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Equine veterinary journal2021; doi: 10.1111/evj.13534

Effect of omeprazole and sucralfate on gastrointestinal injury in a fasting/NSAID model.

Abstract: Equine gastric ulcer syndrome (EGUS) is a common and significant cause of morbidity in horses, with a range of clinical signs, including inappetence, colic and poor performance. Hospitalised horses are exposed to factors that may induce EGUS, including fasting and nonsteroidal anti-inflammatory drug (NSAID) administration, and may be at risk for development of squamous (ESGD) and glandular gastric disease (EGGD). Prophylactic anti-ulcer medication is often prescribed for these patients, but drug selection is complicated by different aetiology and response to treatment of ESGD and EGGD. Objective: To establish the efficacy of sucralfate or omeprazole used prophylactically in horses exposed to a combined feed-fast and NSAID administration EGUS induction protocol. We hypothesised that these drugs would be equally effective for prevention of gastric lesions in the experimental cohort. Methods: Randomised crossover experimental design. Methods: Horses (n = 14) received either omeprazole (1 mg/kg PO q24h) or sucralfate (20 mg/kg PO q8h) while undergoing the feed-fast/NSAID protocol, allowed an 8-week washout period, and then administered the alternate treatment. Serial gastroscopy, ultrasound and haematology documented treatment effects. Results: ESGD and EGGD score increased over time under both treatments. There was a significant effect of treatment on EGGD scores (P < .001), with post-treatment EGGD scores higher for horses receiving sucralfate (median 3; IQR 2.25,3) than omeprazole (1; 1,1). The effect of treatment on ESGD scores just achieved significance (P = .05), with post-treatment ESGD scores higher for sucralfate (4; 3,4) than omeprazole (2; 2,3). Conclusions: This study was performed in healthy horses, and response to treatment may differ in horses with clinical illness. Additional investigation in a larger population may be required to detect significant differences in other clinical parameters. Conclusions: Omeprazole was superior to sucralfate for mitigating gastric lesion severity in healthy horses exposed to a feed-fast/NSAID model.
© 2021 EVJ Ltd.
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Publication Date: 2021-10-31 PubMed ID: 34719063DOI: 10.1111/evj.13534Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research article discusses a study comparing the efficacy of omeprazole and sucralfate for the prevention of gastric lesions in horses exposed to significant risk factors such as fasting and NSAID administration.

Objective and Hypothesis

The research aimed to understand better the effects of sucralfate and omeprazole when used as preventative medicine in cases where horses undergo a combined fasting/nonsteroidal anti-inflammatory drug (NSAID) protocol which is known to induce Equine Gastric Ulcer Syndrome (EGUS). The hypothesis was that both of these drugs would be equally effective in the prevention of gastric lesions.

Methods

  • The research utilized a randomized crossover experimental design, where horses were randomly assigned to different treatment groups.
  • The researchers administered either omeprazole (1 mg/kg) or sucralfate (20 mg/kg) to a group of 14 horses undergoing the fasting/NSAID protocol.
  • A washout period of 8 weeks was allowed wherein the horse is discharged from the initial treatment and then administered the alternate treatment.
  • Effects of the treatments were observed and documented using serial gastroscopy, ultrasound, and haematology.

Results

  • The study observed that both squamous gastric disease (ESGD) and glandular gastric disease (EGGD) scores showed an increment over time under both treatments.
  • Results revealed a significant effect of treatment on EGGD scores, which were higher in horses receiving sucralfate than those receiving omeprazole.
  • Similar trends were seen on ESGD scores, with a marginally significant difference; the scores higher again for horses receiving sucralfate.

Conclusions

  • It was important to note that this study was conducted on healthy horses, and it was mentioned that treatment responses might differ in clinically ill horses.
  • Researchers also underlined the potential need for further investigation on a larger scale to discern significant differences in other clinical parameters.
  • Based on the study’s results, it was concluded that omeprazole was more effective than sucralfate in mitigating the severity of gastric lesions in healthy horses exposed to the fasting/NSAID model.

Cite This Article

APA
Bishop RC, Kemper AM, Wilkins PA, McCoy AM. (2021). Effect of omeprazole and sucralfate on gastrointestinal injury in a fasting/NSAID model. Equine Vet J. https://doi.org/10.1111/evj.13534

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Bishop, Rebecca C
  • Department of Veterinary Clinical Medicine, University of Illinois, Urbana, Illinois, USA.
Kemper, Ann M
  • Department of Veterinary Clinical Medicine, University of Illinois, Urbana, Illinois, USA.
Wilkins, Pamela A
  • Department of Veterinary Clinical Medicine, University of Illinois, Urbana, Illinois, USA.
McCoy, Annette M
  • Department of Veterinary Clinical Medicine, University of Illinois, Urbana, Illinois, USA.

