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B. W. Sykes - One of the best experts on this subject based on the ideXlab platform.

  • Diagnostic accuracy of blood sucrose as a screening test for Equine Gastric Ulcer syndrome (EGUS) in weanling foals
    Acta Veterinaria Scandinavica, 2018
    Co-Authors: Michael Hewetson, B. W. Sykes, Gd Hallowell, Monica Venner, Jan Volquardsen, Ingrid Vervuert, Geoffrey Theodore Fosgate, Riitta-mari Tulamo
    Abstract:

    Equine Gastric Ulcer syndrome is an important cause of morbidity in weanling foals. Many foals are asymptomatic, and the development of an inexpensive screening test to ensure an early diagnosis is desirable. The objective of this study was to determine the diagnostic accuracy of blood sucrose for diagnosis of EGUS in weanling foals. 45 foals were studied 7 days before and 14 days after weaning. The diagnostic accuracy of blood sucrose for diagnosis of Gastric lesions (GL); glandular lesions (GDL); squamous lesions (SQL) and clinically significant Gastric lesions (CSL) at 45 and 90 min after administration of 1 g/kg of sucrose via nasoGastric intubation was assessed using ROC curves and calculating the AUC. For each lesion type, sucrose concentration in blood was compared to gastroscopy; and sensitivities (Se) and specificities (Sp) were calculated across a range of sucrose concentrations. Cut-off values were selected manually to optimize Se. Because of concerns over the validity of the gold standard, additional Se, Sp, and lesion prevalence data were subsequently estimated and compared using Bayesian latent class analysis. Using the frequentist approach, the prevalence of GL; GDL; SQL and CSL before weaning was 21; 9; 7 and 8% respectively; and increased to 98; 59; 97 and 82% respectively after weaning. At the selected cut-off, Se ranged from 84 to 95% and Sp ranged from 47 to 71%, depending upon the lesion type and time of sampling. In comparison, estimates of Se and Sp were consistently higher when using a Bayesian approach, with Se ranging from 81 to 97%; and Sp ranging from 77 to 97%, depending upon the lesion type and time of sampling. Blood sucrose is a sensitive test for detecting EGUS in weanling foals. Due to its poor specificity, it is not expected that the sucrose blood test will replace gastroscopy, however it may represent a clinically useful screening test to identify foals that may benefit from gastroscopy. Bayesian latent class analysis represents an alternative method to evaluate the diagnostic accuracy of the blood sucrose test in an attempt to avoid bias associated with the assumption that gastroscopy is a perfect test.

  • Courses for horses: Rethinking the use of proton pump inhibitors in the treatment of Equine Gastric Ulcer syndrome
    Equine Veterinary Education, 2018
    Co-Authors: B. W. Sykes
    Abstract:

    Oral omeprazole has been the cornerstone of Equine Gastric Ulcer syndrome (EGUS) treatment for nearly 20 years. However, approximately 15-30% of Equine squamous Gastric disease (ESGD) cases and 75% of Equine glandular Gastric disease (EGGD) cases fail to heal within current treatment guidelines. Recently, a number of factors that may affect the efficacy of oral omeprazole have been highlighted and the pharmacodynamics of a number of novel proton pump inhibitors (PPIs) have been described in the horse. The purpose of this article is to review the factors that affect oral omeprazole efficacy, with the goal of maximising therapeutic response, and the novel PPIs recently described.

  • The effects of dose and diet on the pharmacodynamics of omeprazole in the horse.
    Equine Veterinary Journal, 2017
    Co-Authors: B. W. Sykes, C. Underwood, Ristan M. Greer, Catherine M. Mcgowan, Paul C. Mills
    Abstract:

