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The most common treatment options for equine gastric glandular disease (EGGD) include misoprostol, oral omeprazole, and sucralfate, either alone or in combination, as well as long-acting intramuscular injectable omeprazole (LAIOMEP). A recent study comparing these options found that healing occurred in only 29% of treated horses and healing primarily involved only severe lesions.*

EGGD describes nonulcerative lesions of the lower, glandular region of the stomach, and includes many types of lesions, including those that are flat, erythematous, nodular, or fibrinosuppurative. Although grouped with equine squamous gastric disease (ESGD) under the umbrella term equine gastric ulcer syndrome or EGUS, EGGD has different risk factors, clinical signs, and pathophysiology.

“In other words, EGGD is a horse of a different color and not nearly as well understood. Medications successfully used to treat ESGD are not particularly effective with EGGD, yet no other targeted treatment options exist,” explained Ashley Fowler, Ph.D., a nutritionist for Kentucky Equine Research.

Exploring the available options, researchers at the University of Nottingham in the United Kingdom compared the efficacy of the four currently available treatments mentioned above. Eighty-four client-owned horses that underwent gastroscopy and treatment between 2012 and 2019 were included in the study. Gastroscopic examinations and lesion grading were performed by four board-certified veterinary practitioners. Horses were evaluated 4, 8, and 12 weeks after treatment was initiated.

Across all treatment options, lesions in 29% of horses were declared healed and lesions in an additional 43% of horses improved. However, 21% percent of horses remained unchanged and 7% worsened.

“These outcomes are markedly lower than response rates reported in previous studies for LAIOMEP and misoprostol but similar for oral omeprazole and sucralfate,” explained Fowler. “Researchers suggested these low success rates might have been due to negligible owner compliance with therapy administration.”

When evaluating factors that could predict outcome, severity was significant. Only severe lesions were likely to improve, whereas mild cases were more likely to worsen.

No significant difference in outcome was noted between the four different treatments, which the researchers described as unexpected.

“In fact, this is the first study to report worsening with both misoprostol and LAIOMEP and a high proportion of horses resistant to treatment,” Fowler said. “The researchers suggested that unknown management factors may contribute to treatment failures and that further research is required in larger, multicenter prospective studies.”

Without consistently effective treatment options and until a better understanding of exactly how these lesions develop, support your horse’s overall gastrointestinal health with Kentucky Equine Research’s line of digestive health products. Of special interest in cases of EGGD is Sucralox, a source of sucrulfate available in Australia. Sucralox also contains a fast-acting antacid to help neutralize gastric acid.

*Pratt, S.L., M. Bowen, G.H. Hallowell, E. Shipman, J. Bailey, and A. Redpath. Does lesion type or severity predict outcome of therapy for horses with equine glandular gastric disease? A retrospective study. Veterinary Medicine and Science. doi:10.1002/vms3.1034.

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