🚀 Quick Summary
- The Problem: Standard Omeprazole (Gastrogard) only heals 25% of Glandular/Pyloric ulcers.
- The Diagnosis: If your horse still acts ulcer-y after 30 days of treatment, re-scope. Look specifically at the Pylorus (exit valve).
- The Cure: You need Misoprostol (Cytotec) + Sucralfate.
- The Difference: Squamous ulcers are “acid burns.” Glandular ulcers are “failed mucosal defense” (breakdown of the slime layer).
Table of Contents
Open Table of Contents
Anatomy 101: Squamous vs. Glandular Stomach
The horse stomach is divided into two distinct regions:
-
Squamous (Top 1/3): White, skin-like tissue.
- Vulnerability: No mucus protection. Highly sensitive to acid splash.
- Disease: ESGD (Equine Squamous Gastric Disease).
- Cause: Fasting, Exercise.
-
Glandular (Bottom 2/3): Pink, slimy tissue.
- Defense: Secreting acid (pH 1-2) but protected by a thick mucus/bicarbonate layer.
- Disease: EGGD (Equine Glandular Gastric Disease). Includes the Pylorus (exit).
- Cause: Breakdown of defense (Stress, NSAIDs, Bacteria?).
Why Omeprazole Fails (The 25% Cure Rate)
Studies consistently show Omeprazole heals >80% of Squamous Ulcers but <25% of Glandular Ulcers.
- Reason 1: The glandular region is bathed in acid 24/7. Even with Omeprazole, the pH rarely stays high enough (4+) for long enough to allow deep tissue healing in this hostile zone.
- Reason 2: The problem isn’t usually too much acid. It’s too little protection. Omeprazole suppresses acid, but it doesn’t fix the mucus layer or blood flow issue.
The “New” Hero: Misoprostol Protocol
Misoprostol (Cytotec) is a synthetic Prostaglandin E1 analogue.
- Mechanism:
- Inhibits Acid: Stops basal acid secretion (different pathway than Omeprazole).
- Boosts Defense: Stimulates mucus & bicarbonate secretion.
- Increases Flow: Dilates mucosal blood vessels to bring healing factors to the site.
The Evidence (Varley et al., 2019)
- Misoprostol Cure Rate: 72%
- Omeprazole+Sucralfate Cure Rate: 20%
The “Kitchen Sink” Combo Therapy
For severe or refractory EGGD cases, vets often prescribe a triple threat:
1. Omeprazole (AM)
- Role: General acid suppression.
- Dose: Full tube (4 mg/kg).
2. Misoprostol (AM & PM)
- Role: Mucosal healing / Blood flow.
- Dose: 5 mcg/kg, twice daily. (Tablets dissolved in water).
3. Sucralfate (Noon & Night)
- Role: Physical coating (Band-Aid).
- Dose: 20 mg/kg, twice daily (separate from other meds by 1 hour).
Management Changes for EGGD
Glandular ulcers are often stress-related.
- Rest Days: Give 2-3 days off per week. EGGD horses heal faster with reduced workload.
- Vegetable Oil: Add Corn Oil (Wait, really? Yes).
- Correction: While Corn Oil is inflammatory, studies show the PGE2 boost from Omega-6s specifically helps Glandular mucus production.
- Better Option: Use Camelina Oil for anti-inflammatory benefits + calorie density.
- Direct Contact: Increase turnout/grazing time.
Case Study: The “Mystery Colic” Horse
Subject: “Apollo”, 6yo Warmblood. Symptoms: Mild colic episodes after eating. Girthy. First Scope: Grade 2 Squamous Ulcers. Treated with Gastrogard for 30 days. Result: Squamous healed. Still colicking. Re-Scope: Found Grade 3 Pyloric Ulcers hiding at the bottom. New Plan: Misoprostol + Sucralfate. Result (60 Days): Complete healing. No colic since.
Safety Warning: Handling Misoprostol
WARNING: Misoprostol causes uterine contractions.
- Pregnant Women: Do NOT handle this drug. It can cause miscarriage.
- Handling: Wear gloves. Do not breathe dust if crushing tablets.
- Side Effects (Horse): Mild colic/cramping or loose manure is possible. Start at a lower dose if sensitive.
🏆 Final Verdict
If you treated for ulcers and “failed” or relapsed quickly: Demand a Re-Scope. Look specifically at the Pylorus. If lesions are there, put down the Gastrogard. Ask your vet for Misoprostol. It is the only drug with a fighting chance against the glandular beast.