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- Title
Mäßige Therapieerfolge sowohl bei einer hochdosierten Therapie mit Omeprazol-Granulat (Equizol<sup>®</sup>) als auch bei der Kombinationstherapie aus Omeprazol-Paste (Gastrogard<sup>®</sup>) und Sucralfat (Sucrabest<sup>®</sup>) bei Pferden mit Equine Glandular Gastric Disease (EGGD).
- Authors
Jung, Florina; Barsnick, Rosa
- Abstract
Equine Gastric Ulcer Syndrome (EGUS) is of ongoing importance in sport and pleasure horses and is a frequently diagnosed disease in equine practice. A distinction is made between lesions of the cutaneous mucosa ("Equine Squamous Gastric Disease" – ESGD), which are classically treated with omeprazole. In Germany, there are approved oral preparations for horses in paste or granular form however, there is no-approved drug for the treatment of lesions of the glandular mucosa ("Equine Glandular Gastric Disease" – EGGD). Rendle et al. recommend in their consensus statement for EGGD firstly a combination therapy of oral omeprazole and sucralfate (GGS), secondly a monotherapy with misoprostol (MP) or thirdly a therapy with intramuscularly administered "long acting injectable omeprazole" (LAIOMEP), all as first-line treatment options for EGGD. The first treatment recommendation (omeprazole + sucralfate) is widely used as a standard in EGGD patients in Germany at the Equine Veterinaey Center in Kirchheim. LAIOMEP is not available in Germany, but shows good treatment results in EGGD. Misoprostol has to be used following the prescribing cascade in horses and is not always available in Germany. Due to super-bioavailability of omeprazole in granular form (Equizol®) it is licensed for use in EGUS at a dose of 2mg/kg. The aim of the study was to assess whether doubling this dose could possibly improve the therapeutic success in EGGD, as prolonged high serum levels of omeprazole from intramuscular administration of a long-acting formula appear to improve outcome when treating EGGD. Overall, there is commonly a high number of "non-responders" in the treatment of EGGD, presumably because sufficient acid suppression is often not achieved. Based on the patient population of a private equine veterinary hospital, two medication protocols were retrospectively investigated. Included in the study were 31 patients diagnosed with only EGGD or both EGGD and ESGD in gastroscopy and which returned for control gastroscopy after four weeks. 48% of the patients underwent gastroscopy due to previous colic, and 29% of the horses had a concomitant chronic disease that could potentially cause ongoing stress and pain for the horse (e.g., EOTRH, osteoarthritis, etc.). 21 horses received 4mg/kg omeprazole in paste form (Gastrogard®) in combination with 12mg/kg bw sucralfate (Sucrabest®) twice daily for treatment. The other group of 10 horses was treated with a monotherapy of 3,5–4mg/kg omeprazole in granule form (Equizol®). This is about twice the Equizol® recommended dose for the Therapy of EGUS as mentioned above. ESGD and EGGD findings were separately evaluated according to a scoring system with grades 0 to 4 adopted from the work of Vondran (2016). All owners also received similar recommendations for husbandry and feeding. In the Gastrogard®/Sucrabest® group (GGS), the healing rate after four weeks was 44% for ESGD and 19% for EGGD. The healing rates in the Equizol® group (EQ) were 71% for ESGD and 20% for EGGD. Overall, gastric findings improved by an average of 1.3 grades under GGS therapy for ESGD in 83% of patients, and 57% of EGGD findings improved by an average of 1 grade. Under EQ therapy, there was an improvement in scoring of ESGD by an average of 1.8 grades in 86% of the patients. EGGD improved by an average of 1.4 grades in 50% of the horses. High-dose Equizol® therapy did not show a significantly better therapeutic outcome compared to the Gastrogard®/Sucrabest® medication commonly used in practice. Colic preceding the therapy as well as the presence of a concomitant disease did not show a significant influence on the therapy success. However, based on the results of this study, there is also no good reason to recommend a combination therapy with omeprazole paste and sucralfate, which on the one hand is much more difficult for horse owners to apply and quite similar in terms of costs. On the other hand sucralfate as a human drug must be redesignated for the combination therapy following the prescription cascade, which in Germany is only permitted in the case of a so-called therapeutic emergency based on the veterinary drug law. Thus, a need for more effective treatment options for lesions of the glandular gastric mucosa still remains. LAIOMEP therapy, which is currently not available in Germany, seems to be promising in treatment of EGGD. Further investigations on the causes of glandular lesions are also very important. With a better understanding, the development of EGGD could possibly be prevented by prophylactic measures or at least healing could be supported by an appropriately adapted husbandry, feeding and training design.
- Subjects
GERMANY; GASTRIC mucosa; VETERINARY drugs; GASTRIC diseases; COMORBIDITY; HORSE owners; HORSE breeding; INDUCED labor (Obstetrics)
- Publication
Pferdeheilkunde, 2023, Vol 39, Issue 5, p417
- ISSN
0177-7726
- Publication type
Article
- DOI
10.21836/PEM20230502