Grant Funding

  • ILLU-888-949 / U.S. Department of Agriculture

References

This article includes 57 references
  1. Begg L, O'Sullivan C. The prevalence and distribution of gastric ulceration in 345 racehorses. Aust Vet J 2003;81:199-201.
  2. Murray MJ, Grodinsky C, Anderson CW, Radue PF, Schmidt GR. Gastric ulcers in horses: a comparison of endoscopic findings in horses with and without clinical signs. Equine Vet J 1989;21:68-72.
  3. McClure SR, Glickman LT, Glickman NW. Prevalence of gastric ulcers in show horses. J Am Vet Med Assoc 1999;215:1130-3.
  4. Luthersson N, Nielsen KH, Harris P, Parkin TDH. Risk factors associated with equine gastric ulceration syndrome (EGUS) in 201 horses in Denmark. Equine Vet J 2009;41:625-30.
  5. Niedźwiedź A, Kubiak K, Nicpoń J. Endoscopic findings of the stomach in pleasure horses in Poland. Acta Vet Scand 2013;55:45.
  6. Murray MJ, Schusser GRF, Pipers FS, Gross SJ. Factors associated with gastric lesions in Thoroughbred racehorses. Equine Vet J 1996;28:368-74.
  7. Vatistas NJ, Snyder JR, Carlson G, Johnson B, Arthu RM, Thurmond M. Cross-sectional study of gastric ulcers of the squamous mucosa in Thoroughbred racehorses. Equine Vet J 1999;31:34-9.
  8. Rabuffo TS, Orsini JA, Sullivan E, Engiles J, Norman T, Boston R. Associations between age or sex and prevalence of gastric ulceration in Standardbred racehorses in training. J Am Vet Med Assoc 2002;221:1156-9.
  9. Dionne RM, Vrins A, Doucet MY, Pare J. Gastric Ulcers in Standardbred racehorses: prevalence, lesion description, and risk factors. J Vet Intern Med 2003;17:218-22.
  10. Jonsson H, Egenvall A. Prevalence of gastric ulceration in Swedish Standardbreds in race training. Equine Vet J 2006;38:209-13.
  11. Sykes BW, Sykes KM, Hallowell GD. A comparison of three doses of omeprazole in the treatment of equine gastric ulcer syndrome: A blinded, randomised, dose-response clinical trial. Equine Vet J 2015;47:285-90.
  12. Hepburn RJ. Endoscopic examination of the squamous and glandular gastric mucosa in sport and leisure horses: 684 horses (2005-2011) [abstract]. Proceedings of the 11th International Equine Colic Research Symposium 5; 2014.
  13. Sykes BW, Hewetson M, Hepburn RJ, Luthersson N, Tamzali Y. European college of equine internal medicine consensus statement-equine gastric ulcer syndrome in adult horses. J Vet Intern Med 2015;29:1288-99.
  14. Frank N, Andrews FM, Elliott SB, Lew J. Effects of dietary oils on the development of gastric ulcers in mares. Am J Vet Res 2005;66:2006-11.
  15. Andrews FM, Buchanan BR, Smith SH, Elliott SB, Saxton AM. In vitro effects of hydrochloric acid and various concentrations of acetic, propionic, butyric, or valeric acids on bioelectric properties of equine gastric squamous mucosa. Am J Vet Res 2006;67:1873-82.
  16. Hallowell G. Pathogenesis of equine squamous and glandular gastric disease. UK-Vet Equine 2018;2:70-5.
  17. Pedersen SK, Cribb AE, Windeyer MC, Read EK, French D, Banse HE. Risk factors for equine glandular and squamous gastric disease in show jumping Warmbloods. Equine Vet J 2018;50:747-51.
  18. Sykes BW, Bowen M, Habershon-Butcher JL, Green M, Hallowell GD. Management factors and clinical implications of glandular and squamous gastric disease in horses. J Vet Intern Med 2019;33:233-40.
  19. Meschter CL, Gilbert M, Krook L, Maylin G, Corradino R. The effects of phenylbutazone on the morphology and prostaglandin concentrations of the pyloric mucosa of the equine stomach. Vet Pathol 1990;27:244-53.
  20. MacAllister CG, Morgan SJ, Borne AT, Pollet RA. Comparison of adverse effects of phenylbutazone, flunixin meglumine, and ketoprofen in horses. J Am Vet Med Assoc 1993;202:71-7.
  21. MacKay RJ, French TW, Nguyen HT, Mayhew IG. Effects of large doses of phenylbutazone administration to horses. Am J Vet Res 1983;44:774-80.
  22. Traub-Dargatz JL, Bertone JJ, Gould DH, Wrigley RH, Weiser MG, Forney SD. Chronic flunixin meglumine therapy in foals. Am J Vet Res 1988;49:7-12.
  23. Collins LG, Tyler DE. Phenylbutazone toxicosis in the horse: a clinical study. J Am Vet Med Assoc 1984;184:699-703.
  24. Carrick JB, Papich MG, Middleton DM, Naylor JM, Townsend HG. Clinical and pathological effects of flunixin meglumine administration to neonatal foals. Can J Vet Res 1989;53:195-201.
  25. Pedersen SK, Cribb AE, Read EK, French D, Banse HE. Phenylbutazone induces equine glandular gastric disease without decreasing prostaglandin E2 concentrations. J Vet Pharmacol Ther 2018;41:239-45.
  26. Richardson LM, Whitfield-Cargile CM, Cohen ND, Chamoun-Emanuelli AM, Dockery HJ. Effect of selective versus nonselective cyclooxygenase inhibitors on gastric ulceration scores and intestinal inflammation in horses. Vet Surg 2018;47:784-91.
  27. Ricord M, Andrews FM, Yniguez FJM, Keowen M, Garza F Jr, Paul L. Impact of concurrent treatment with omeprazole on phenylbutazone-induced equine gastric ulcer syndrome (EGUS). Equine Vet J 2021;53:356-63.
