November 23, 2009
A frustrated horse owner seeks out options for her gastric ulcer-suffering horse.
I purchased a 6-year-old Quarter Horse two years ago that was treated for ulcers with Tagamet and then colicked a few months later. He was taken to Cornell University and after being scoped, was diagnosed with having a few Grade 1 ulcers with evidence of healed ulcers. He continued to colic occasionally, which I later realized was due to not getting enough of the Tagament. I consulted with my veterinarian and decided to switch him to Zantac. We also switched him to a senior feed, as recommended by Cornell, to help reduce the acid in his stomach. He continued to do well on the Zantac, gaining weight and overall looking great. However, one other symptom he has is burping, which smells terrible. A few months ago, we decided to start backing him off the Zantac. He stayed on pasture and was grained twice a day (senior) and given hay in the morning and night.
Now that we have started backing him off the Zantac, he burps more often and shows some of the same signs that we observed in the beginning (lying down, stretching while standing).
My question is, can a horse have acid reflux without having ulcers? When I tell people he burps, they look at me like I’m crazy. I have been trying to get help for this horse but there are not a lot of people knowledgeable on this condition.
It is likely that this horse does have clinical gastric ulcers. The Zantac helps his clinical signs, but for whatever reason, the signs are persistent. Although there is new evidence that even horses at pasture have a relatively high incidence of gastric ulcers, it is unusual in my experience for a horse to show long-term clinical signs when managed as you have managed your horse. The ones that did seem to persist had issues with gastric outflow (the stomach cannot empty properly and acid level rises where it causes persistent and hard to control gastric ulcers).
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Alfalfa is actually a better feed for horses with gastric ulcers than grass hay. Alfalfa has a buffering effect, which increases stomach pH (lowers acidity), so this is one change you could slowly make. Adding corn oil (two to eight ounces per concentrate feeding) to feed is reported to help protect the stomach lining and may be helpful to manage ulcers.
As far as I know, the over-the-counter equine antacid supplements may slightly reduce stomach acidity. My feeling about these is that they may be helpful in a mild case, but they have not been shown to support the healing of gastric ulcers, as Gastrogard (and to a lesser extent Zantac, clearly has). That said, it might not be a bad idea to try one of these as they are relatively inexpensive and likely will not hurt.
When all is said and done, you will likely be best off having a second gastroscopy performed on the horse so that you understand better what the state of the problem is now. This would allow your veterinarian to visualize the stomach, the esophagus (for evidence of reflux) and even the outflow of the stomach (in case there was a problem there). It has been two years since the first scoping and there may now be an explanation that was not there before. The investment in some diagnostics now may pay off in the long term.
I prefer treating horses with persistent gastric ulcers with a full 28 days of Gastrogard, and then try to maintain them with the 1/4 dose (packaged as Ulcergard). This at least reduces the cost to one-fourth that of the treatment dose, and is conveniently dosed only once a day, versus at least twice daily for Zantac (ranitidine).
Dr. Doug Thal, Sante Fe, New Mexico, member of the American Association of Equine Practitioners