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  Discussion on Hind gut ulcers and no diarrhea
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Member:
dlsenDrO

Posted on Saturday, Feb 27, 2016 - 10:39 am:

My 8 year old Dutch Warmblood was diagnosed with grade 1-2 ulcers. The only symptoms he had were behavioral, he was not off-feed, colicky, girthy or having loose manure. We had him scoped to confirm the ulcer suspicion after all other avenues came to a dead end. He has been responding to the Gastrogard and I want to be proactive and put him on a supplement for hind gut ulcers as well. But he doesn't have any loose manure. In fact, his manure is on the firmer side. What are the odds that a horse would have hind gut ulcers without the classic loose manure symptoms? Would it be worth it to treat him for them anyway, or will hind gut supplements dry his manure out more?
Member:
gramsey1

Posted on Saturday, Feb 27, 2016 - 1:32 pm:

It is hard to get them off the Gastrogard without the ulcers coming back. Double the course of treatment, then cut the dose in half for two weeks. Then cut it in half again for two more weeks.
In addition, add a little alfalfa to his diet. Spread the feeding out if you can.
We also use Succeed for a couple of months after ending the low dose Gastrogard.
Finally, if you read the articles here, you will see that the generics don't seem to work as well as the name brand product.
I purchased an early generics from Abler. And confirmed that it did not work as well as Gastrogard. But, Abler subsequently coated the drug, and put it in paste form. It must have enabled the drug to get past the stomach and into the portion of gut where it could be absorbed. the new version worked for us. And is substantially less expensive.
My 2 cents.
Member:
dlsenDrO

Posted on Saturday, Feb 27, 2016 - 8:17 pm:

Guy, when you say to double the course, do you mean 56 days versus 28 on a full tube? We did 28 days full tube and are now on 4 weeks half tube to 2 weeks 1/4 tube. He is getting alfalfa and free choice hay. What did you think about the Success? I am going back and forth between that and EquiShure. Glad to hear about the Abler product. It is certainly nice to have a back up after the insurance money runs out. Did you have to do a second course of omeprazole?
Member:
gramsey1

Posted on Sunday, Feb 28, 2016 - 9:02 am:

We transition OTTBs from the track to new lives as show or sport horses. The best information we have is that most have ulcers. The first couple we restarted were scoped and diagnosed. Yes, the two we had diagnosed took two full treatments.

We stopped spending money for diagnosis. The treatment is low risk and relatively low cost. So, we started doubling everything (time wise). We haven't tried the 28 day followed by a double long taper. It might work fine.

The active ingredient in EquiShure is sodium bicarbonate, an acid neutralizer. Since the omeprazole is going after the acid problem. It probably isn't necessary. The free choice hay and supplemental alfalfa should do the trick there.

The active ingredients in Succeed are amino acids. They tackle the problem from a different angle. The links below show how they are used in humans. I am not aware of research on how they work in horses. The product was first recommended to me by one of the track trainers we work with. His was one of the OTTBs we have worked that did not show signs of stomach ulcers. Succeed makes more sense to me.

https://www.webmd.com/vitamins-supplements/ingredientmono-878-glutamine.aspx?acti veingredientid=878&

https://www.webmd.com/vitamins-supplements/ingredientmono-1083-threonine.aspx?act iveingredientid=1083&activeingredientname=threonine

All this information is unscientific and anecdotal, your results may very different. I hope everything works out for you and your horse.
Moderator:
DrO

Posted on Sunday, Feb 28, 2016 - 7:29 pm:

This is a pretty good article on Colonic Ulcers and should give you some ideas to pursue your concerns. First obtain some objective evidence that there is a problem.
DrO

Colonic Ulcers

Frank M. Andrews, DVM, MS, DACVIM
LVMA Equine Committee Professor and Director
Equine Health Studies Program
Rebecca McConnico, DVM, PhD, DACVIM
Professor of Equine Medicine
Department of Veterinary Clinical Sciences
School of Veterinary Medicine

Louisiana State University
Baton Rouge, LA 70803

Ulcers in the equine colon (intestine) are common in performance horses and lead to decreased performance, vague clinical signs (partial loss of appetite, rough dull hair coat, intermittent mild colic, and diarrhea), changes in blood work (low protein and high white blood count, and inflammation) and may go undiagnosed for months because horses are usually normal between acute episodes. All ages and breeds of horses are susceptible to ulcers of the colon and current treatment focuses on reducing bulk in the diet, use of gut coating agent and condition agents, mild laxatives, and oils to promote healing.1

Ulcers of the colon are usually referred to as Right Dorsal Colitis (RDC) as most of the ulcers are located in this part of the large intestine, which is in contact with the right body wall. This condition occurs less frequently than gastric ulcers, but might lead to fluid under the skin (edema) and diarrhea. In one study of 545 horses, nearly half (44%) of non-performance had colonic ulcers, whereas 65% of performance horses had colonic ulcers.2 Colonic ulcers are probably associated with stress induced release of the body's natural steroids or the administration of non-steroidal anti-inflammatory agents, like Bute or Banamine. Early in the condition, horses present with non-specific signs of mild intermittent or recurring colic episodes, lethargy and loss of appetite. However, as the condition worsens clinical signs may include complete loss of appetite, fever, colic and diarrhea. Progression of RDC may lead to dehydration, ventral edema, and weight loss. Other conditions that could look like RDC include gastric ulcers, other causes of colic (large colon displacement and/or impaction), infectious causes of diarrhea (Salmonellosis, Potomac Horse Fever, Clostridium), granulomatous and eosinophilic enteritis (inflammatory bowel disease), and intestinal neoplasia (cancer).

