Following that gut feeling: The evolution of gastric ulcer research

For much of his 27-year career in the field of veterinary medicine, Dr Ben Sykes has focussed on the common issue of Equine Gastric Ulcer Syndrome. Now a world-leading expert on the topic, he is actively changing the way we think, talk about, treat, prevent, and manage EGUS in our horses internationally. 

Leading equine veterinarian Dr Ben Sykes’ (BSc BVMS MS MBA DipACVIM PhD FHEA) research has primarily focused on Equine Gastric Ulcer Syndrome (EGUS) with an interest in nutraceutical strategies to help combat the disease.

When Dr Ben Sykes undertook his vet degree in Perth, he didn’t intend to become an equine vet. “I was very fortunate… towards the end of my degree, one 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 – in particular, 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.

“Twelve years ago, 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 EGUS 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 indeed often a more complex disease than once thought. A key knowledge breakthrough Dy Sykes has seen during his time in EGUS clinical research is a growing understanding of the distinction between Equine Glandular Gastric Disease (EGGD) and Equine Squamous Gastric Disease (ESGD).

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 ulceration in the ventral (lower) glandular region of the horse’s 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 behaviour 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 behavioural stress, ensuring that we minimise their stress loads, and optimising their general wellbeing. Positive gastric outcomes are a benefit of that,” explains Dr Sykes.

Glandular disease impacts on behaviour, and as Dr Sykes explains there is an interrelationship between that and other causes of pain such as orthopaedic 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 recently 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-defeatist in the context of managing EGUS from a welfare and performance point of view.

“One of the outcomes of this research was 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 recognise right from the onset, 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.”

Ten years ago, Dr Sykes published research data looking at the impact of a supplement formulation on the recurrence of EGUS in a racehorse population. As leaders in the digestive health space, Kelato independently picked up the data and the eventual result was the development of their PROTEK GI – a supplement designed for horses with EGUS, or at risk of developing it.

Five years ago, Dr Sykes made the connection between his research and Kelato’s product. “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 that started,” he explains of his partnership with the brand.

“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 for total gut health

PROTEK GI works by providing “coating agents” which form an “alkaline 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… 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.”

Trust the science with PROTEK GI. Shop now or find out more by emailing our team at info@kelato.us

This article was written in conjunction with Equestrian Life.