  28. Malmkvist J, Poulsen JM, Luthersson N, Palme R, Christensen JW, Søndergaard E. Behaviour and stress responses in horses with gastric ulceration. Appl Anim Behav Sci 2012;142:160-7.
  29. Nicol CJ, Davidson HPD, Harris PA, Waters AJ, Wilson AD. Study of crib-biting and gastric inflammation and ulceration in young horses. Veterinary Record 2002;151:658-62.
  30. Cook VL, Blikslager AT. The use of nonsteroidal anti-inflammatory drugs in critically ill horses. J Vet Emerg Crit Care (San Antonio) 2015;25:76-88.
  31. Dukti SA, Perkins S, Murphy J, Barr B, Boston R, Southwood LL. Prevalence of gastric squamous ulceration in horses with abdominal pain. Equine Vet J 2006;38:347-9.
  32. Zavoshti FR, Andrews FM. Therapeutics for equine gastric ulcer syndrome. Vet Clin North Am Equine Pract 2017;33:141-62.
  33. Korman MG, Bolin TD, Szabo S, Hunt RH, Marks IN, Glise H. Sucralfate: the Bangkok review. J Gastroenterol Hepatol 1994;9:412-5.
  34. Chen BW, Hiu WM, Lam SK, Cho CH, Ng MM, Luk CT. Effect of sucralfate on gastric mucosal blood flow in rats. Gut 1989;30:1544-51.
  35. Szabo S, Vattay P, Scarbrough E, Folkman J. Role of vascular factors, including angiogenesis, in the mechanisms of action of sucralfate. Am J Med 1991;91:158S-60.
  36. Konturek SJ, Brzozowski T, Majka J, Czarnobilski K. Role of nitric oxide and prostaglandins in sucralfate-induced gastroprotection. Eur J Pharmacol 1992;211:277-9.
  37. Sykes BW, Jokisalo JM. Rethinking equine gastric ulcer syndrome: Part 1 - Terminology, clinical signs and diagnosis. Equine Vet Educ 2014;26:543-7.
  38. Murray MJ. Equine model of inducing ulceration in alimentary squamous epithelial mucosa. Dig Dis Sci 1994;39:2530-5.
  39. Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39:175-91.
  40. Murray MJ. Equine model of inducing ulceration in alimentary squamous epithelial mucosa. Dig Dis Sci 1994;39:2530-5.
  41. R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2020.
  42. Noguchi K, Gel YR, Brunner E, Konietschke F. nparLD: an R software package for the nonparametric analysis of longitudinal data in factorial experiments. J Stat Softw 2012;50:1-23.
  43. Siwinska N, Zak A, Baron M, Cylna M, Borowicz H. Right dorsal colon ultrasonography in normal adult ponies and miniature horses. PLoS One 2017;12:e0186825.
  44. Ricord M, Andrews FM, Yñiguez FJM, Keowen M, Garza F, Paul L, Chapman A, Banse HE. Impact of concurrent treatment with omeprazole on phenylbutazone-induced equine gastric ulcer syndrome (EGUS). Equine Vet Educ 53, 356-63.
  45. Freeman DE, Mooney A, Giguère S, Claire J, Evetts C, Diskant P. Effect of feed deprivation on daily water consumption in healthy horses. Equine Vet J 2021;53:117-24.
  46. Tasker JB. Fluid and electrolyte studies in the horse. IV. The effects of fasting and thirsting. Cornell Vet 1967;57:658-67.
  47. Gwee KA, Goh V, Lima G, Setia S. Coprescribing proton-pump inhibitors with nonsteroidal anti-inflammatory drugs: risks versus benefits. J Pain Res 2018;11:361-74.
  48. Ittivavirah SP, Shenika MS. Evaluation of antioxidant and anti-inflammatory activity of Omeprazole against experimentally induced colitis. J Sci Innov Res 2014;3:352-6.
  49. Sykes BW, Sykes KM, Hallowell GD. A comparison of two doses of omeprazole in the treatment of equine gastric ulcer syndrome: a blinded, randomised, clinical trial. Equine Vet J 2014;46:416-21.
  50. Mason LV, Moroney JR, Mason RJ. Prophylactic therapy with omeprazole for prevention of equine gastric ulcer syndrome (EGUS) in horses in active training: a meta-analysis. Equine Vet J 2019;51:11-9.
  51. Miura MS, Saleh C, De Andrade M, Assmann M, Ayres M, Neto JFL. Topical sucralfate in post-adenotonsillectomy analgesia in children. Otolaryngology-Head Neck Surg 2009;141:322-8.
  52. Saunders DP, Epstein JB, Elad S, Allemano J, Bossi P, Van De Wetering MD. Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients. Support Care Cancer 2013;21:3191-207.
  53. Clarkson JE, Worthington HV, Furness S, McCabe M, Khalid T, Meyer S. Interventions for treating oral mucositis for patients with cancer receiving treatment. Cochrane Database of Systematic Reviews 2010.
    doi: 10.1002/14651858.cd001973.pub4google scholar: lookup
  54. Xia W, Park B, Otutaha BF, Macfater WS, Maccormick AD, Sammour T. Topical analgesia following excisional haemorrhoidectomy: a systematic review and meta-analysis of randomised controlled trials. Int J Colorectal Dis 2020;35:181-97.
  55. Bruno A, Tacconelli S, Patrignani P. Variability in the response to non-steroidal anti-inflammatory drugs: mechanisms and perspectives. Basic Clin Pharmacol Toxicol 2014;114:56-63.
  56. Davis JL. Nonsteroidal anti-inflammatory drug associated right dorsal colitis in the horse. Equine Vet Educ 2017;29:104-13.
  57. Jones SL, Davis J, Rowlingson K. Ultrasonographic findings in horses with right dorsal colitis: five cases (2000-2001). J Am Vet Med Assoc 2003;222:1248-51.

