Gut response

GASTRIC (STOMACH) ULCERS AFFECT OVER HALF OF HORSES1 AND CAN LEAD TO LOSS OF PERFORMANCE IN COMPETITION HORSES, UNPREDICTABLE BEHAVIOUR AND POOR CONDITION. JANE CARLEY REPORTS ON THE LATEST IN TREATMENT, MANAGEMENT AND CARE FOR ULCER-PRONE HORSES.

ABOVE: GASTRIC ULCERS CAN CAUSE PAIN, LEADING TO BEHAVIOURAL CHANGES AND PERFORMANCE ISSUES.

ABOVE RIGHT: THE HORSE’S STOMACH, SHOWING TWO DISTINCT LOCATIONS FOR ULCERS WITH DIFFERENT CAUSES AND THUS TREATMENT APPROACHES REQUIRED. A n ulcer is the loss of the surface of the stomach lining, exposing the sensitive layers below to stomach acid, which causes pain.

Veterinary surgeon Paul Thomason explains that there are two types of gastric ulcer.

“Ulcers are found in the squamous mucosa in the upper part of the stomach when excess acid eats into the area, whereas glandular ulcers occur in the lower part of the stomach which sits in acid all the time. Glandular ulcers are now considered to be stress-related – due not just to a lack of fibre but other factors such as low grade lameness and frequency of exercise. Horses exercised more than five times a week may be prone to glandular ulcers.”

Lack of fibre is a factor in squamous ulcers, he comments, “This leads to inadequate stomach fill to protect from acid, but is also linked to

a high concentration of soluble carbohydrates which increase acidity.”

Ulcers may affect appetite and the ability to digest food so horses lose or struggle to maintain weight. They also cause pain, leading to behavioural changes and performance issues such as ‘girthiness’, or reluctance to go forward or lengthen strides. As signs are variable and subtle, it’s impossible to tell whether a horse has ulcers from symptoms alone, so it’s important to contact your vet if you are concerned. Ulcers are diagnosed by gastroscopy – a quick and painless procedure, passing a camera through the nose into the stomach, explains Dr Esther Rawlinson of Boehringer Ingelheim.

“If diagnosed with ulcers, your vet will recommend a course of treatment and management plan for your horse. They are likely to prescribe oral omeprazole, a licensed medication for treatment and prevention of gastric ulcers in horses. Alongside medication, it is important to identify and eliminate the trigger factors, to not only resolve the ulcers, but help prevent further episodes.”

IMAGE: BOEHRINGER INGELHEIM

Paul Thomason comments that omeprazole is very effective in treating squamous ulcers, and while glandular ulcers are not directly caused by acid attack, it can make them more painful, so controlling acid is important.

Esther adds: “Key is to minimise stress and keep to a regular routine. Horses should have access to forage and water at

all times, as a minimum going no longer than six hours without forage.”

Previously-held views about withholding hay or other fibre before work have now been discounted, says Paul, with small forage feed or access to ad-lib hay or haylage advisable before even fast work.

Jasmin Grogan, nutritionist at Baileys Horse Feeds suggests:

“Feed half a scoop of chaff, ideally alfalfa-based, 20-30minutes before exercise. Alfalfa is a ‘superfibre’ so has a high digestible fibre content with a good calcium source which is a natural acidity buffer. By doing this, it creates what is in effect a ‘fibremat’ in the horse’s stomach to help defend against acid splash.

Providing plenty of forage and fibre is key to prevention and ongoing management of ulcers, points out Paul.

“When the horse is eating forage, saliva is constantly being produced and it has high levels of bicarbonate which buffers acid – a horse can produce a bucket’s worth of saliva in a day.” F

“Ad-lib forage is preferable,” comments Jasmin. “Having said this, for horses that are overweight or good doers, this is not always practical as it would provide too many calories and weight gain. In this scenario, a minimum 1.5% bodyweight in fibre dry matter needs should be provided. In practical terms, taking a 500kg horse as an example – 1.5% bodyweight is 7.5kg, however, to compensate for a typical moisture content in hay, this figure is multiplied by 1.2 to ensure sufficient dry matter intake, leaving a total of 9kg ‘as fed’ hay, assuming hay is the sole forage source.”

If the horse is a poor/picky forage eater, fibre products can help supplement their intake, she adds. “This can vary from lowcalorie options to higher calorie, conditioning fibres.”

Duration of treatment with omeprazole depends on the type of ulcer, comments Paul.

During the initial period he suggests that it can be beneficial to stop or reduce the frequency of exercise, particularly if that is believed to be a stressor, before gently reintroducing it.

RIGHT: AN IMAGE OF THE STOMACH TAKEN DURING GASTROSCOPY SHOWS A GLANDULAR ULCER.

