Equine vets recommend PROTEK GI and here’s why!

Kelato’s PROTEK GI is rapidly becoming the leading digestive health supplement recommended by equine veterinarians as a tool to support horses’ total digestive health and those with gastrointestinal disturbances or gastric stress. 

UNDERSTANDING THE TERM “EGUS”

To properly understand Equine Gastric Ulcer Syndrome (EGUS), we first need to clarify the terminology. The term “EGUS” has been around for the past 20 years, but in more recent times the terminology has significantly changed.

EGUS is an over-arching umbrella term that simply describes ulcerative, erosive and hyperkeratotic diseases of the stomach. The problem is, EGUS is often inappropriately or incompletely used. Leading equine veterinarian Dr Ben Sykes (BSc BVMS MS MBA DipACVIM PhD FHEA) has spent a lot of time researching EGUS and the results have changed the way we think, talk about, treat, prevent and manage the condition.

We now know there are very distinct differences between diseases in the upper squamous mucosa versus the lower glandular mucosa of the horse’s stomach. So, EGUS is now divided into Equine Squamous Gastric Disease (ESGD) and Equine Glandular Gastric Disease (EGGD).

ESGD and EGGD are COMPLETELY different in terms of causes, prevalence, risk factors, treatment, management and prevention. You CANNOT extrapolate one from the other! For example, exercise intensity and diet play a role in squamous gastric disease, whereas the risk factors for glandular gastric disease are very different. So, if your horse is diagnosed with EGGD and you only address the risk factors for ESGD, it won't necessarily help to resolve the problem! 

CAUSES OF ESGD AND EGGD

ESGD

The squamous mucosa has limited defence mechanisms against stomach acid. Ulcers occur when the squamous mucosa is exposed to acid, which burns the sensitive lining. Squamous gastric disease is primarily a disease of domestication and intensive management. In terms of risk factors, exercise and diet play a large role in disease manifestation. 

Exercise has been shown to cause the pH in the squamous mucosa to decrease very quickly. The horse squeezes the abdominal muscles, which physically reduces the space in the stomach and pushes the acid up into the squamous mucosa. Anything at a trot or above will achieve this. What’s also really important is the duration of exposure. So, the length of time we exercise the horse is going to have a significant impact on the time the squamous mucosa is exposed to acid. Normally, the presence of forage serves as a physical barrier to stop acid splash. If you exercise the horse on an empty stomach, the acid will slosh around and burn the sensitive squamous mucosa.

Diets high in soluble carbohydrates (i.e. starch and sugar) are also a risk factor for ESGD. However, it’s important to recognise that grains are NOT the devil. A common misconception is you can’t feed any grain to horses with gastric ulcers. Yes, there are benefits to replacing some of the starch in the horse’s diet with fat or high-energy fibrous feed, but you can also counteract this issue by providing appropriate roughage. 

It’s also important to note that studies demonstrating soluble carbohydrates as a risk factor for ESGD used very high carbohydrate diets that were far in excess of what you would feed a riding or sport horse. These levels were more comparable to what a racehorse eats. This is why diet is one of the key contributing factors and why we see so much ESGD in racehorse populations.

EGGD

The acid glands are located in the glandular region of the stomach. Since the glandular mucosa is normally exposed to very acidic conditions, it has protective mechanisms in the form of a muco-bicarbonate layer. This creates an “alkaline slime” that coats the area and protects it from acid burn. EGGD involves a breakdown of these normal defence mechanisms. We don’t fully understand why the muco-bicarbonate layer breaks down, but we have identified some risk factors.

The use of non-steroidal anti-inflammatory drugs (NSAIDs; e.g. flunixin or phenylbutazone) has the potential to cause EGGD. This typically manifests when NSAIDs are used at higher levels than the labelled doses. So, it’s important to be conscious of administration and to stay within the dosing guidelines.

There is minimal data to support the role of diet in EGGD. Modifying the diet in terms of managing the amount of soluble carbohydrates will not treat EGGD.

Exercise does play a role in EGGD, but it appears to have different mechanisms. It was found that horses exercised five to seven days a week were 10 times more likely to develop EGGD than horses worked four days or less. These results show it’s really important that horses have dedicated rest days for glandular gastric health. At least three rest days per week will allow the glandular mucosa to recover and repair from injury associated with exercise.

There is also a growing body of evidence that behavioural stress is central to the glandular disease process. There is a range of data that shows if we stress horses or have horses that are “stressed”, they are more likely to develop EGGD compared to horses that aren’t. One study found that an increased number of riders or handlers increase the risk of EGGD. We don’t know why this is, but it could be that changing individuals is a stressor. Each rider is different, and this variation could result in poor timing with cues, different riding styles, etc. 

PREVENTION AND MANAGEMENT 

Following your vet’s advice in terms of treatment, implementing appropriate management practices and reducing the risk factors for EGUS play an integral role in preventing further ulceration and maintaining optimal stomach health. 

Treatment

If you suspect your horse has EGUS, it is recommended to consult with your vet first, as they will be able to advise on diagnostics and the best treatment protocol.

While omeprazole remains the treatment of choice for ESGD, the efficacy of omeprazole alone for EGGD is questionable. Dr Sykes has also taken an interest in researching effective adjunctive therapies for EGUS with a focus on nutraceutical strategies. The promising results of Ben’s research are what give him confidence in recommending PROTEK GI. “We were able to show a significant protective effect in horses under very high ulcerogenic conditions. That research was very encouraging, and it was really nice to see that Kelato have formulated that into PROTEK GI.”

