The

The Veterinary Journal 167 (2004) 1–2

Veterinary Journalwww.elsevier.com/locate/tvjl

Editorial

Endurance horses and gastric ulceration – a sore point

The F�eed�eeration Equestre Internationale (FEI) is re-

sponsible for the general conduct of international

equestrian events, including supervision and mainte-

nance of the health and welfare of the horses taking

part. The Federation�s Veterinary Regulations, available

on line at www.horsesport.org, deal specifically with the

condition, fitness, welfare and medication of competing

horses. As with all regulations, however, a balancedjudgement is required in their drafting as there can be a

wide spectrum of opinion as to what is the best ap-

proach to dealing with difficult issues, compounded in

the FEI�s case by the over-riding need to operate in the

best interests of the horse�s welfare. In the FEI�s 2003

Code of Conduct for the Welfare of the Horse, the

opening statement affirms that the FEI expects everyone

involved in international equestrian sport to �acknowl-edge and accept that at all times the welfare of the horse

must be paramount and must never be subordinated to

competitive or commercial influences�. A summary of

the Code is commendably reproduced in schedules for

every FEI event worldwide.

It is not surprising that the use (and abuse) of med-

ication is considered a key part of ensuring the welfare

of the competition horse. In recent years, the Bureau ofthe FEI, acting on the advice of its Veterinary Com-

mittee and Medication Sub-committee, has modified the

list of prohibited substances in the light of scientific

knowledge. Antibiotics are now allowed (with the ex-

ception of procaine penicillin, as procaine itself may be

used as a local anaesthetic), so are most anti-parasitic

agents, and the Federation is currently considering

whether to permit the oestrus suppressant altrenogest.Since 2000, three drugs to treat and prevent gastric ul-

cers may also be given. This change was welcomed by

many competitors in most FEI disciplines and was in-

novative in that it confronted the zero medication rule

that for many years had been a cornerstone for main-

taining the integrity of Thoroughbred racing in Europe.

The evidence however was overwhelming: equine gastric

ulceration syndrome (EGUS) is common in competi-tion and show horses (Murray, 1994; McClure et al.,

1999) with a prevalence of over 80% in Thoroughbred

horses in training (Murray et al., 1989; Vatistas et al.,

1994).

Commonsense tells us that ulcers will affect the health

and well-being of a horse and that if humans wish to

1090-0233/$ - see front matter � 2003 Elsevier Ltd. All rights reserved.

doi:10.1016/j.tvjl.2003.10.001

house animals, feed them grain, limit their exposure to

pasture (or roughage), train them, transport them and

compete with them they should not be surprised if

EGUS is the result. As with barley beef cattle, a high

cereal diet fed to a horse will lead to increased acidity in

the stomach. Exercising, particularly at the trot or gal-

lop, exposes the unprotected part of the stomach to

hydrochloric acid. Ulcers then form. Add to that theintensity of competition or training and we have a po-

tential welfare problem.

The FEI conducted a detailed evaluation to ascertain

whether the three proposed permitted medications had

any secondary performance enhancing properties and

concluded that they did not (other than relieving any

distress caused to the horse by the ulcers themselves).

And so, subject to annual review, the histamine type-2receptor antagonists cimetidine and ranitidine, and the

proton pump inhibitor omeprazole are now permitted

when horses compete under FEI Rules.

Not everybody supported the FEI�s move, however.

In March 2002, the Board of the American Endurance

Ride Conference (AERC) were so concerned that they

requested a �variance for the discipline of Endurance

Riding to the recently passed FEI Rule allowing theanti-ulcer medication during competition� as they wan-

ted endurance to remain a �no foreign substance cate-

gory sport�. This caused difficulty as FEI Rules override

National Rules for international competition, but the

AERC felt that any horse with ulcers that needed (un-

interrupted) treatment was too ill to compete and, if a

drug was being used for prevention, then withdrawal

from the competition was the answer. This view is un-derstandable as a point of principle but must be ques-

tioned on welfare grounds. Is EGUS an inevitable result

of training and competing? If so, is it reasonable to

provide medication to prevent these lesions, always as-

suming that the medication is specific to the treatment of

gastric ulceration and has no performance-enhancing

effects?

A preliminary report from the University of Cali-fornia, Davis, published in this issue of The Veterinary

Journal, is therefore timely. Dr. Jorge Nieto and his

colleagues performed gastric endoscopy at the end of a

50 or 80 km endurance ride and found evidence of

gastric ulceration in 67% of horses, with a high evidence

of gastric bleeding from the glandular mucosa (Nieto

2 Editorial / The Veterinary Journal 167 (2004) 1–2

et al., 2004). Although the sample size was small makinginterpretation difficult (gastroscopy data was used from

nine horses finishing a 50 km ride and 21 completing an

80 km ride), the findings are potentially important as the

authors provide evidence of a clinical condition not

previously reported in endurance horses. By highlighting

the prevalence of EGUS in low level endurance com-

petitions, the paper has served to raise awareness that

this is a problem that probably affects all competitionhorses.

There are of course alternative ways to prevent and

treat EGUS besides medication, for example by in-

creasing pasture turnout or providing ad libitum access

to hay, reducing training levels and minimising stressors

such as competition or transportation. But how realistic

are these options? Moreover, ulcer symptoms can go

unrecognised by owners and veterinarians, such thathorses with severe ulcers may not show any obvious

signs whereas others suffering from mild ulcers may be

markedly affected clinically, so surely there is a clear

argument on both health and welfare grounds for reg-

ularly testing competition horses endoscopically for the

presence of EGUS? The Davis work will be of great

interest to equine clinicians and to the endurance com-

munity and will hopefully stimulate further research intothis important area.

References

McClure, S.R., Glickman, L.T., Glickman, N.W., 1999. Prevalence of

gastric ulcers in show horses. Journal of the American Veterinary

Medical Association 215, 1130–1133.

Murray, M.J., 1994. Gastric ulcers in adult horses. Compendium on

Continuing Education for the Practising Veterinarian 16, 792–797.

Murray, M.J., Grodinsky, C., Anderson, C.W., Radue, P.F., Schmidt,

G.R., 1989. Gastric ulcers in horses: a comparison of endoscopic

findings in horses with and without clinical signs. Equine Veter-

inary Journal (Suppl.), 68–72.

Nieto, J.E., Snyder, J.R., Beldomenico, P., Aleman, M., Kerr, J.W.,

Spier, S.J., 2004. Prevalence of gastric ulcers in endurance horses –

A preliminary report. The Veterinary Journal 167, 33–37.

Vatistas, N.J., Snyder, J.R., Carlson, G., Johnson, B., Arthur, R.M.,

Thurmond, M., Lloyd, K.C., 1994. Epidemiological study of

gastric ulceration in the Thoroughbred racehorse: 202 horses

(1992–1993). Proceedings of the American Association of Equine

Practitioners 40, 125.

Andrew Higgins

Editor

E-mail address: tvj@aht.org.uk