Gastric Ulcer Research: Insights for Equine Health
For much of his career in the field of veterinary medicine, Dr Ben Sykes has focused on the common issue of Equine Gastric Ulcer Syndrome. A world-leading expert on the topic, he is actively changing the way we think, talk about, treat, prevent, and manage EGUS (also known as gastric ulcers) in our horses worldwide.
When DrSykes undertook his vet degree, he didn’t intend to become an equine vet. “I was very fortunate… towards the end of my degree, one of my lecturers tapped me on the shoulder and said, ‘Why don’t you think about doing horses full time? They’re interesting, and it’s an area you seem to like and have an aptitude for.’”
It all went from there, with Dr Sykes spending the first 15 years of his career in equine clinical practice. His post-graduate training spanned Australia and the US, and over time he developed a focus on internal medicine – particularly the equine gut.
“A big part of that was the gastric ulcer issue,” explains Dr Sykes. “It was a common issue affecting horses all around the world – particularly the sport horse population I was working with.”
From there, Dr Sykes developed an interest in clinical research; he not only wanted to better understand the disease, but also to solve some of the challenges veterinarians were facing in terms of treatment.
“I started doing more and more clinical research and really focusing on the pointy end… the things that make a difference to our treatment and management of EGUS.”
“It’s not just a disease of horses with poor appetite and weight loss…”
Dr Sykes explains that a big shift in thinking when it comes to gastric ulcers is the fact that it’s not just about ‘stomach problems’, but in fact a far bigger picture.
“Previously, we often saw gastric ulcer disease as a disease of horses with poor appetite and weight loss… that was the classic ulcer horse,” he explains.
It’s now understood that gastric ulcers are often a more complex disease than once thought. A key knowledge breakthrough Dr Sykes has seen during his time inclinical research is a growing understanding of the distinction between Equine Squamous Gastric Disease (ESGD) and Equine Glandular Gastric Disease (EGGD).
ESGD refers to lesions specifically affecting the squamous portion (non-glandular region) of the equine stomach – that is, the upper half of the stomach – while EGGD refers to lesions in the glandular(lower) region of the stomach.
“We’ve got two largely independent diseases that both affect the stomach. Alongside that recognition, there is a growing understanding that the management strategies that we use for treatment, prevention, and long-term management of squamous disease are very different from what we use for glandular disease.”
Squamous disease: Nutrition first
When it comes to squamous disease, Dr Sykes explains that good nutrition comes first.
“Our goal is always to focus on the nutrition of the horse first. This includes the appropriate provision of roughage and limiting the amount of non-structural carbohydrates in the horse’s diet; these are the cornerstones of gastric health management in our horses. There are also a lot of really positive welfare benefits, not just gastric health benefits, to this approach in terms of grazing behavior and the wellbeing of horses, particularly in the stable environment.”
Glandular disease: Environmental optimization
“When we think about glandular disease, we are really looking at factors associated with optimizing the quality of life and wellbeing of horses – such as reducing behavioral stress, ensuring that we minimize their stress loads, and optimizing their general wellbeing. Positive gastric outcomes are a benefit of that,” explains Dr Sykes.
Glandular disease impacts behavior, and as Dr Sykes explains, there is an interrelationship between that and other causes of pain such as orthopedic disease or musculoskeletal disease.
“We are looking at the bigger picture of pain and what pain means to horses – especially performance horses – and the welfare impacts of that. It’s not just about talking about gastric goals anymore; it’s about talking about the positive welfare benefits of the strategies, as well as the gastric health benefits of the strategies.”
“This goes back to more holistic discussion than just gastric health; everything we do for the stomach is good for the horse in general.”
Science-led rule changes
The welfare aspects of the strategies used to manage gastric ulcers are now a serious part of the discussion. Dr Sykes’ research has seen the British Horse Racing Authority review their rules around the use of omeprazole – an effective treatment for squamous disease.
“Omeprazole is an absolute cornerstone for managing gastric disease in the horse, and historically, different jurisdictions have had different rules when it comes to how long it needs to be withdrawn before racing,” says Dr Sykes.
While Australia has allowed omeprazole use up until the day before racing, the British Horse Racing Authority required zero detectable concentrations – meaning omeprazole effectively couldn’t be used in the three days prior to racing.
“Looking at omeprazole use and these rules, we found that with the three-day withholding period, the horses were getting gastric ulcers back at rates comparable to having never been treated in the first place. They were racing with a very high prevalence of disease, which is somewhat self-defeating in the context of managing EGUS from a welfare and performance point of view.
“One of the outcomes of this research was that the British Horse Racing Authority reviewed their rules and adopted the rule that’s been in place for Australian racing for many years, which is to allow omeprazole use up until the day prior to a race.”
Supplement support
“One of the things that’s really important to recognize right from the outset is the supplement market is largely unregulated, and there’s really nothing to stop people making claims… many of which are completely unvalidated and unsupported,” warns Dr Sykes. “As a clinical scientist, the goal is always to try and apply evidence to what we’re doing to allow us to make the best decisions possible.”
Dr Sykes published research data looking at the impact of a supplement’s formulation on the recurrence of EGUS in a racehorse population.
Dr Sykes made the connection between his research and Kelato’s product. As leaders in the digestive health space, Kelato independently picked up the research, and the result was the development of PROTEK GI – a supplement designed for horses with gastric ulcers, or at risk of developing them.
“I really liked the idea of taking evidence-based supplements to the market to deliver products that are actually backed by science… and so that was how the relationship started,” explaining his partnership with Kelato.
“From there we’ve continued to work together to expand and build on that knowledge base. Our aim is to apply a holistic approach to the story around EGUS, with supplements being a critical element of that story – but at the same time, part of a much bigger picture that involves the general wellbeing of the horse.”
PROTEK GI works by providing coating agents which form its signaturealkaline slime barrier over the stomach wall to protect it from acid burn and strengthen the mucosal lining.
“We’re also now starting to see the EGUS conversation roll over into the broader context of gastrointestinal health… with not just the stomach but also thinking about hindgut health and the broader context of total gastrointestinal health and those implications on horse wellbeing and welfare,” explains Dr Sykes.
“With that in mind, PROTEK GI also has hindgut elements in there, primarily a live yeast probiotic and prebiotic that have been included to provide hindgut support as well. We have a lot of scientific evidence now on the benefits of this yeast (Saccharomyces cerevisiae) and its positive effects on hindgut health.
“So, although we talk about PROTEK GI largely as an EGUS supplement – because that’s where the largest amount of research is being done – we actually have data and evidence to support it as a total gastric health supplement beyond just gastric ulcers.”