Diet is a key factor in prevention and treatment of ulcers, and Kate Hore, nutritionist for NAF suggests that where the horse is showing mild signs of discomfort or ‘girthiness’ and the owner is reluctant to scope, a high forage and fibre diet

IMAGE: BOEHRINGER INGELHEIM and a reduction in cereals fed can show improvement.

“A diet based on fibre and forage can be enough even for a competition horse, and if more energy is needed, then oil can offer a significant part of the energy quota,” she explains. “It needs to be introduced gradually, and should be high in omega-3. There are a range of branded oils which meet this criteria, or linseed or cod liver oil are suitable.”

A concentrated balancer with a broad spectrum of

If you’re competing at national or international level, it’s important to look for feed and supplement brands that manufacture according to Clean Sport guidelines and adhere to the BETA NOPS code which sets the standard for the control of Naturally Occurring Prohibited Substances.

vitamins and minerals should also form part of a forage-based diet where additional calories are suppled by oil, Kate adds.

For horses with ulcers but which also have reasonable calorie requirements, there are also a range of low starch, higher calorie feeds, points out Jasmin. F

Soluble fibre β-glucans in the hard feed increases the viscosity of stomach contents and coat ulcerated surfaces, explains TopSpec nutritionist Nicola Tyler. “For this to work effectively you need significant quantities of hard feed, so balancers and supplements are unlikely to provide sufficient β-glucans. Unfortunately, this also means it is hard to help horses that are good doers with sufficient β-glucans in an affordable way.”

She adds that while inclusion of certain calcium and magnesium salts may have a mild, short-term effect on improving the gastric environment, marine-derived, slow-releasing calcium has been found to be an effective, and longer acting, acid buffer.

The BETA feed assurance mark highlights feed products which are suitable for use in a dietary regime where scientific evidence supports reduction in the evidence of EGUS and is designed to help owners identify appropriate feeds. T

1. Sykes, B.W. et al. ECEIM Consensus Statement – Equine Gastric Ulcer Syndrome in Adult Horses. JVIM (2015) 29: 1288-1299

BELOW: GASTRIC ULCERS CAN AFFECT THE HORSE’S ABILITY TO DIGEST FOOD, AND LEAD TO COLIC.

Boehringer Ingelheim Animal Health UK Ltd equitop.co.uk, petsuk@boehringer-ingelheim.com, 01344 746957. Baileys Horse Feeds 01371 850 247 (option 2), nutrition@baileyshorsefeeds.co.uk. Nupafeed info@nupafeed.co.uk, 01438 861900. TopSpec 01845 565030. NAF Equine naf-equine.eu, 0800 373106.

There are a range of gastric supplements on the market, but it’s important to understand their functions.

“A number of ingredients are used to help horses with ulcers,” explains Kate Hore. “Some horses benefit from antacids such as calcium carbonate and magnesium carbonate to simply balance the acid. A number of botanicals have been shown to soothe the mucosal gut lining including psyllium, liquorice, marshmallow and ginger. Supplements are especially applicable when omeprazole treatment ends to avoid the risk of reflux ulcers, so aim to introduce them before the horse comes off omeprazole.”

Research into human gastric ailments is significantly more advanced than that for horses, but has also helped to guide equine product development, she adds.

“The use of probiotics and prebiotics has been shown to benefit the microbiota in the hind gut but also all along the digestive tract. Post-biotics are metabolites of digestion produced by the microbes in the hind gut, including B-vitamins, which are best absorbed in the small intestine. If post-biotics are supplemented, they can dissolve in the gut and be used throughout the digestive tract – it’s a big development in human treatment and we now have equine specific evidence for its use.”

Prebiotics such as the liquid form of sea buckthorn have been shown to be useful in helping horses withstand the stress of training and competition, suggests Jemma Noble of Nupafeed.

A study by two veterinary colleges in the USA found that horses treated with a product containing sea buckthorn berries and pulp showed significantly lower scores for glandular ulcer numbers and severity than untreated controls during a trial involving feed deprivation. The researchers concluded that the product could be useful in preventing glandular ulcers in horses confined to stalls (stabled horses).

IF YOU’RE COMPETING AT NATIONAL OR INTERNATIONAL LEVEL, IT’S IMPORTANT TO LOOK FOR FEED AND SUPPLEMENT BRANDS WHO MANUFACTURE ACCORDING TO CLEAN SPORT GUIDELINES AND ADHERE TO THE BETA NOPS CODE WHICH SETS THE STANDARD FOR THE CONTROL OF NATURALLY OCCURRING PROHIBITED SUBSTANCES.

FIRM UP from Global Herbs can help to get back to healthy droppings, a fast-acting herbal mix to encourage firmer stools, this natural supplement has a gentle action, supporting the growth of good bacteria in the gut and soothing irritation. Ideal for changes in diet, rich grass, post-treatment in stressful situations to aid normal digestion.