    Background: Esomeprazole warrants further investigation as a treatment for Equine Gastric Ulcer syndrome. Objectives: To investigate the duration of intraday acid suppression achieved with two doses of esomeprazole under two dietary conditions. Study design: A four way crossover design. Methods: Six adult Thoroughbreds instrumented with percutaneous gastrotomy tubes were used. IntraGastric pH was measured for continuous 23 h periods (08.00–07.00 h) for 6 consecutive days (Days 0–5). Baseline data was recorded on Day 0 and esomeprazole was administered on Days 1–5. Two doses (0.5 and 2.0 mg/kg bwt/day per os once daily) and two diets (a high grain/low fibre (HG/LF) and ad libitum hay (HAY) diet) were studied. Data for the percentage of time pH was above 4 (%tpH>4) and median intraday pH was reported for two measurement points and analysed using generalised estimating equations. Results: An inconsistent effect of both diet and dose was evident with mean %tpH>4 and mean of the median intraday pHs typically higher at the 2.0 mg/kg bwt dose and in HG/LF diet. A cumulative effect of dosing was present with the magnitude of acid suppression observed on Day 5 consistently higher than that observed on Day 1. The magnitude of acid suppression, at measurement point 1, compared favourably with previous reports on omeprazole and exceeded human therapeutic breakpoints for the 0.5 mg/kg bwt dose in the HG/LF diet and 2.0 mg/kg bwt dose in the HAY diet. Main limitations: Instrumentation may have modified Gastric function and horses were not fasted or exercised. Conclusions: The findings of the present study suggested that both dose and diet affect the response to esomeprazole in the horse and that a cumulative effect is present over the first 5 days of treatment. Further investigation into the clinical efficacy of esomeprazole and trials directly comparing esomeprazole and omeprazole appear to be warranted.

  • A comparison of the prevalence of Gastric Ulceration in feral and domesticated horses in the UK
    Equine Veterinary Education, 2015
    Co-Authors: S. Ward, B. W. Sykes, H. Brown, A. Bishop, Lee Ann Penaluna
    Abstract:

    Equine Gastric Ulcer syndrome is common in domesticated horses, especially those performing in athletic endeavours. However, the prevalence of Equine Gastric Ulcer syndrome in feral populations of horses is not documented. This study investigated the prevalence and severity of squamous and glandular Gastric Ulceration in an abattoir population of horses in the UK. Both squamous and glandular Ulceration were more prevalent in domesticated horses when compared to the feral horses studied.

  • European College of Equine Internal Medicine Consensus Statement—Equine Gastric Ulcer Syndrome in Adult Horses
    Journal of Veterinary Internal Medicine, 2015
    Co-Authors: B. W. Sykes, Michael Hewetson, R.j. Hepburn, N. Luthersson, Y. Tamzali
    Abstract:

    The term Equine Gastric Ulcer Syndrome (EGUS) was first used in 1999 to describe Gastric Ulceration in the horse.1 However, as discussed by Merritt,2 the terminology is commonly misused. The committee reinforces the importance of distinguishing between diseases of the squamous and glandular mucosa because, as discussed in this statement, important differences exist between the two. In human medicine, the term peptic Ulcer disease (PUD) is used as an umbrella term to describe erosive and Ulcerative diseases of the stomach and it is recognized that a large number of individual diseases are present under the term.3 Furthermore, while some different diseases might share similarities in pathophysiology and treatment regimens, it is recognized in human medicine that the direct extrapolation of either from one specific disease (such as NSAID-associated Ulceration) to another (such as Helicobacter pylori associated Ulceration) is inappropriate.3Merial, Boehringher Ingelheim, Virbac, Abler and Bova Compounding.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1939-1676hb2016Companion Animal Clinical Studie

J. M. Jokisalo - One of the best experts on this subject based on the ideXlab platform.

Frank M. Andrews - One of the best experts on this subject based on the ideXlab platform.

  • impact of concurrent treatment with omeprazole on phenylbutazone induced Equine Gastric Ulcer syndrome egus
    Equine Veterinary Journal, 2020
    Co-Authors: Megan Ricord, Frank M. Andrews, Francisco J. Morales Yñiguez, M. L. Keowen, F. Garza, Linda Paul, Ann Chapman, Heidi E. Banse
    Abstract:

