Original Research
A Comparison Between Omeprazole and a Dietary Supplement for the Management of Squamous Gastric Ulceration in Horses

https://doi.org/10.1016/j.jevs.2016.02.228Get rights and content

Highlights

  • Succeed was noninferior to omeprazole for resolution of ulceration after 90 days.

  • Omeprazole and Succeed significantly reduced ulcer scores at days 30 and 60.

  • After 90 days of treatment, the efficacy of omeprazole appeared to be reduced.

Abstract

Although several studies have assessed the short-term effect of dietary supplements on the treatment and prevention of gastric ulceration in horses, few have assessed the response over a duration of more than 30 days. A blinded randomized noninferiority clinical trial was conducted using 42 Thoroughbred horses in race training with squamous ulceration of ≥ grade 2/4, randomly assigned to one of two treatment groups for a period of 90 days: omeprazole at the full label dose of 4 mg/kg or the Succeed digestive conditioning supplement. Noninferiority analyses and Wilcoxon sign rank tests were used to analyze the data. At day 90, Succeed was noninferior to 4 mg/kg omeprazole administered daily in terms of the proportion of horses with complete resolution of squamous ulceration. At day 30, Succeed was found to be inferior to omeprazole in terms of the proportion of horses with grade ≤1/4 squamous ulceration. The proportion of horses with reducing squamous ulcer score (compared with day 0) was statistically significant for both treatments at days 30 and 60. At day 90 of the 17 horses on Succeed, nine had a reducing squamous ulcer score (P value = .049), and of the 19 horses on omeprazole, 10 had a reducing squamous ulcer score at day 90 (P value = .091). The noninferiority of Succeed compared to omeprazole at 90 days for the complete resolution of squamous ulceration and the reduced efficacy of omeprazole following 90 days of treatment are likely to be of interest to practitioners managing gastric ulceration in performance horses.

Introduction

The prevalence of squamous ulceration in racing Thoroughbreds has been reported as >70% in several studies [1], [2], [3], [4], [5], [6], [7], [8], [9]. Equine gastric ulcer syndrome (EGUS) is detrimental to horse health and performance due to associated pain and discomfort [10], [11]. Omeprazole, a proton pump inhibitor, is the most commonly used treatment for gastric ulceration in horses and is the only product licensed for this purpose in most countries. Omeprazole has been shown to be efficacious in the short term in four previous studies with healing rates of 73% to 80% and improvement rates of up to 92% following 25 to 56 days of treatment [12], [13], [14], [15]. The bioavailability of oral enteric coated omeprazole is variable but unaffected by feeding or fasting [16]. Withdrawal of omeprazole after 56 days of treatment has been reported as resulting in a rapid return of gastric ulceration [15]. However, another study showed only a 20% recurrence rate following withdrawal of omeprazole following 56 days treatment [13]. To the authors' knowledge, the efficacy of omeprazole over a period of greater than 60 days in horses maintained in race training has not been reported.

Nutraceutical approaches for dealing with EGUS are being developed and tested. Hellings and Larsen [17] administered a mixture of B vitamins and salts of organic acids to performance horses presenting with EGUS for up to 7 weeks and concluded that this may promote healing of gastric ulcers. A pectin and lecithin mixture, supplemented with an antacid, reduced the severity of gastric ulceration over a 35-day period [18], but pectin–lecithin may be ineffective when given without an antacid [19]. A dietary supplement comprised of sea buckthorn berries reduced the severity of glandular, but not squamous, ulceration in Thoroughbred horses [20]. Sykes et al [21] reported that a combination of pectin–lecithin complex (Apolectol), live yeast, and magnesium hydroxide, when supplemented for 24 to 27 days reduced the severity of glandular and squamous gastric ulcers in Thoroughbred horses in race training. Andrews et al [22] reported that a supplement containing a number of ingredients, including pectin, lecithin, sea buckthorn, and L-Glutamine, may result in less severe recurrence of squamous ulceration following omeprazole treatment.