RRP: 500G £15.50. 1KG £28.90 | globalherbs.co.uk/product/diareeze

extends your horse’s eating time to support healthy digestion. It helps keep him happily occupied for several hours while eating with his head in a naturally lowered position. Unique design features a regulator grid that slides down evenly as forage is consumed. The Forager helps reduce the risk of colic, ulcers and boredom behaviours while reducing forage waste. Volume: 12 Kg of forage.

RRP: £295 | Haygain.co.uk

is a multi-vitamin and mineral balancer for horses and ponies prone to gastric ulcers and ideal for those that maintain weight easily on forage alone. It includes apple pectin and lecithin to help support the stomach lining as well as containing a natural source of calcium and FOS to help maintain a healthy pH in the stomach.

Spillers-feeds.com

is a naturally organic aloe vera feed supplement supporting comprehensive well-being in equine athletes. From digestion, coat, skin and hoof support, this easy-to-feed, taste-free supplement has been tested by an accredited Newmarket laboratory. It is NOPs certified and does not contain any synthetic compounds, so all your horse gets is pure, human-grade organic aloe vera in a daily sachet.

RRP: £55.20 FOR 30 DAYS. Multi-buy discounts available | aloeride.com

is a BETA NOPs and FEMAS certified forage suitable for competition horses, especially ones that have to be stabled for extended periods of time or travel regularly. It is dust-free and high in fibre supporting a healthy respiratory and digestive system essential for optimising performance. High Fibre HorseHage comes with a 100% quality guarantee and does not contain chemical additives or mould inhibitors. It comes in easy-to-handle bales and splits into useful wedges.

horsehage.co.uk

SARACEN HORSE FEEDS RE-LEVE No Oats. No Wheat. No Barley. A cereal-free, low starch, fully balanced mix utilises fibre and oil sources to optimise power generation and recovery. The mix is suitable for horses prone to Equine Gastric Ulcer Syndrome and includes a live yeast and BMC, a natural mineral source, which has been proven to support the gastrointestinal health of horses as it buffers excessive acid in the stomach and hindgut.

RRP: £20.50 FOR 20KG | saracenhorsefeeds.com

BIOEQUUS from Hi-Form is a symbiotic formulation containing pre- and probiotics which help to promote a healthy microbial balance in the digestive tract. This pleasant-tasting formula helps to maintain a healthy bacterial flora and has a beneficial impact on metabolic processes. A 500g tub fed at 10g per day will last approximately 50 days.

SUPPORT offers total digestive tract support, targeting both the fore and hindgut using the highest-grade active ingredients including prebiotics, with zero artificial fillers or bulking agents. When coupled with correct management and forage, PharmaTRAC supports the gastric environment, helping to maintain an optimum pH level and can be fed as part of a year-round maintenance programme or when extra support may be required during times of stress.

RRP: £45 FOR 1KG | bettalife.co.uk

hiformequine.co.uk

is a unique supplement that has been specifically designed to support your horse’s gastric health. Formulated as tasty pellets which are mixed with the feed, it contains 77% Apolectol, a patented combination of fruit and vegetable fibre, glycerol and lecithin. Apolectol forms a gel in the stomach, helping stabilise the protective mucus layer to support the stomach’s natural defences and maintain healthy gastric acidity for optimal gastric health.

equitop.co.uk

GASTRO BSC-Gastro provides a powerful blend of proven extracts to support gastric healing and mucosal defence against acid wear. This triple pronged formula of omega, anti-oxidant and prebiotic extracts nourishes both upper and lower regions of the stomach, as well as helping to soothe and stabilise the hindgut. BSC-Gastro is a highly palatable liquid supplement. Feeding rate can be adjusted to cover periods of increased risk such as stabling, travel and competition. Not an anti-acid, BSCGastro is designed to ensure optimum digestion and nutrient absorption. Fully FEI compliant.

RRP: £78.00 FOR 3 LITRES 15% off your first bottle – use code GASTRO15 nupafeed.co.uk

is designed to optimise digestive health and stimulate appetite in horses. It contains vitamin B12 and high levels of a pure, protected probiotic yeast and a pre-biotic MOS. TopSpec Digestive Aid is particularly effective for horses that are working hard, on high concentrate/ low forage diets, or are stressed. It is ideal for use after antibiotic/worming treatments which can upset the hindgut microbial balance. This proven formula, containing grass and mint leaves with added peppermint oil works on appetite both externally (appetising smell) and internally (via a range of ingredients).