    BACKGROUND Phenylbutazone is commonly prescribed for treatment of various painful or inflammatory disorders in horses, but is associated with gastrointestinal (GI) adverse effects. Anecdotally, many practitioners prescribe omeprazole concurrently with phenylbutazone to reduce development of Equine Gastric Ulcer syndrome (EGUS), but the efficacy and safety of this practice remains unknown. OBJECTIVES To evaluate the effect of omeprazole on phenylbutazone-induced Equine glandular Gastric disease (EGGD) and Equine squamous Gastric disease (ESGD). STUDY DESIGN Randomised block experimental design. METHODS Twenty-two horses with EGGD and ESGD scores ≤2 were included. Horses were assigned to treatment groups: phenylbutazone (4.4 mg/kg PO q 12 h; PBZ), phenylbutazone plus omeprazole (4 mg/kg PO q. 24 h; PBZ/OME) or placebo (CON) in a randomised block design based upon initial EGGD score. Horses were treated for up to 14 days. Gastroscopy was performed weekly; CBC and biochemistry were performed at Day 0 and study end. Horses were monitored for signs of colic and/or diarrhoea. RESULTS EGGD score increased in PBZ (median change 1, inter-quartile range, [IQR], 0-2) compared to PBZ/OME (median change 0, IQR -1 to 0; P = .05). PBZ/OME (6/8) had more intestinal complications than CON (0/6; difference between proportions = 75%; 95% CI, 23%-93%; P = .03). Plasma protein concentrations decreased in PBZ, compared to CON (mean difference between groups, 14 g/L; 95% CI, 1.04-27; P = .03). Five horses were withdrawn from the study due to intestinal complications (n = 3 PBZ/OME and n = 2 PBZ); one horse (PBZ) was withdrawn due to severe grade 4 EGGD. MAIN LIMITATIONS Small sample size and changes in management for the 2-3 days prior to study initiation; variable treatment duration among groups due to development of complications. CONCLUSIONS Administration of omeprazole ameliorated PBZ-induced EGGD, but was associated with an increase in intestinal complications. Caution should be exercised when co-prescribing NSAIDs and omeprazole in horses, particularly in association with change in management.

  • Impact of concurrent treatment with omeprazole on phenylbutazone‐induced Equine Gastric Ulcer syndrome (EGUS)
    Equine Veterinary Journal, 2020
    Co-Authors: Megan Ricord, Frank M. Andrews, Francisco J. Morales Yñiguez, M. L. Keowen, F. Garza, Linda Paul, Ann Chapman, Heidi E. Banse
    Abstract:

    BACKGROUND Phenylbutazone is commonly prescribed for treatment of various painful or inflammatory disorders in horses, but is associated with gastrointestinal (GI) adverse effects. Anecdotally, many practitioners prescribe omeprazole concurrently with phenylbutazone to reduce development of Equine Gastric Ulcer syndrome (EGUS), but the efficacy and safety of this practice remains unknown. OBJECTIVES To evaluate the effect of omeprazole on phenylbutazone-induced Equine glandular Gastric disease (EGGD) and Equine squamous Gastric disease (ESGD). STUDY DESIGN Randomised block experimental design. METHODS Twenty-two horses with EGGD and ESGD scores ≤2 were included. Horses were assigned to treatment groups: phenylbutazone (4.4 mg/kg PO q 12 h; PBZ), phenylbutazone plus omeprazole (4 mg/kg PO q. 24 h; PBZ/OME) or placebo (CON) in a randomised block design based upon initial EGGD score. Horses were treated for up to 14 days. Gastroscopy was performed weekly; CBC and biochemistry were performed at Day 0 and study end. Horses were monitored for signs of colic and/or diarrhoea. RESULTS EGGD score increased in PBZ (median change 1, inter-quartile range, [IQR], 0-2) compared to PBZ/OME (median change 0, IQR -1 to 0; P = .05). PBZ/OME (6/8) had more intestinal complications than CON (0/6; difference between proportions = 75%; 95% CI, 23%-93%; P = .03). Plasma protein concentrations decreased in PBZ, compared to CON (mean difference between groups, 14 g/L; 95% CI, 1.04-27; P = .03). Five horses were withdrawn from the study due to intestinal complications (n = 3 PBZ/OME and n = 2 PBZ); one horse (PBZ) was withdrawn due to severe grade 4 EGGD. MAIN LIMITATIONS Small sample size and changes in management for the 2-3 days prior to study initiation; variable treatment duration among groups due to development of complications. CONCLUSIONS Administration of omeprazole ameliorated PBZ-induced EGGD, but was associated with an increase in intestinal complications. Caution should be exercised when co-prescribing NSAIDs and omeprazole in horses, particularly in association with change in management.

