June 13, 2023

Chasing the Ulcer Diagnosis - Why It's Worth It

From The Vet, Dr. Dan Carter...

Some horses with ulcers are easy to spot - they lose their appetites or experience chronic colic. Sometimes it’s hard to recognize a horse suffering from these painful intestinal sores. In this column, I’m going to talk you through recognizing when a horse might have ulcers and knowing how to obtain a diagnosis.

A lot of times, a horse who’s reluctant to be tacked up, seems uncharacteristically opposed to performing certain parts of his job (e.g. jumping, doing collected work) or displaying unusual behavior problems at horse shows may be experiencing pain from ulcers. Their symptoms may mimic other ailments. I used to check a fair amount of mares with the aforementioned attitude issues for ovarian problems, but now I lean toward scoping for ulcers first. Even when I’m fairly sure we’re dealing with ulcers, I scope before putting a horse on any type of medication. Here's why.

Recognizing The Problem

Even when scoping doesn’t reveal ulcers, the information we do or do not come away with puts us on a faster track to a diagnosis. I’m going to give you a few anecdotal examples to explain what I mean here. An owner brought
a horse experiencing digestive problems to my clinic. We scoped the horse, and we found that its stomach was full of bot fly larvae, causing the horse to be unable to properly digest its feed. This discovery gave way to a $6 fix in the form of dewormer.

Image of fly larvae in horse's stomach

Another time, I scoped a horse expecting to encounter ulcers, but instead I found a phytobezoar - a stone-like buildup of organic material in the intestinal tract. We had to break up the bezoar over the course of a few days, but we were a lot closer to resolving the issue at the end of that time than we would have been had we not scoped.

Diagnosis Time: Don’t Shoot In The Dark

I get the “but scoping is so expensive” reaction from a fair amount of owners. Sure, it’s a few hundred dollars, which isn’t anything to sneeze at, but a solid diagnosis is the most valuable information you’ll ever get.

Here’s what I mean.

There has emerged a tendency among some owners and trainers to administer an ulcer treatment medication for a certain amount of time (a week, usually) to see if the horse responds favorably. If symptoms are reduced or eliminated, a tube of the medication is administered daily for a month, ostensibly to permanently eliminate the ulcers. Here’s the problem with this practice (aside from the fact that it’s not condoned in veterinary circles): each tube of medication runs about $30. By the time you’ve medicated a horse who hasn’t even been formally diagnosed with ulcers for those five weeks, you’ve spent more than $1,000.

Even if you do eliminate the ulcer problem temporarily with this shoot-in-the-dark method, you don’t have a grasp on the severity of the ulcers - veterinarians categorize them on a scale of one to three. Scoping, at a cost of roughly $300, allows vets to get a grasp on just how dire the situation is before proceeding with a treatment plan. Here’s another consideration - if you don’t eliminate the ulcer problem by administering the medication yourself, you’ve just set the horse back in his treatment by a month.

Medicating an undiagnosed horse often doesn’t permanently solve the problem, either. At our clinic, if we do find ulcers upon scoping, we grade the ulcers, designate a treatment period for administration of medication and then rescope every 30 days until the problem is completely resolved. This way, we determine which horses are prone to ulcers of which severity, and we can put in place preventative measures if need be. For example, all horses need hay to be moving through the gastrointestinal tract as regularly as possible, but it’s an especially important consideration for the ulcer-prone horse - forage works to neutralize the Ph in horses’ saliva and in the non-glandular portion of the stomach. Some ulcer patients may also need to be placed on a maintenance medication indefinitely. Owners won’t know what kind of maintenance program their equine needs, however, if they opt to avoid the scoping process.

The main thing I’m hoping you’ll take away from this column is that the most expensive medicine is the one that doesn’t work. Sure, the expense of scoping is outside most owners’ maintenance budgets, but it’s a lot more affordable and effective to get a diagnosis first and then proceed with treatment under the direction of a veterinarian.

Dr. Dan Carter is one of only five veterinarians in the U.S. who is also an AFA Certified Journeyman Farrier. Click here to learn more about Dan Carter, DVM, CJF.

Gastric Ulcers