Page 753 - The Veterinary Care of the Horse

MEDICATION

Oral omeprazole is the drug of choice for ESGD. It is administered once daily as a paste and
VetBooks.ir works by reducing acid production in the stomach. When given for 2–4 weeks and then at a

reduced dose for another month it is very effective at healing ulcers of the squamous mucosa.
When used alone it is not so effective at healing ulcers in the glandular area of the stomach

so is often combined with sucralfate.

A long-acting intramuscular injection of omeprazole given at 5–7 day intervals is reported
to give better acid suppression and rates of healing of ulcers in the glandular area of the

stomach than oral omeprazole. This medicine is not currently licensed for use in horses and
further investigations are ongoing. One advantage is that it does not interfere with feeding

routines (see below).

Sucralfate does not have a licence for use in horses but is used in combination with oral
omeprazole to provide a protective coating for the ulcers in the glandular portion of the

stomach. It binds to the damaged tissue and helps to prevent further damage from digestive
juices and aid healing.

The combination of oral omeprazole and sucralfate works best if the omeprazole is
administered after 8 hours with no food and 60–90 minutes before feeding. Sucralfate should

be given at least 30 minutes after the omeprazole.

Stabled horses tend to eat less overnight so, from a practical point of view, oral
omeprazole is usually given at the start of the day and sucralfate 30 minutes later.

Misoprostol is sometimes used for treatment of EGGD. It suppresses inflammation and acid

production and in limited studies is reported to be more effective than using a combination of
oral omeprazole and sucralfate. However, it does not have a veterinary licence and more
studies need to be done. It needs to be handled with care as it can induce abortion in humans

and should not be given to pregnant mares. It should not be used in combination with
omeprazole.

Antibiotics are occasionally prescribed in refractory cases of EGGD if bacterial colonization

of the mucosal surface is considered to be inhibiting healing. The antibiotic is selected based
on culture results from biopsy specimens.

Corticosteroids are occasionally used in cases of EGGD that have not responded to other