This article is a follow on article to the large Equine Gastric Ulcer Syndrome (EGUS) we hold on the website. This article will discuss the various treatments offered by professionals and vets.
Please ensure you read the main EGUS article here please follow the link.
Treatment for Equine Squamous Gastric Disease (ESGD)
As ESGD is caused by acid splashing onto the squamous mucosa, ESGD is very effectively treated by switching off acid production. Omeprazole is a proton pump inhibitor (often termed a ‘PPI’) available as a licensed oral paste or granules which switches off acid production. Unfortunately, feed lowers the absorption of this product so it is best given on an empty stomach (2-3h without food) and at least 30 minutes prior to being fed. Three to four weeks of omeprazole usually gives excellent healing of ESGD. Repeat gastroscopy is advised to ensure full healing before stopping treatment.
Treatment for Equine Glandular Gastric Disease (EGGD)
Despite EGGD not being directly caused by acid injury, acid suppression is still an important part of the treatment of glandular lesions as it is considered that the presence of acid will prevent glandular lesions from healing. Medications used include:
- Omeprazole: a proton pump inhibitor (often termed a PPI drug) available as a licensed oral paste which switches off acid production. Unfortunately feed lowers absorption of this product so it is best given on an empty stomach (2-3h without food) and at least 30 minutes prior to being fed. Three to four weeks of this paste usually gives excellent healing in squamous ulcer disease but is usually inadequate for glandular healing when used alone and is therefore often used in combination with sucralfate. Treatment for 6-8 weeks or even longer is often required to heal glandular ulcers. An unlicensed injectable omeprazole product is also now available which results in longer acid suppression for 5-7 days. Some studies have shown this product to result in better glandular healing.
- Sucralfate: an oral product that forms a gel layer over ulcers in an acidic environment and improves blood supply to the mucosa supporting mucus production. It is usually used in combination with oral omeprazole for treatment of glandular ulcer disease. No equine licensed product is available so human tablets can be crushed and given by dosing syringe or an unlicensed paste or powder used from a compounding pharmacy.
- Misoprostal: an oral product which improves blood supply to the mucosa supporting mucus production and decreases acid production. There is no licensed equine product; human tablets are crushed and given by dosing syringe. This medicine must be stored responsibly and should not be handled by women of childbearing age as it can cause abortion. Some vets have had success with drug whilst others have not.