  • Advances in Diagnostics and Treatments in Horses and Foals with Gastric and Duodenal Ulcers.
    Veterinary Clinics of North America: Equine Practice, 2018
    Co-Authors: Pilar Camacho-luna, Benjamin R. Buchanan, Frank M. Andrews
    Abstract:

    Equine Gastric Ulcer syndrome (EGUS) primarily describes Ulceration in the terminal esophagus, nonglandular squamous mucosa, glandular mucosa of the stomach, and proximal duodenum. EGUS is common in all breeds and ages of horses and foals. This article focuses on the current terminology for EGUS, etiologies and pathogenesis for lesions in the nonglandular and glandular stomach, diagnosis, and a comprehensive approach to the treatment and prevention of EGUS in adult horses and foals.

  • Therapeutics for Equine Gastric Ulcer Syndrome
    Veterinary Clinics of North America: Equine Practice, 2017
    Co-Authors: Fereydon Rezazadeh Zavoshti, Frank M. Andrews
    Abstract:

    Equine Gastric Ulcer syndrome (EGUS) is an umbrella term used to describe Ulcers in the nonglandular squamous and glandular mucosa, terminal esophagus, and proximal duodenum. Gastric Ulcers in the squamous and glandular regions occur more often than esophageal or duodenal Ulcers and likely have a different pathogenesis. At present, omeprazole is accepted globally as the best pharmacologic therapy for both regions of the stomach; however, the addition of coating agents and synthetic prostaglandins could add to its effectiveness in treatment of EGUS. Dietary and environmental management are necessary for prevention of recurrence.

  • Nutritional management of Gastric Ulceration
    Equine Veterinary Education, 2015
    Co-Authors: Frank M. Andrews, C. Larson, Pat Harris
    Abstract:

    Summary Gastric Ulcers are common in horses and Equine Gastric Ulcer syndrome describes Ulcers in the distal oesophagus, nonglandular and glandular stomach as well as the proximal duodenum. Ulcers in the distal oesophagus and nonglandular region of the stomach are probably caused by hydrochloric acid, whereas Ulcers in the glandular stomach and proximal duodenum are likely to be caused by a breakdown in the mucosal defence mechanisms. Regardless of the location of Ulcers, initial treatment with pharmacological agents is necessary to suppress hydrochloric acid; however, nutrition and management changes are required to maintain Ulcer healing and help prevent recurrence. In addition, many dietary supplements have been marketed to help maintain stomach health and some scientific data on their effects on Gastric Ulcer scores and Gastric juice pH are presented.

Gd Hallowell - One of the best experts on this subject based on the ideXlab platform.

  • Diagnostic accuracy of blood sucrose as a screening test for Equine Gastric Ulcer syndrome (EGUS) in weanling foals
    Acta Veterinaria Scandinavica, 2018
    Co-Authors: Michael Hewetson, Gd Hallowell, Ben William Sykes, Monica Venner, Jan Volquardsen, Ingrid Vervuert, Geoffrey Theodore Fosgate, Riitta-mari Tulamo
    Abstract:

    Background Equine Gastric Ulcer syndrome is an important cause of morbidity in weanling foals. Many foals are asymptomatic, and the development of an inexpensive screening test to ensure an early diagnosis is desirable. The objective of this study was to determine the diagnostic accuracy of blood sucrose for diagnosis of EGUS in weanling foals. Results 45 foals were studied 7 days before and 14 days after weaning. The diagnostic accuracy of blood sucrose for diagnosis of Gastric lesions (GL); glandular lesions (GDL); squamous lesions (SQL) and clinically significant Gastric lesions (CSL) at 45 and 90 min after administration of 1 g/kg of sucrose via nasoGastric intubation was assessed using ROC curves and calculating the AUC. For each lesion type, sucrose concentration in blood was compared to gastroscopy; and sensitivities (Se) and specificities (Sp) were calculated across a range of sucrose concentrations. Cut-off values were selected manually to optimize Se. Because of concerns over the validity of the gold standard, additional Se, Sp, and lesion prevalence data were subsequently estimated and compared using Bayesian latent class analysis. Using the frequentist approach, the prevalence of GL; GDL; SQL and CSL before weaning was 21; 9; 7 and 8% respectively; and increased to 98; 59; 97 and 82% respectively after weaning. At the selected cut-off, Se ranged from 84 to 95% and Sp ranged from 47 to 71%, depending upon the lesion type and time of sampling. In comparison, estimates of Se and Sp were consistently higher when using a Bayesian approach, with Se ranging from 81 to 97%; and Sp ranging from 77 to 97%, depending upon the lesion type and time of sampling. Conclusions Blood sucrose is a sensitive test for detecting EGUS in weanling foals. Due to its poor specificity, it is not expected that the sucrose blood test will replace gastroscopy, however it may represent a clinically useful screening test to identify foals that may benefit from gastroscopy. Bayesian latent class analysis represents an alternative method to evaluate the diagnostic accuracy of the blood sucrose test in an attempt to avoid bias associated with the assumption that gastroscopy is a perfect test.

