different horse types. Broadly the disease is divided based on location to Equine Squamous Gastric Disease (ESGD), affecting the upper part of the stomach and Equine Glandular Gastric Disease (EGGD) affecting the lower part of the stomach where it empties into the small intestine. Some confuse EGGD with diseases of the ‘hind-gut’ or colon which are entirely different conditions. In fact hind gut ulceration is usually associated with parasites or the use of painkiller medications (e.g Bute)

Glandular Disease

Sqaumous Disease

How do I know if my horse has gastric ulcers? 

A range of signs can be associated with diseases of different parts of the stomach or intestines as shown in the table below. None of these signs are specific to gastric disease and the only way to definitively diagnose gastric disease is to have your horse gastroscoped. Hind gut ‘ulcers’ can only be documented by ultrasound imaging of the colon. To undertake ultrasound assessment of the colon it is normally necessary to clip your horse.

Clinical SignEquine Squamous Gastric DiseaseEquine Glandular Gastric Disease
Colic Mild to moderate usually after feeding
Possible link to recurrent colic
Mild and possibly recurrent, not related to feeding
Inappetence Often reported with ESGD Reduced appetite or altered feeding
Weight loss Related to reduced food intake Unexplained weight loss (i.e. with normal appetite)
Stereotypic behaviour Associated between oral sterotypies (e.g. crib biting) and ESGD.
Causal link not demonstrated
Not considered directly associated with EGGD
Changes in temperament Nervousness has been linked to ESGD Changes to temperamnent including nervousness and rideability
Poor performance Potential link, although causation has not been demonstrated Changes in rideability including reluctance to go forward
Other   Abnormal cutaneous sensitivity including self mutilation, resentment to girthing or leg aids

What does gastroscopy involve? 

In order to assess the entirety of the stomach your horse will have to be starved overnight (from 6pm) and water removed from the stable 2 hours before the examination. We will happily hospitalise your horse to do this, but you are also welcome to do this at home. Remember to be strict or the examination will have to be repeated! If you do bring your horse in the morning of the examination remember not to feed them en-route, it is very easy to slip into auto-pilot and hang a haynet in the horsebox.

Your horse will need to be sedated to have the gastroscope passed up your horse’s nostril, to the back of its throat and down the oesophagus into the stomach. The scope is then steered around the stomach to assess it within its entirety. Horses may also need to be twitched to prevent them moving their head during the procedure, which can result in a nose-bleed. If this happens it always stops, and looks worse than it is.

How do I treat my horse with gastric ulcers? 

True gastric ulceration occurs in the squamous (upper) portion of the stomach (ESGD) and can be effectively managed in almost all cases with oral omeprazole paste (Peptizole, Gastroguard, Ulcer Gold), which reduces the production of acid in the stomach. The drug is most effective if administered on an empty stomach in the morning, one hour before feeding. Horses will typically improve clinically within a week of treatment, although stopping medication early can result in a return of signs. Once healed, it is possible to prevent recurrence by removing risk factors and changing the diet. A range of supplements can be purchased, but please discuss these with your vet as some will have no effect on the health of your horse’s stomach. Ocassionally horses may require ongoing low dose ‘maintenance therapy’ using omeprazole.

Disease of the glandular stomach (EGGD) are not, in fact, ulcers. Research carried out by our team has shown that these are an inflammatory condition that are rarely associated with gastric ulceration. Although omeprazole can be helpful to lower the acidity of the stomach to encourage healing, we no longer believe that acid injury is the cause of this condition. Indeed, EGGD rarely heals with the use of oral omeprazole alone. Other medicines, that are not authorised for use in horses, are frequently used and we have extensive experience in using these medicines. If you have any questions about this you can discuss them with anyone in the medicine team. EGGD often takes longer for complete healing but stopping treatment early often results in an immediate return of signs and disease. Specific supplements can be useful, but the choice of active ingredient is very important.

Can I treat my horse without it having a gastroscope? 

Although treatment without the results of gastroscopy used to be the norm, this is no longer recommended since different diseases require different medicines and treatment periods. Although horses will improve clinically with untargeted treatment while receiving medication, the underlying disease is not changed if the wrong treatment is selected. As such, signs usually recur and attempts to ‘save-money’ can often be counter-productive. We offer a discounted ‘all-in’ gastroscopy fee to ensure this procedure remains cost effective.

Does my horse need rescoping at the end of treatment? 

We strongly recommend that all horses are re-scoped at the end of treatment to ensure complete healing. This is particularly important for EGGD where disease will recur if complete healing is not achieved. We offer a discounted re-scoping fee in recognition of the benefit this has to your horse’s health.

Where can I find out more? 

Our medicine specialists are actively working to improve the professions understanding of gastric disease in horses. The following scientific studies are freely available, others can be found in the waiting room.

David Rendle, Mark Bowen, Tim Brazil et al (2018) Recommendations for the management of equine glandular gastric disease. UK-Vet Equine 2018 2:Sup1, 2-11 https://www.magonlinelibrary.com/doi/pdf/10.12968/ukve.2018.2.S1.3

Varley G, Bowen IM, Nicholls V et al (2016) Misoprostol is Superior to Combined Omeprazole and Sucralfate for Healing Glandular Gastric Lesions. Equine Veterinary Journal 48, 11–12 https://onlinelibrary.wiley.com/doi/full/10.1111/evj.15_12612

Sykes, B. W., Bowen, M., Habershon-Butcher, J. L. et al. (2018). Management factors and clinical implications of glandular and squamous gastric disease in horses. Journal of veterinary internal medicine, 33(1), 233-240.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335573/pdf/JVIM-33-233.pdf