Nutrition Focus: Revisiting Gastric Ulcers

Lorna Edgar – specialist equine nutritionist

Revisiting Gastric Ulcers

After talking about the digestive system last month, I thought it might be appropriate to revisit and remind ourselves about Gastric Ulcers and how we can make some small changes in everyday stable management to help reduce the risks of getting them and treating them.

Research has shown that more than 90 per cent of racehorses in intensive training have gastric ulcers and two different studies on leisure horses have found that up to 37 per cent in one study and 53 per cent in another have gastric ulcers, so it is highly likely that polo ponies are at high risk too.

How do they occur?

As we will have learnt from last month’s article, the horse is designed to have a constant flow of fibre passing through its digestive system. The stomach continuously produces hydrochloric acid in its lower glandular region to begin the digestive process, PRODUCING APPROX 1 ½ LITRES PER HOUR. Saliva is produced through chewing (when the horse is ‘trickle feeding’ naturally it will produce up to 12 litres per day), which helps neutralise the acid through its bicarbonate content and acts as a buffer to the gastric acid in the stomach. The lower, glandular area, of the stomach is protected by mucus. The upper, squamous region of the stomach has no built-in protection because it relies on the physical barrier of the continuously ingested fibre.

Generally, ulceration of the upper squamous region can occur when acid from the lower region splashes up, either because of insufficient fibre passing through the stomach and/or through the physical effect of exercise.

Ulcers in the glandular region (pyloric ulcers) are less common but can occur when the protective barrier is compromised, for example, through stress or continued use of drugs, like ‘bute’.

Exercise Causing Ulcers

The severity of ulcers seems to be greatest in horses that are in training for prolonged periods of time; researchers have looked at the effects of exercise on the digestive system and found that there is increased pressure when a horse exercises at high intensity, leading to compression of the stomach, thus pushing the acidic contents of the gastric region into the squamous region – the ‘sloshing’ effect. The longer the training, the increased time the squamous region is exposed to acid, increasing the potential for ulcers to occur.

What are the Signs of Ulcers?

The only way to make a definitive diagnosis is via a gastroscope examination. The symptoms that would lead you to a discussion with your vet include: • Poor appetite • Weight loss – ‘good doers’ are just as susceptible • Loose droppings/acidic smelling droppings • Mild signs of colic • ‘Girthiness’/grumpiness/hypersensitive • Resistance or explosiveness under saddle • Excessive recumbency (lying down) • Dull coat • Poor performance/exercise intolerance

Photography courtesy of Lorna Edgar

Following gastroscopic diagnosis, there are a number of medications which can be recommended by your vet, most commonly, omeprazole, a proton pump inhibitor which suppresses the production of stomach acid. Alongside medical treatment, management and diet are instrumental for recovery and prevention of recurrence.

What Supplements can be Used?

A growing variety of supplements are available with some ingredients now also being included in feeds as well. These may help support a treatment and management regime and aid in the prevention or recurrence of ulcers. Key ingredients include: • Antacids – Support the buffering of gastric acid, helping to neutralise stomach pH • Beta-glucans – Soluble fibre which can act as a coating for the stomach lining, as well as improving the digestion of starch and sugar within the foregut • Pre- and probiotics – Support the population of beneficial bacteria within the hindgut, helping to promote the digestion of fibre. • Gum Arabic – A natural prebiotic and source of soluble dietary fibre (a complex polysaccharide) which supports the relief of inflammation and the integrity of the stomach lining. • Pectin – a water-soluble fibre commonly found in beet pulp which turns into a gel in contact with gastric acid which could help protect the lining of the stomach.

How to Assist with Feeding & Management

Constant access to ad lib forage is ESSENTIAL, to keep the horse chewing and producing saliva, which contains its own buffer to help neutralise stomach acid. If the horse can’t be worked from the field, then lengthy daily spells of turnout on grass are also important for increasing the fibre intake and to help reduce stress.