  • Diagnostic accuracy of blood sucrose as a screening test for Equine Gastric Ulcer syndrome (EGUS) in weanling foals
    Acta Veterinaria Scandinavica, 2018
    Co-Authors: Michael Hewetson, B. W. Sykes, Gd Hallowell, Monica Venner, Jan Volquardsen, Ingrid Vervuert, Geoffrey Theodore Fosgate, Riitta-mari Tulamo
    Abstract:

    Equine Gastric Ulcer syndrome is an important cause of morbidity in weanling foals. Many foals are asymptomatic, and the development of an inexpensive screening test to ensure an early diagnosis is desirable. The objective of this study was to determine the diagnostic accuracy of blood sucrose for diagnosis of EGUS in weanling foals. 45 foals were studied 7 days before and 14 days after weaning. The diagnostic accuracy of blood sucrose for diagnosis of Gastric lesions (GL); glandular lesions (GDL); squamous lesions (SQL) and clinically significant Gastric lesions (CSL) at 45 and 90 min after administration of 1 g/kg of sucrose via nasoGastric intubation was assessed using ROC curves and calculating the AUC. For each lesion type, sucrose concentration in blood was compared to gastroscopy; and sensitivities (Se) and specificities (Sp) were calculated across a range of sucrose concentrations. Cut-off values were selected manually to optimize Se. Because of concerns over the validity of the gold standard, additional Se, Sp, and lesion prevalence data were subsequently estimated and compared using Bayesian latent class analysis. Using the frequentist approach, the prevalence of GL; GDL; SQL and CSL before weaning was 21; 9; 7 and 8% respectively; and increased to 98; 59; 97 and 82% respectively after weaning. At the selected cut-off, Se ranged from 84 to 95% and Sp ranged from 47 to 71%, depending upon the lesion type and time of sampling. In comparison, estimates of Se and Sp were consistently higher when using a Bayesian approach, with Se ranging from 81 to 97%; and Sp ranging from 77 to 97%, depending upon the lesion type and time of sampling. Blood sucrose is a sensitive test for detecting EGUS in weanling foals. Due to its poor specificity, it is not expected that the sucrose blood test will replace gastroscopy, however it may represent a clinically useful screening test to identify foals that may benefit from gastroscopy. Bayesian latent class analysis represents an alternative method to evaluate the diagnostic accuracy of the blood sucrose test in an attempt to avoid bias associated with the assumption that gastroscopy is a perfect test.

  • Diagnostic accuracy of blood sucrose as a screening test for Equine Gastric Ulcer syndrome (EGUS) in weanling foals
    'Springer Science and Business Media LLC', 2018
    Co-Authors: Hewetson M, Venner M, Volquardsen J, Sykes B, Gd Hallowell, Fosgate G T, Tulamo R M
    Abstract:

    Equine Gastric Ulcer syndrome is an important cause of morbidity in weanling foals. Many foals are asymptomatic, and the development of an inexpensive screening test to ensure an early diagnosis is desirable. The objective of this study was to determine the diagnostic accuracy of blood sucrose for diagnosis of EGUS in weanling foals

  • Diagnostic accuracy of blood sucrose as a screening test for Equine Gastric Ulcer syndrome (EGUS) in adult horses
    Acta Veterinaria Scandinavica, 2017
    Co-Authors: Michael Hewetson, Gd Hallowell, Ben William Sykes, Riitta-mari Tulamo
    Abstract:

