EGUS Client Ed

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A copy of Dr. Joan\'s powerpoint presentation on Equine Gastric Ulcer Syndrome from the June 28th 2011 client education night. If you have any questions, please do not hesitate to contact us!

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EGUS Client Ed

  1. 1. Equine Gastric Ulcer Syndrome Joan Norton VMD DACVIM Client Education Night June 28th 2011
  2. 2. Update on EHV-1 <ul><li>June 28th USDA Final Situation Report </li></ul><ul><ul><li>There are no new cases and no new premises affected . Disease spread in connection with this incident has been contained and no further situation reports will be generated. </li></ul></ul><ul><li>Total of 90 cases in 10 states (13 fatalities) </li></ul><ul><ul><li>AZ, CA, CO, ID, NM, NV, OK, OR, UT, WA </li></ul></ul>
  3. 3. Equine Gastric Ulcer Syndrome Joan Norton VMD DACVIM Client Education Night June 28th 2011
  4. 4. Who Gets Ulcers? <ul><li>EVERYONE! </li></ul><ul><ul><li>Endurance horses 98% </li></ul></ul><ul><ul><li>Thoroughbred racehorses 93% </li></ul></ul><ul><ul><li>Standardbred racehorses 70% </li></ul></ul><ul><ul><li>Thoroughbred broodmares 71% </li></ul></ul><ul><ul><li>Pleasure horses 53% </li></ul></ul>
  5. 5. Normal Anatomy
  6. 6. Normal Anatomy Squamous mucosa Glandular mucosa No secretions No protective barriers Produces HCl & Pepsinogen Mucus layer Bicarbonate layer Exstensive blood flow
  7. 7. Normal Anatomy
  8. 8. Why do they happen? <ul><li>Acid contacting the squamous mucosa </li></ul><ul><ul><li>Increased acid production </li></ul></ul><ul><ul><li>Shift in stomach fluids </li></ul></ul><ul><ul><li>Decreased natural buffers </li></ul></ul><ul><li>Less protection in glandular mucosa </li></ul><ul><ul><li>Decreased mucus layer </li></ul></ul><ul><ul><li>Lower bicarbonate </li></ul></ul><ul><ul><li>Decreased blood flow to surface </li></ul></ul>
  9. 9. Ulcers- Grade 1
  10. 10. Ulcers- Grade 2
  11. 11. Ulcers- Grade 3
  12. 12. Horse Dependent Factors <ul><li>Age and gender </li></ul><ul><ul><li>No direct correlation </li></ul></ul><ul><li>Temperament </li></ul><ul><li>Bacteria? </li></ul><ul><ul><li>Helicobacter spp. </li></ul></ul><ul><ul><li>Higher concentrations in ulcerated areas </li></ul></ul><ul><ul><li>Cause or effect? </li></ul></ul>
  13. 13. Management Factors <ul><li>Exercise Intensity </li></ul><ul><ul><li>Increased acid secretion </li></ul></ul><ul><ul><li>Decreased stomach volume </li></ul></ul><ul><li>Stall Confinement </li></ul><ul><ul><li>Different feeding programs? </li></ul></ul><ul><li>Shipping </li></ul><ul><ul><li>Experimental model </li></ul></ul>
  14. 14. Feeding Factors <ul><li>Feeding Schedule </li></ul><ul><ul><li>Continuous grazing </li></ul></ul><ul><ul><ul><li>Less acid due to saliva production </li></ul></ul></ul><ul><ul><li>Intermittent feeding </li></ul></ul><ul><ul><ul><li>75% BID vs 57% TID </li></ul></ul></ul><ul><li>High Concentrate Diets </li></ul><ul><ul><li>Digestible carbs -> VFAs -> ulcers </li></ul></ul><ul><ul><li>Alfalfa may be protective </li></ul></ul>
  15. 15. Medications <ul><li>Nonsteroidal Anti-inflammatories </li></ul><ul><ul><li>Bute and Banamine </li></ul></ul><ul><ul><ul><li>Chronic use </li></ul></ul></ul><ul><ul><ul><li>Appropriate dosage </li></ul></ul></ul><ul><ul><li>Inhibit prostaglandins </li></ul></ul><ul><ul><ul><li>Decrease blood flow to surface of stomach </li></ul></ul></ul><ul><ul><ul><li>Decrease mucus production </li></ul></ul></ul><ul><ul><ul><li>Increase HCl production </li></ul></ul></ul>
  16. 16. Clinical Signs <ul><li>Vague and numerous </li></ul><ul><ul><li>Acute and recurrent colic </li></ul></ul><ul><ul><li>Diarrhea </li></ul></ul><ul><ul><li>Poor hair coat </li></ul></ul><ul><ul><li>Poor appetite ** , picky eating </li></ul></ul><ul><ul><li>Weight loss </li></ul></ul><ul><ul><li>Attitude changes </li></ul></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><li>Decreased performance </li></ul></ul>
  17. 17. Diagnosis <ul><li>History </li></ul><ul><li>Physical Exam </li></ul><ul><li>Minimum Database (PCV/TP) </li></ul><ul><li>GASTROSCOPY </li></ul><ul><ul><li>Only way to definitively diagnose ulcers! </li></ul></ul>