Succeed Digestive Conditioning Program (Succeed) is a daily supplement designed to support gastrointestinal health of horses. Succeed is a nutraceutical supplement containing oat oil rich in polar lipids, oat flour rich in oat Beta Glucan, L-Glutamine, and L-Threonine and extracts of the cell wall of Saccharomyces cerevisiae, one containing beta glucan and the other a mannan oligosaccharide. Anecdotally, this product is used in the management of gastric ulceration. However, it has not previously been evaluated in a blinded clinical trial.

The aim of the present study was to examine the hypothesis that Succeed is not inferior to omeprazole for the treatment of squamous ulceration in horses in race training over the course of 90 days.

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Study Design

A blinded randomized clinical trial was conducted to compare the efficacy of 4 mg/kg orally administered omeprazole (Gastrogard) (Merial Animal Health Ltd, Harlow UK) with a dietary supplement (Succeed) (Freedom Health LLC, Ohio) for the management of squamous gastric ulceration over a period of 90 days. A sample size calculation was conducted which determined that 28 horses in each group would be required to provide 80% power, assuming 90% efficacy of both treatments and that a 20% difference

Results

Sixty-six horses underwent an initial gastroscopy; the retention of horses at various stages of the trial is described in Fig. 1, showing the percentage of horses with squamous gastric ulceration of grade ≥2/4 from the initial group presented and the percentage of horses remaining in each treatment group at each time point.

Interobserver agreement for grading of squamous gastric ulceration was found to be substantial [26] ranging from Κ = 0.65 to Κ = 0.73 for the three paired estimates of

Discussion

The present study is the first to demonstrate that a nutraceutical supplement that provides a number of ingredients targeted to support gastrointestinal health is noninferior to omeprazole in terms of its ability to ameliorate squamous ulceration in the horse when provided in the diet for at least 90 days. When used at a dosage of 27g po q24 hours, the Succeed Digestive Conditioning Program supplement was found to be noninferior to 4 mg/kg omeprazole administered q24 hours at the end of a

Conclusions

To the author's knowledge, this is the first study to report the efficacy of treatments for gastric ulceration over a period of greater than 2 months. Succeed was shown to be noninferior to omeprazole following 90 days of treatment. Given the often-prolonged use of treatments for gastric ulceration over a racing season, the authors believe this to be a notable finding. Additionally, the finding that prolonged administration of omeprazole did not result in a statistically significant resolution

Acknowledgments

The authors thank Freedom Health LLC, for providing the funding for this trial and the veterinarians and trainers involved in the conduct of the trial. The work described within this article, and N.C.K., PhD, is funded by Freedom Health LLC.

References (33)

  • N.J. Vatistas et al.

    Cross-sectional study of gastric ulcers of the squamous mucosa in Thoroughbred racehorses

    Equine Vet J

    (1999)
  • J.E. Nieto et al.

    Effect of gastric ulceration on physiologic responses to exercise in horses

    Am J Vet Res

    (2009)
  • B.W. Sykes et al.

    A comparison between pre- and post exercise administration of omeprazole in the treatment of equine gastric ulcer syndrome: a blinded, randomised, clinical trial: pre- vs. post exercise omeprazole for equine gastric ulcer syndrome

    Equine Vet J

    (2014)
  • M. Doucet et al.

    Efficacy of a paste formulation of omeprazole for the treatment of naturally occurring gastric ulcers in training standardbred racehorses in Canada

    Can Vet J

    (2003)
  • M.J. Murray et al.

    Effects of omeprazole on healing of naturally-occurring gastric ulcers in Thoroughbred racehorses

    Equine Vet J

    (1997)
  • F.M. Andrews et al.

    Efficacy of omeprazole paste in the treatment and prevention of gastric ulcers in horses

    Equine Vet J

    (1999)
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