Original ResearchA Comparison Between Omeprazole and a Dietary Supplement for the Management of Squamous Gastric Ulceration in 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.
Section snippets
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.
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2019, Journal of Equine Veterinary ScienceCitation Excerpt :Recent studies have highlighted that there is often gastric ulceration recurrence post or even during long-term pharmacologic treatment, and this might be where changes in nutrition and managemental practices can perhaps play a very important role. The long-term study of Kerbyson et al [5], for example, found that a proportion of the horses had the same or higher ulcer score after 90 days, compared with their starting point, despite long-term administration of omeprazole or a supplement (with no other designed change in management or nutrition). Other changes may be required, therefore, in addition to the use of pharmaceutical agents or nutritional supplements, to manage EGUS.
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