Equine veterinarian Dr Andrea Boland (BSc BVMS) is happy and confident in recommending the PROTEK GI. “As a vet, we want to have confidence in what we are recommending. If there’s a horse that has an issue, I’ll recommend PROTEK GI. The results have spoken for themselves. It’s just been unbelievable, the turnaround”.

Management – ESGD

Prevention and management of ESGD require a multifaceted approach. We have established that there are 3 dominant factors that contribute to ESGD – a high carbohydrate diet, inadequate roughage and the amount of exercise a horse does at a trot or above. If we have relatively high amounts of these risk factors, we have a relatively high risk of ESGD. 

Roughage 

Even though lush green pasture is a great source of calories, it has its limitations in terms of stomach health. Lush pasture lacks the structural integrity required to form a ball in the stomach and prevent acid splash onto the squamous mucosa. Instead, it would create more of a watery slush. Lush pasture also empties from the stomach faster than hay. This is an important consideration when managing a horse for ESGD, particularly if they have a history of the condition. In this instance, supplementing the diet with hay will be of benefit. 

Ad libitum access to hay also isn’t protective in all circumstances. The type of hay may have an influence on this. Lucerne is typically the forage of choice due to its high calcium content and buffering capacity. However, various factors such as expense or caloric content may limit how much is used in an average equine diet.

A general rule of thumb is to provide your horse with at least 1.5% of its body weight in forage per day for optimal digestive health and function. This works out to be 16.5lb of forage per day for an 1100lb horse. Providing larger quantities of medium-quality hay (dust and mould free of course!) will be of more benefit than feeding a smaller amount of lucerne. Regardless, feeding a variety of hay types is preferable for most horse diets and lucerne should never constitute the sole forage type. Remember, the presence of roughage in the horse’s stomach stops acid from splashing onto the squamous mucosa. If we have periods of more than 6 hours without feeding, the risk of ESGD increases by 4 – 5 times. So, there is a significant effect of meal feeding versus continuous access.

What about chaff? Chaff is quite expensive for what it is – i.e. chopped hay. For digestive health, it is better to provide adequate long-stemmed forage and limit chaff intake. The more the horse chews, the more saliva they produce which contains bicarbonate and buffers stomach acid. 

Soluble Carbohydrates

Remember, grain is NOT the devil! It’s HOW you feed it that’s important. Studies have shown horses are 2.5 times more likely to develop ESGD if you exceed 1g of starch per kg body weight per meal. If you look at the levels of most commercial feeds, the starch content is well below that threshold, even when you feed the highest rate. So, the vast majority of sport horses won’t be consuming these quantities. However, meal size also comes into play when discussing hindgut health and the general rule of thumb is to feed no more than 5.5lb of hard feed per meal. For horses that require a high carbohydrate diet for performance (e.g. racehorses), replacing some of the grain with fat or high-energy fibrous feeds can be of benefit.

Exercise

When managing ESGD, it is important to limit the amount of time the horse spends at a trot or above. Anything greater than a trot increases the exposure of the squamous mucosa to acid. How long we exercise over the course of a week matters – the longer the physical exposure to acid, the deeper the burn. So, we need to think about how we exercise our horses, particularly if they have a history of recurrent disease. For example, reducing the duration of exercise and focusing on high-intensity interval (HIIT) training can dramatically reduce the risk of ESGD. Cooling down at a long, extended walk instead of a trot following a training session will also reduce the amount of time the acid is splashing on the squamous mucosa.  

When you exercise relative to feeding is another important consideration. Feeding 2-4lb of hay prior to exercise will soak up some of the stomach acid and provide a fibrous mat. In this instance, lucerne hay is a great choice because it is highly palatable and is high in calcium, which will further enhance the buffering effect of chewing and saliva production. Feeding hay will ensure a greater buffering effect compared to grain or chaff where the horse chews significantly less. Ultimately, the key take-home message is to NEVER exercise a horse on an empty stomach.

Management – EGGD

Diet and exercise intensity have no influence on EGGD. In terms of preventing and managing EGGD, we can address risk factors by including two to three absolute rest days per week. Implement short, focused, intense training sessions rather than lower-intensity sessions drawn out over more days per week. Environmental enrichment is also important. Allowing horses to express their natural behaviour with cohabitation and mutual grooming will significantly benefit their welfare.

DIGESTIVE HEALTH SUPPLEMENTS

In Australia, Perth Equine Hospital’s Senior Associate Veterinarian, Dr Bec Caslick (BSc BVMS), highlights the importance of high-quality, scientifically supported supplements such as PROTEK GI to help maintain gastric health. "I think people can feel confident that it really does help the horse from the stomach right through to the hindgut in one simple, affordable product."

What is PROTEK GI?

PROTEK GI is unique due to the combination of antacids and the “coating agents” pectin and lecithin. These ingredients provide an enhanced barrier for the squamous mucosa and supplement the natural defence mechanisms (muco-bicarbonate layer) of the glandular mucosa in the horse’s stomach. For hindgut health, PROTEK GI contains a prebiotic and live yeast probiotic that work together to maintain a healthy hindgut environment, stimulate the growth of beneficial microbes and assist feed conversion efficiency.

PROTEK GI helps your horse’s gut better cope with the stresses of exercise, stabling, traveling and competition. You will start to notice positive changes in your horse such as improvements in:

• Attitude
• Ability to perform
• Body condition
• Coat quality
• Appetite
• Manure consistency

 

Want to find out more? Head to the PROTEK GI page or email info@protekgi.com