Once a horse is diagnosed with gastrointestinal diseases, treatment approaches must be considered. Here, your situation gets challenging. Unless you know its etiology and where the horse is currently in the disease process, the most appropriate course of action is often uncertain. Add to this the practical realities of the patient: the owner likely seeks to get their horse back in optimal condition for the next race or event but seeks to spend as little money as possible. This can all leave you in an untenable position.
For gastric ulcers, treatment with proton pump inhibitors, especially omeprazole, is the remedy of choice. It has been proven effective in multiple studies, and the commercial form of omeprazole, Gastrogard®, is FDA-approved for this application in the U.S. But again, this is all dependent on the client’s ability and willingness to pay. Treatment with omeprazole or other acid inhibitors has its downside. First, by virtue of how this class of products works—by shutting off acid produced by the parietal cells of the lower stomach—acid inhibitors have no benefit for intestinal or colonic disease. In fact, by modifying a natural physiological component of digestion, their long-term and consistent use may be giving rise to more issues, perhaps farther along the GI tract. For an animal that is fed something other than its natural, intended diet—that is, higher proportions of non-structural carbohydrate fed intermittently—the risk is greatest.
Additionally, recent research has shown that gastric ulceration is, in fact, two distinct syndromes, distinguishing between those in the upper, squamous portion of the stomach (Equine Squamous Gastric Disease, or ESGD) and those in the lower, glandular portion (Equine Glandular Gastric Disease, or EGGD). Here, the efficacy of omeprazole has been distinguished as well. While consistently shown to be effective for treatment of squamous ulceration, omeprazole has been shown to be less efficacious in glandular ulceration applications.
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