RRP: £32.95 topspec.com

mix and cubes are both formulated to be sympathetic to a horse’s stomach and digestive system by being low in starch and sugar and providing high levels of slow release calories, from superfibres and oil. Both contain top quality protein sources, to build and repair muscle tissue, backed up with boosted levels of vitamins, chelated minerals and antioxidants to support performance, immunity and recovery. Ideal for any ‘stressy’ or sharp horses as well as those prone to gastric ulcers.

Designed to help retain clear areas in the glandular and non-glandular regions of the stomach, Five Star GastriVet is also fortified with targeted hindgut nutrients to provide and support live cultures. This supports natural anti-inflammatory processes and helps balance pH levels and offer acid ease. Five Star GastriVet addresses the integrity of the stomach wall lining, supports the fibre mat in the stomach and offers hindgut nourishment.

Naf-equine.eu.uk

THE IMPORTANCE OF SUPPLYING SUFFICIENT FIBRE FOR ALL HORSES IS WIDELY APPRECIATED HOWEVER, THE PERCEIVED NEED FOR CEREALS AND THE ENERGY THEY SUPPLY PERSISTS DESPITE THEIR LINKS TO DISEASES AND BEHAVIOURAL ISSUES. AS A RESULT, RESEARCHERS ARE INCREASINGLY FOCUSSING ON HOW TO FEED THE PERFORMANCE HORSE TO MAINTAIN HEALTH WITHOUT COMPROMISING

Recent studies presented at the European Workshop on Equine Nutrition in 2022, compared the performance of horses fed a combination of chopped alfalfa and oats alongside their forage with those just fed oats. They found no difference in speed, maximal power or muscle thickness between the two groups. In addition, the same research group found that when higher than recommended levels of starch were fed, the addition of alfalfa helped to counteract potential negative effects on the microbiome and digestion.

Our basic understanding of the impact of diet on the microbiota is increasing and again, it is well accepted that adding cereals increases the bacteria that digest starch at the expense of fibre digesting bacteria. Physical exertion and stress may have a significant, albeit temporary effect, on the gut microbiota composition and therefore host metabolism. Researchers also suggest that the type and intensity of physical training may impact the gut microbiota too.

The significance of this is yet to be fully understood but studies in humans are showing significant links between the microbiota and the health and behaviour of the host. We are just starting to understand more about this in the context of the horse too. It is known that the end products of fibre digestion (VFAs) interact with the cells of the gut and activate the production of serotonin – a neurotransmitter sometimes referred to as the happy chemical. What isn’t known yet in the horse is how the proportions of different VFAs produced from different feeds may impact on behaviour. Previous studies though, have compared high fibre (alfalfa based) versus starch based rations and found horses on high fibre rations

BELOW: DENGIE HAS A RANGE OF FEEDS APPROVED BY BETA FOR HORSES AND PONIES PRONE TO EGUS, INCLUDING NEW ULSER LITE. ABOVE: DRESSAGE RIDER AND TRAINER ANNA MILLER FEEDS ALFA-A TO ALL OF HER HORSES. LEFT INSET: CALCIUM & MAGNESIUM FOUND NATURALLY IN ALFALFA BUFFERS ACIDITY.

had lower resting heart rates and were less reactive to novel stimuli.

The simple answer is yes. Studies in the early 2000s (Nadeua et al, 2000; Lybbert et al, 2007) showed that it was more beneficial for horses with ulcers (ESGD) compared to grass forages, as the high levels of calcium and magnesium act as natural buffers to acidity. Alfalfa has really deep roots – about 3 to 4 metres – and the calcium at this depth in the soil is more available for absorption. This means that alfalfa plants can take up more calcium than grass – chopped alfalfa contains between 30 and 50% more calcium than grass forages.

In addition, alfalfa is very low in starch compared to other forages. Like other plants, alfalfa makes sugar when photosynthesising but it stores any surplus sugar as starch in its roots – the part that horses don’t eat! Grass plants tend to store sugar as fructan in leaves and stems and cereals store starch in grains which are the bits that horses do eat!

As a herbivore the horse has a large digestive system which can hold a lot of fibrous material. When a range of horses were weighed before and after having forage withheld overnight in preparation for an exploratory gastroscope, they were found to have lost between 17-20kgs which is equivalent to a typical bag of feed. This drop in weight results from waste or indigestible material passing out of the digestive system and not being replaced! This fibrous material acts as an important fluid reservoir. The gut can hold around 50 litres of water and the amount is significantly influenced by diet. Meal feeding has been shown to result in transient dehydration in the gut and feeding a few large meals each day can cause a level of dehydration sufficient enough to disrupt the flow of material through the gut. Feeding a greater proportion of fibre and reducing meal feeding could help to improve the hydration status of the gut too.

In many cases, the Dengie range can be used to provide the horse with sufficient energy for the work they are doing reducing the need to feed cereals and thereby reducing starch intake significantly. For more information please contact the Dengie Feedline on 01621 841188 or visit dengie.com

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