Todayโs path rounds are on ๐ ๐๐ฌ๐ญ๐ซ๐ข๐ ๐ฎ๐ฅ๐๐๐ซ๐ฌ! This was a request 
๐๐ก๐๐ญ ๐ข๐ฌ ๐ข๐ญ?
Gastric ulcers are areas where the stomach ๐ฆ๐ฎ๐๐จ๐ฌ๐ (the lining) has become eroded, exposing the underlying tissue. This often associated with hemorrhage and inflammation.
๐๐ก๐จ ๐ ๐๐ญ๐ฌ ๐ข๐ญ?
All species can get this, but today we are going to talk about horses! They are probably the most frequently affected species with this disease, due to the unique anatomy of their stomach.
๐๐ก๐๐ญ ๐๐๐ฎ๐ฌ๐๐ฌ ๐ ๐๐ฌ๐ญ๐ซ๐ข๐ ๐ฎ๐ฅ๐๐๐ซ๐ฌ?
As mentioned previously, the cause of gastric ulcers in horses is fairly unique. Horses have two types of mucosa in their stomach, a ๐ ๐ฅ๐๐ง๐๐ฎ๐ฅ๐๐ซ ๐ญ๐ฒ๐ฉ๐ that produces stomach acid and a protective mucous layer, and a ๐ง๐จ๐ง-๐ ๐ฅ๐๐ง๐๐ฎ๐ฅ๐๐ซ ๐ญ๐ฒ๐ฉ๐ that is pretty much the same as mouth mucosa with no protective mucous. Now imagine if you tried to drink a super acidic substance how crappy your mouth would feel! Thatโs basically what happens to the non-glandular mucosa in the horseโs stomach. Pretty much any time the stomach acid splashes up onto this mucosa it can get an acid burn, producing an ulcer.
๐๐ก๐๐ญ ๐ฌ๐๐๐ฆ๐ฌ ๐ฅ๐ข๐ค๐ ๐ ๐ก๐จ๐ซ๐ซ๐ข๐๐ฅ๐ ๐๐๐ฌ๐ข๐ ๐ง ๐๐ฅ๐๐ฐ.
Yup, you would be right! Especially with how horses live now. In their โnatural stateโ, horses would be eating entirely forage based diets, nearly all hours of the day. However, we donโt tend to manage horses in this manner! Domesticated horses are often fed large amounts infrequently, leaving them with long periods without food. Horses constantly produce stomach acid, so having these long breaks with nothing to digest allows gastric acid to accumulate, and the stomach content to become very fluid, allowing splashing. Additionally, horses are often fed high-grain diets, which can increase the acidity of stomach acid and make it more damaging to the non-glandular mucosa. Both of these factors, combined with intensive exercise which can cause splashing of the stomach contents, set horses up to get gastric ulcers very easily. In fact, it is estimated that 60-90% of adult horses have gastric ulcers!
๐๐ก๐ฒ ๐๐ซ๐ ๐ญ๐ก๐๐ฒ ๐ ๐ฉ๐ซ๐จ๐๐ฅ๐๐ฆ?
If youโve ever had heartburn, you can probably relate to a horse with gastric ulcers. Horses have abdominal pain, donโt want to eat, donโt want to exercise or train, may lay down frequently or even show signs of colic. Additionally, with severe enough ulcers, there is a risk of ๐ ๐๐ฌ๐ญ๐ซ๐ข๐ ๐ฉ๐๐ซ๐๐จ๐ซ๐๐ญ๐ข๐จ๐ง, where the stomach acid may eat a hole all the way through the stomach wall, releasing stomach contents into the abdomen. Very not good!
๐๐จ๐ฐ ๐ข๐ฌ ๐ข๐ญ ๐๐ข๐๐ ๐ง๐จ๐ฌ๐๐?
Gastric ulcers are diagnosed by ๐๐ง๐๐จ๐ฌ๐๐จ๐ฉ๐ฒ, which is where they stick a camera on a very long tube through the horseโs nose and into their stomach. From there, they can visualize the ulcers and come to a definitive diagnosis. At necropsy, we typically see thick, white to yellow nodules along the junction between the glandular and non-glandular stomach, a line called the ๐ฆ๐๐ซ๐ ๐จ ๐ฉ๐ฅ๐ข๐๐๐ญ๐ฎ๐ฌ. These nodules are areas of inflammation, where the body is responding to the damage and trying to heal. Sometimes we can also see โfreshโ ulcers, which are usually bright red erosions in the normal mucosa.
๐๐จ๐ฐ ๐ข๐ฌ ๐ข๐ญ ๐ญ๐ซ๐๐๐ญ๐๐?
Gastric ulcers are typically treated with medication, with the goal of reducing the amount of stomach acid in the stomach. The typical treatment is ๐จ๐ฆ๐๐ฉ๐ซ๐๐ณ๐จ๐ฅ๐, which prevents the release of stomach acid from the cells that produce it. Lifestyle changes can help to, including more frequent meals, reducing grain, and decreasing stress.
๐๐ก๐จ๐ญ๐จ๐ฌ
1) Diagram of the normal equine stomach. Note the difference in colour between the non-glandular, nice and pink mucosa and the darker glandular mucosa.
2-4) Equine gastric ulcers at necropsy. QOTD: Can you spot a little friend hanging out in one of the photos? Do you know what it is?
๐๐จ๐ฎ๐ซ๐๐๐ฌ
Maxie, G. Jubb, Kennedy and Palmerโs Pathology of Domestic Animals, Volume 2. Sixth Edition.
Sykes, B.W., Hewetson, M., Hepburn, R.J., Luthersson, N., Tamzali, Y. European College of Equine Internal Medicine Consensus Statement โ Equine Gastric Ulcer Syndrome in Adult Horse. Journal of Veterinary Internal Medicine 2015: 29(5), 1288-1299.
Photo 1 courtesy of Sykes et al.
Photo 2-3 courtesy of University of Calgary Diagnostic Services Unit.
Photos 4-5 courtesy of Noahโs Arkive.