    Background Equine Gastric Ulcer syndrome (EGUS) is common in adult horses, particularly those involved in performance disciplines. Currently, detection of EGUS by gastroscopy is the only reliable ante mortem method for definitive diagnosis; however it is unsuitable as a screening test because it is expensive, time consuming, and is not readily available to most veterinarians. Sucrose permeability testing represents a simple, economical alternative to gastroscopy for screening purposes, and the feasibility of this approach in the horse has been previously reported. The aim of this study was to determine the diagnostic accuracy of blood sucrose as a screening test for EGUS in a large group of adult horses with and without naturally occurring Gastric disease. Results One hundred and one adult horses with or without naturally occurring Gastric Ulceration were studied. The diagnostic accuracy of blood sucrose for diagnosis of Gastric lesions (GL), glandular lesions (GDL), squamous lesions (SQL), and clinically significant lesions (CSL) at 45 and 90 min after administration of 1 g/kg of sucrose via nasoGastric intubation was assessed using receiver operator characteristics (ROC) curves and calculating the area under the curve (AUC). For each lesion type, sucrose concentration in blood was compared to gastroscopy, as the gold standard, and sensitivities (Se) and specificities (Sp) were calculated across a range of sucrose concentrations. Ulcer grading was performed blindly by one observer; and the results were validated by comparing them with that of two other observers, and calculating the level of agreement. Cut-off values were selected manually to optimize Se. The prevalence of GL, GDL, SQL, and CSL was 83, 70, 53 and 58% respectively. At the selected cut-offs, Se ranged from 51 to 79% and Sp ranged from 43 to 72%, depending upon the lesion type and time of sampling. Conclusions Blood sucrose is neither a sensitive or specific test for detecting EGUS in this population of adult horses with naturally occurring Gastric Ulceration. Further studies aimed at evaluating the performance characteristics of the test in different study populations are warranted. Given the limitations of endoscopy, due consideration should also be given to alternative methods for comparison of blood sucrose with a gold standard.

  • Diagnostic accuracy of blood sucrose as a screening test for Equine Gastric Ulcer syndrome (EGUS) in adult horses.
    Acta Veterinaria Scandinavica, 2017
    Co-Authors: Michael Hewetson, Gd Hallowell, Ben William Sykes, Riitta-mari Tulamo
    Abstract:

    Equine Gastric Ulcer syndrome (EGUS) is common in adult horses, particularly those involved in performance disciplines. Currently, detection of EGUS by gastroscopy is the only reliable ante mortem method for definitive diagnosis; however it is unsuitable as a screening test because it is expensive, time consuming, and is not readily available to most veterinarians. Sucrose permeability testing represents a simple, economical alternative to gastroscopy for screening purposes, and the feasibility of this approach in the horse has been previously reported. The aim of this study was to determine the diagnostic accuracy of blood sucrose as a screening test for EGUS in a large group of adult horses with and without naturally occurring Gastric disease. One hundred and one adult horses with or without naturally occurring Gastric Ulceration were studied. The diagnostic accuracy of blood sucrose for diagnosis of Gastric lesions (GL), glandular lesions (GDL), squamous lesions (SQL), and clinically significant lesions (CSL) at 45 and 90 min after administration of 1 g/kg of sucrose via nasoGastric intubation was assessed using receiver operator characteristics (ROC) curves and calculating the area under the curve (AUC). For each lesion type, sucrose concentration in blood was compared to gastroscopy, as the gold standard, and sensitivities (Se) and specificities (Sp) were calculated across a range of sucrose concentrations. Ulcer grading was performed blindly by one observer; and the results were validated by comparing them with that of two other observers, and calculating the level of agreement. Cut-off values were selected manually to optimize Se. The prevalence of GL, GDL, SQL, and CSL was 83, 70, 53 and 58% respectively. At the selected cut-offs, Se ranged from 51 to 79% and Sp ranged from 43 to 72%, depending upon the lesion type and time of sampling. Blood sucrose is neither a sensitive or specific test for detecting EGUS in this population of adult horses with naturally occurring Gastric Ulceration. Further studies aimed at evaluating the performance characteristics of the test in different study populations are warranted. Given the limitations of endoscopy, due consideration should also be given to alternative methods for comparison of blood sucrose with a gold standard.

K M Sykes - One of the best experts on this subject based on the ideXlab platform.