Diagnosis
A presumptive diagnosis of RDC can be made on history (recurrent colic episodes, intermittent diarrhea, loss of performance, weight loss), clinical signs as mentioned above, changes in blood work (mild anemia, toxic changes in white blood cells, and a high number of white blood cells, low blood proteins and high inflammatory proteins, and low calcium). Peritoneal (belly) fluid analysis might show a mild increase in WBC count and increase in total protein concentration (> 2.5 g/dl). The presence of blood in the manure can be helpful as an ancillary diagnostic test in horses with RDC.2 Recently, a new test (Succeed Fecal Blood Test, Freedom Health, LLC, Aurora, OH) (Figure 1) was commercially developed to measure blood in the manure and this test was shown to be very good at predicting RDC. The positive test might help your veterinarian determine if the horse has RDC, but will be used as a part of a total diagnostic approach.

Your veterinarian may put an endoscope (gastroscope) in the stomach, to see if the horse has gastric ulcers, because the clinical signs of gastric ulcers are similar to those of RDC. If gastric ulcers are present then your veterinarian may want to start antiulcer treatment to see if the horse gets better. However, sometimes gastric and colonic ulcers can occur in the same horse, especially if there is concurrent changes in the blood work. Treatment with antiulcer medications will have no affect on colonic ulcers.

Another diagnostic your veterinarian may perform is abdominal ultrasound of the right dorsal colon. This technique may show thickening (normal < 0.4 cm) of the colon wall, which lies against the right body wall in the abdominal cavity.3 Your veterinarian will scan the right dorsal colon by placing the probe between the ribs over the colon in the right side of the horse. Examination of the colon might reveal thickening of the colon.

If the horse has diarrhea, your veterinarian will make every effort to rule-out infectious causes such as, Salmonellosis and Clostridium, by using fecal cultures. However, these conditions will have similar clinical signs might occur in the same horse.

Treatment
The principle goals of treatment for RDC includes discontinuing or avoiding the use of NSAIDs (especially Bute and Banamine), decreasing gut fill and bulk in the diet (mechanical load on the colon) to allow the colon to rest, frequent feedings, reducing inflammation, coating and restoring the normal colon absorptive function and implementing methods to decrease stress.1 To reduce gut fill your veterinarian might recommend replacing the dry hay in the diet with an alfalfa-based complete pelleted feed like Equine Senior (Purina SeniorÔ, Purina Mills, St. Louis, MO). This reduces gut fill and decreases the mechanical load on the colon. The horse can be allowed to graze small amounts of fresh grass (10 to 15 minute intervals four to six times daily) to help decrease the stress of stall or dry paddock confinement and maintain body weight. The switch to a complete feed diet should be made over several days to a week to allow the gastrointestinal tract time to acclimatize to the feed change. This dietary change is only temporary and may last up to 3 to 4 months or at which time the blood work returns to normal. Your veterinarian may recommend weekly blood work once the horses diet is switched to the pellets.

Your veterinarian may recommend psyllium mucilloid (Equisyl AdvantageÔ, Animal Heath Care Products) or psyllium hyDrOphilic mucilloid (MetamucilÒ, Proctor & Gamble, Cincinnati, OH) added to the diet to lubricate and shorten transit time for feed material and increase water content in the intestines. Also, psyllium increased the concentration of fatty acid in the colon and reduces inflammation.

Furthermore, your veterinarian may suggest the addition of corn or safflower oil (1 cup, added to feed, q12h) added to the complete feed to increase Omega-3 fatty acids. Omega-3 fatty acids effectively block the chemicals released in the body due to stress, which decreases inflammation in the colon due to the ulcers.

The use of medication routinely used for gastric ulcers (antacids, omeprazole, or ranitidine) would not be expected to be effective in treatment of RDC. However, your veterinarian might recommend the use of sucralfate, a sucrose octasulfate and polyaluminum hyDrOxide complex, that binds to the ulcer bed and forms a bandage over the ulcer. Also, sucralfate, once it has adhered to the ulcer crater, stimulates local protective chemicals called prostaglandins, which has a “cytoprotective” effect on the colon mucosa.

Minimizing physiologic and environmental stresses can also be helpful in controlling RDC. Stall rest, reduction of strenuous exercise or training, and reduction in travel are ways to decrease stress. Horses should always have adequate amounts of clean fresh water and should be provided a mineral/salt mix to ensure adequate water intake. Flavored water can be given to horses at home so that water intake can remain the same on the road and at shows.

Length of Treatment and Prognosis
Generally it takes between 1 to 2 weeks to see improvement in clinical signs, once the diet has been changed. Weekly monitoring of blood work is important indicators of response to treatment and prognosis. Improvement in blood work might take several weeks. In addition to blood work, your veterinarian will recommend serial ultrasonographic examinations of the Right Dorsal Colon to help in monitoring response to treatment. Typically weekly to every two week ultrasonographic examinations can help your veterinarian gauge therapy. The swelling in the wall of the Right Dorsal Colon should decrease within 4 to 6 week after initiation of dietary changes and treatment, but may take longer in some horses.

The response to treatment is good, especially if the horses' clinical signs, blood work, and ultrasound signs improve rapidly. Be sure you contact your veterinarian as soon as you recognize these signs as the longer it continues the more difficult it is to treat successfully.
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