Citations

This article has been cited 4 times.
  1. Zhou K, Dong Z, Zhou X, Zhai B, Li B, Zhang J, Cheng F. The Prevalence of Gastric Ulcer Syndrome in 395 Horses in Jiangyin City, China, Jiangsu Province. Animals (Basel) 2024 Dec 17;14(24).
    doi: 10.3390/ani14243636pubmed: 39765539google scholar: lookup
  2. Vokes J, Lovett A, Sykes B. Equine Gastric Ulcer Syndrome: An Update on Current Knowledge. Animals (Basel) 2023 Apr 5;13(7).
    doi: 10.3390/ani13071261pubmed: 37048517google scholar: lookup
  3. Flood J, Stewart AJ. Non-Steroidal Anti-Inflammatory Drugs and Associated Toxicities in Horses. Animals (Basel) 2022 Oct 26;12(21).
    doi: 10.3390/ani12212939pubmed: 36359062google scholar: lookup
  4. Alshabeeb MA, Alyabsi M, Paras B. Prevalence of exposure to pharmacogenetic drugs by the Saudis treated at the health care centers of the Ministry of National Guard. Saudi Pharm J 2022 Aug;30(8):1181-1192.
    doi: 10.1016/j.jsps.2022.06.013pubmed: 36164570google scholar: lookup
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