  • a comparison of three doses of omeprazole in the treatment of Equine Gastric Ulcer syndrome a blinded randomised dose response clinical trial
    Equine Veterinary Journal, 2015
    Co-Authors: B. W. Sykes, K M Sykes, G D Hallowell
    Abstract:

    SummaryReasons for performing the study A previous study demonstrated that a dose effect between 1.6 and 4.0 mg/kg bwt of omeprazole per os s.i.d. is present in the treatment of Equine Gastric Ulceration. In the same study, healing of glandular Ulceration appeared inferior to healing of squamous Ulceration. However, several limitations were recognised in that study and further investigation is warranted. Objectives To further investigate the presence of a dose relationship in the treatment of Gastric Ulceration under conditions that may favour omeprazole efficacy such as administration prior to exercise and after a brief fast, and potential differences between the response of squamous and glandular Ulceration to omeprazole therapy. Study design A blinded, randomised, dose–response clinical trial. Methods Sixty Thoroughbred racehorses with grade ≥2/4 squamous and/or glandular Ulceration were identified by gastroscopy. Horses were randomly assigned to receive either 1.0, 2.0 or 4.0 mg/kg bwt of enteric coated omeprazole per os s.i.d. 1–4 h prior to exercise. Gastroscopy was repeated at approximately 28 days. Results The lower doses studied (1.0 and 2.0 mg/kg bwt) were noninferior to the reference dose (4.0 mg/kg bwt) in the treatment of squamous Ulceration. Healing was greater in squamous Ulceration than glandular Ulceration (86% vs. 14%; P<0.0001). Improvement in Ulcer grade was more likely in squamous lesions than glandular lesions (96% vs. 34%; P<0.0001). Worsening of the glandular Ulcer grade was observed in 36% of horses. Conclusions The results of this study suggest that, under the conditions studied, where omeprazole is administered before exercise and following a brief fast, doses of omeprazole as low as 1 mg/kg bwt per os s.i.d. may be as effective as higher doses. The proportion of glandular Ulceration that heals with 28 days of omeprazole therapy is less than that of squamous Ulceration.

  • Efficacy of a Combination of Apolectol, Live Yeast (Saccharomyces cerevisiae [CNCM I-1077]), and Magnesium Hydroxide in the Management of Equine Gastric Ulcer Syndrome in Thoroughbred Racehorses: A Blinded, Randomized, Placebo-Controlled Clinical Tri
    Journal of Equine Veterinary Science, 2014
    Co-Authors: B. W. Sykes, K M Sykes, Gayle D Hallowell
    Abstract:

    To date, prevention of Equine Gastric Ulcer syndrome (EGUS) has relied on management changes or pharmaceutical agents. The identification of an alternative means of prevention would be useful. Therefore, the objective of this study was to evaluate the combination of Apolectol, a live yeast (Saccharomyces cerevisiae [CNCM I-1077]), and magnesium hydroxide for the prevention of development of, or exacerbation of existing, EGUS in Thoroughbred racehorses. Twenty-four Thoroughbred racehorses without significant Gastric Ulceration (grade, ≤2 of 4) were identified on gastroscopy. Treated horses received 95 g Apolectol, 2 g S. cerevisiae, and 20 g magnesium hydroxide 1–4 hours before exercise. Control horses received 95 g of a feed pellet as a placebo. Gastroscopy was repeated at 24–27 days. There was no change in squamous (P = .45) or glandular (P = 1.0) Ulcer grade over time in horses in the treatment group. In the placebo group, Ulcer grade increased in both the squamous (P = .04) and glandular (P = .19) mucosa but only reached significance in the squamous mucosa group. Worsening of the Ulcer grade was more likely in the placebo group in the glandular (P = .04) but not in squamous (P = .10) mucosa. The combination studied may be an effective prophylactic against EGUS development or exacerbation.

  • Administration of trimethoprim-sulphadimidine does not improve healing of glandular Gastric Ulceration in horses receiving omeprazole: a randomised, blinded, clinical study
    BMC Veterinary Research, 2014
    Co-Authors: B. W. Sykes, K M Sykes, Gayle D Hallowell
    Abstract:

    Background Interest in Equine Gastric Ulcer Syndrome (EGUS) has recently increased in part due to a growing awareness of the differences between squamous and glandular disease. The pathophysiology and epidemiology of squamous and glandular disease are different and recently it has been shown that the response of glandular Gastric Ulceration to monotherapy with omeprazole is poor. Given these differences it has been recommended that specific treatment guidelines be formulated for Equine glandular disease and that adjunctive therapies be investigated. Along these lines it has been suggested that the addition of antimicrobials may enhance healing. The objective of this study was to investigate whether the addition of trimethoprim-sulphadimidine to omeprazole therapy would result in superior healing of naturally occurring Equine glandular Ulceration compared with omeprazole monotherapy.