  18. 18. Diagnosis <ul><li>SUCEED Equine Fecal Blood Test </li></ul><ul><ul><li>Many false positives </li></ul></ul><ul><li>GASTROSCOPY </li></ul><ul><ul><li>Only way to definitively diagnose ulcers! </li></ul></ul>
  19. 19. Gastroscopy <ul><li>Video endoscopic examination </li></ul><ul><li>Must be fasted </li></ul><ul><ul><li>12-18 hours </li></ul></ul><ul><ul><ul><li>Can be housed at JVC the night before </li></ul></ul></ul><ul><ul><li>Empty stomach for good visualization </li></ul></ul><ul><ul><li>Excellent time to perform endocrine testing! </li></ul></ul>
  20. 20. Gastroscopy
  21. 21. Gastroscopy <ul><li>What do we look at? </li></ul><ul><ul><li>Upper airway </li></ul></ul><ul><ul><ul><li>Nasal passage, larynx </li></ul></ul></ul><ul><ul><li>Esophagus </li></ul></ul><ul><ul><li>Squamous and glandular mucosa </li></ul></ul><ul><ul><li>Margo plicatus </li></ul></ul><ul><ul><li>Pylorus </li></ul></ul><ul><ul><li>Proximal duodenum </li></ul></ul>
  22. 22. Treatments <ul><li>Management changes </li></ul><ul><ul><li>Increased turn-out </li></ul></ul><ul><ul><li>More frequent, smaller feedings </li></ul></ul><ul><ul><li>Constant roughage </li></ul></ul><ul><ul><li>Decrease stressful situations </li></ul></ul><ul><ul><li>Change in exercise regime </li></ul></ul>
  23. 23. Treatment <ul><li>Omperazole Gastrogard/Ulcergard </li></ul><ul><ul><li>Only FDA approved drug </li></ul></ul><ul><ul><li>Proton-pump inhibitor </li></ul></ul><ul><ul><li>Improved clinical signs with 28Dy course </li></ul></ul><ul><ul><ul><li>Better performance </li></ul></ul></ul><ul><ul><ul><li>Weight gain </li></ul></ul></ul><ul><ul><ul><li>Attitude </li></ul></ul></ul><ul><ul><ul><li>Appetite </li></ul></ul></ul><ul><ul><ul><li>Appearance </li></ul></ul></ul>
  24. 24. Gastrogard/Ulcergard <ul><li>“ Treatment” regime </li></ul><ul><ul><li>Whole tube once daily for 28 days </li></ul></ul><ul><li>“ Prevention” regime </li></ul><ul><ul><li>1/4 tube once daily </li></ul></ul><ul><ul><li>Targeted treatments </li></ul></ul><ul><ul><ul><li>1-2 days prior to competition/stress </li></ul></ul></ul><ul><ul><ul><li>During competition/stress </li></ul></ul></ul><ul><ul><ul><li>After competition/stress </li></ul></ul></ul>
  25. 25. Other Treatments <ul><li>Histamine Type-2 Receptor Antagonists </li></ul><ul><ul><li>Ranitidine/Cimetidine </li></ul></ul><ul><ul><ul><li>Ranitidine more potent </li></ul></ul></ul><ul><ul><ul><li>Lowers gastric acid production </li></ul></ul></ul><ul><ul><ul><ul><li>High doses </li></ul></ul></ul></ul><ul><ul><ul><li>Must be given every 8 hours </li></ul></ul></ul><ul><ul><ul><li>Costs as much or more than Gastrogard </li></ul></ul></ul>
  26. 26. Coating Agents <ul><li>Sucralfate/Carafate </li></ul><ul><ul><li>Coats stomach </li></ul></ul><ul><ul><li>Binds to ulcerated areas </li></ul></ul><ul><ul><li>Not effective when used alone </li></ul></ul><ul><ul><li>Must be given without feed </li></ul></ul><ul><li>Pepto Bismol </li></ul><ul><ul><li>Coats but may worsen ulcers </li></ul></ul>
  27. 27. Other Treatments <ul><li>Synthetic hormones (misoprostol) </li></ul><ul><ul><li>Improves blood flow </li></ul></ul><ul><ul><li>May cause cramping </li></ul></ul><ul><ul><li>Human concerns </li></ul></ul><ul><li>Prokinetic agents </li></ul><ul><ul><li>Increase gastric emptying </li></ul></ul><ul><ul><li>Colitis? Diarrhea? </li></ul></ul>
  28. 28. Dietary Supplements <ul><li>Seabuckthorn Berry Extract </li></ul><ul><ul><li>May prevent but does not heal </li></ul></ul><ul><li>Calcium carbonate supplements </li></ul><ul><ul><li>Requires large amounts given frequently </li></ul></ul><ul><li>Corn oil (linoleic acid) </li></ul><ul><ul><li>Increases prostaglandins and blood flow </li></ul></ul>
  29. 29. Summary <ul><li>Provide high quality forage 24/7 </li></ul><ul><ul><li>Feed alfalfa to buffer acid </li></ul></ul><ul><li>Limit concentrates, feed frequently </li></ul><ul><ul><li>No more than 6 hours apart </li></ul></ul><ul><li>Judicious use of Bute and Banamine </li></ul><ul><li>Try corn oil and other dietary supplements </li></ul><ul><li>Therapeutic or preventative doses of omeprazole </li></ul>
  30. 30. Appointments for Gastroscopy July 5th - July 28th Monday-Friday* 8am-5pm Client education coupon for PCV/TP: $25 value Special pricing for July: $198 (includes PE, sedation and scope) Savings of $125!

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