Concentrate feed needs to contain minimal starch (<10%) to help keep acidity levels in the digestive tract under control. Exercising on an empty stomach should be avoided, so it is wise to ensure fibre has been consumed – a scoop of alfalfa chaff 20-30 minutes before exercise is ideal and WON’T hinder performance. Alfalfa is known to have natural acid – buffering properties, hence when given before exercise can really help to act as a ‘mat’ and reduce the amount of acid ‘sloshing’ in the stomach.

Fibre Intake

For the hard-working polo pony, who often has limited access to fibre/forage/grass or perhaps are not good hay/haylage eaters, increasing time at hay, haylage or grass, or providing alternative fibre sources is essential to encourage and increase fibre intake. Alfalfa chaffs, soaked beet pulp or beet/alfalfa combinations are also • Oils (Outshine high oil supplement) can be added to an existing balanced diet to provide additional low starch calories

It is important for polo ponies to be allowed access to hay, haylage or grass

very useful, as are freeze dried grasses or hay replacements. These can all be fed in separate buckets from the compound feed, in order to provide a selection and to encourage natural foraging behaviour.

Concentrate Feed

Research suggests that the horse should not receive any more than 1g/kg of bodyweight per meal of starch, or 2g of starch per kg of bodyweight per day, to assist in the treatment and management of gastric ulcers. When looking at feed labels, ‘low starch’ would be 10% and below, with typical competition mixes being around 30% starch. • Removing oats from the diet is an

absolute MUST!

Remember, the ‘rugby ball’ sized stomach does not stretch, not more than 1 ½ scoops of cubes/mix/chaff/ beet per feed! Low starch feeds assist in the treatment and management of gastric ulcers

Feeding a High Calorie Diet…

Forage • Choose a soft, leafy hay or haylage, which is likely to be more nutritious and more digestible • If poor forage eaters offer alternative fibre sources, such as alfalfa chaff, freeze dried grasses or beet pulp such as Speedi-Beet/

Fibre Beet, ideally in separate buckets from the hard feed so they can graze continuously o Alfalfa for its buffering capacity, and beet pulp has a good ‘acid binding’ capacity and high in pectins which are beneficial in that their structure alters to one that is similar to mucus when in an acidic environment, consequently acting as further protection to the stomach

Concentrates • Baileys Ease & Excel, for example, is a low starch (8%) high specification feed, it has a high Digestible Energy (13MJ/kg) which is delivered by oil and fibre and is fully balanced when fed in the correct quantities

Lower Calorie Requirements

Forage • Good-doers must be kept chewing even though forage intake may need controlling to avoid weight gain. Choose coarser, stalkier (less leaf, more stem) hay or haylage which is more mature and should be less nutritious yet still provide plenty of fibre to chew • Give lots of small feeds of forage • Use small-holed nets to make forage last for as long as possible Concentrates • Balancers will provide essential vitamins, minerals and protein without unwanted calories and with minimal starch and sugar • Balancers must be fed to the recommended levels • The balancer can be fed with a small amount of alfalfa • Although beet pulp can be fed for conditioning, when fed in smaller amounts it can be beneficial for good-doers due to its ‘acid binding’ capacity. As a guideline, one mug of Speedi-Beet will soak to approximately a Stubbs scoop in wet volume – making it a great low calorie and low starch fibrous option when fed in this way

Careful Management

So, while diagnosis and treatment are highly recommended, some horses will respond to appropriate changes in management and diet alone but these will need to be maintained to ensure the horse continues to feel comfortable. For some, a small reduction in starch intake or cereal levels will be sufficient to improve their performance, outlook and condition, while others require a more radical approach.

The hard-working polo pony is at risk from ulcers caused by acid-splash during exercise, no matter how little starch they are fed so, for them, careful management is even more important – and doing away with muzzles is a must!

Ensuring that the horse has constant access to water may also help to dilute gastric fluid and help increase the pH so it is less acidic. Studies have shown those without access to water whilst in their paddock were more likely to have ulcers with grade 2 or more.

Plenty of food for thought!

Contact Lorna Edgar of Baileys Horse Feeds on lorna@baileyshorsefeeds.co.uk