Tuesday, April 08, 2014

Regarding Omeprazole

The April 2014 edition of the Endurance News has an article discussing the possibility of allowing endurance horses in AERC events to compete while on Omeprazole.

A common argument, I've heard: "everybody else does it." Really? I was told by my mama at a very young age that particular argument wasn't valid. The common rejoinder "if everybody jumped off a cliff…?" I'm not equating allowing omeprazole with jumping off a cliff, however, the argument "everybody does it" still isn't valid.

As I thought about this issue, several questions came to mind.
  1. Will marginal horses that should have been weeded out of the sport be allowed (even encouraged) to continue to compete to their detriment and the detriment of the sport? (I can think of at least one horse that was weeded out of the sport, and rightly so, due to continued issues with ulcers. Would this rule have allowed him to keep running until something worse happened?)
  2. Should we be letting people take the easy way out by dosing their horse with a drug, rather than managing the horse better? There are management techniques to deal with horses that don't or won't eat due to stress. And keeping a full belly is a good start to managing a horse prone to ulcers. The article in the Endurance News points out this rule change is really to benefit multi-day horses and cautions that drugs are not the [only] answer. Management is still key. However, will people really try to go down the management route before putting drugs into their horse if it's sanctioned by AERC?
  3. Since Omeprazole is used for treatment and prevention of ulcers, where do we draw the line on allowing horses being treated for ulcers to compete? Is there a way to tell if the horse is being treated vs just on preventative? Will drug test levels tell us that? If so, will drug test levels tell us whether the horse is on preventative or just at the start of their treatment phase for a full blown case of ulcers?
  4. Do we really know the long-term effects of allowing Omeprazole for endurance horses? From my understanding, the drug inhibits acid production. Stomach acid is part of the digestive process and is required to help breakdown the foodstuffs the horse is eating. If not enough acid is present, then the effect could be to dump undigested food into the hind gut, which can change the PH of the hind gut and cause the death of healthy microbial population which is necessary for fiber breakdown. Is the hind gut any less important than the stomach? What's scary is we can't really check for that. I can't get a scope of my horse's hind gut. That only can happen at an autopsy.
  5. If we're going to allow Omeprazole, what about allowing Ranitidine (another ulcer treatment that also is good for hind gut ulcers) or Sucralfate (a coating agent; also reportedly good for hind gut)? Why just Omeprazole?
Currently the rules allow for a full dose of Gastrogard (Omeprazole at a full tube; a treatment dose) 24 hours before the start of a ride. And a horse can be given anything they want after a completion exam. Is there really a need to allow dosage of Omeprazole during a vet check?

I believe AERC as an organization needs to be comfortable with the answers to these questions before making this important decision.

* A good article discussing Equine Ulcers by Kerry J. Ridgeway, DVM

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