  • a comparison of two doses of omeprazole in the treatment of Equine Gastric Ulcer syndrome a blinded randomised clinical trial
    Equine Veterinary Journal, 2014
    Co-Authors: B. W. Sykes, K M Sykes, Gd Hallowell
    Abstract:

    SummaryReasons for performing the study Studies on omeprazole have reported that doses as low as 0.7 mg/kg bwt per os are potent suppressors of acid production. Yet, to date, no studies have compared treatment efficacy of different doses in clinical cases of Equine Gastric Ulceration. Furthermore, no studies have been performed to compare the healing response of the squamous and glandular mucosa to acid suppression therapy. Objectives To compare: 1) the efficacy of 2 doses of omeprazole in the treatment of primary squamous and glandular Gastric Ulceration; and 2) the healing response of primary squamous and glandular Gastric Ulceration to acid suppression therapy. Study design A blinded, randomised, dose–response clinical trial. Methods Twenty Thoroughbred racehorses with grade ≥2/4 glandular Ulceration were identified on gastroscopy. Seventeen horses also had grade ≥2/4 squamous Ulceration. Horses were randomly assigned to one of 2 groups. Horses received either 2.0 g (high dose: 4.0 mg/kg bwt) or 0.8 g (low dose: 1.6 mg/kg bwt) of oral omeprazole per os once daily. Gastroscopy was repeated at 28–35 days. Results Time and dose significantly affected grades of squamous (P<0.0001, P = 0.02) and glandular (P = 0.006 and 0.005) Ulceration. Data analysis did not support our hypothesis that the lower dose would have similar effects (i.e. be noninferior) to the higher dose when considering Ulcer healing and Ulcer improvement. Improvement was more likely with the high dose for the squamous (P = 0.05) but not glandular (P = 0.4) mucosa. The percentage of glandular Ulcers that improved was less than squamous Ulcers (P = 0.02). Conclusions The results suggest that a dose–response exists for the treatment of both squamous and glandular Ulcers. Improvement of glandular Ulcers was not as complete as observed with squamous Ulcers and current Equine Gastric Ulcer syndrome treatment recommendations may not be appropriate for glandular disease.

  • a comparison between pre and post exercise administration of omeprazole in the treatment of Equine Gastric Ulcer syndrome a blinded randomised clinical trial
    Equine Veterinary Journal, 2014
    Co-Authors: B. W. Sykes, K M Sykes, G D Hallowell
    Abstract:

    Summary Reasons for performing the study A recent study suggested that the duration of acid suppression achieved with once-daily administration of omeprazole is as short as 12 h and that administration of omeprazole prior to exercise may be superior compared with administration at other times of the day in the treatment of Equine Gastric Ulcer syndrome (EGUS). Objectives The primary objective of the study was to investigate whether the administration of omeprazole prior to exercise resulted in better healing of EGUS compared with administration post exercise. A secondary objective was to investigate the differences between the response of squamous and glandular EGUS to omeprazole therapy. Study design A randomised, blinded, clinical trial. Methods Twenty-five horses with grade ≥2/4 squamous EGUS were identified by gastroscopy. The glandular mucosa was also scored. Horses were randomly assigned to receive 4.0 mg/kg bwt of omeprazole per os once daily either 1–4 h prior to high-intensity exercise (PRE group; 13 horses) or 1–4 h after exercise (POST group; 12 horses). Gastroscopy was repeated at approximately 25 days. Results No differences were observed between the pre- and post exercise treatment groups. Overall, healing was observed in 80% of squamous Ulcers vs. 21% of glandular Ulcers (P = 0.0002), and improvement was seen in 96% of squamous Ulcers vs. 53% of glandular Ulcers (P = 0.001). Worsening was observed in the glandular mucosa of 13% of horses. Conclusions The results of this study suggest that the timing of administration does not affect Ulcer healing. Furthermore, the study demonstrates that the response of glandular Ulceration to omeprazole therapy is inferior to that of the squamous mucosa.