Misoprostol is superior to combined omeprazole‐sucralfate for the treatment of equine gastric glandular disease

Abstract

Summary Background Previous studies have demonstrated a poor response to healing of gastric glandular lesions with oral omeprazole and other medications. Objectives To evaluate the efficacy of two novel treatments (misoprostol [M] and combined omeprazole‐sucralfate [OS]) in horses for gastric glandular disease. Study design Prospective, clinical study. Methods Sixty‐three sports horses with grade >1/4 glandular disease were identified by gastroscopy. Horses received either 5 μg/kg of misoprostol per os BID 1 h prior to feeding or a combination of 4 mg/kg enteric coated omeprazole per os SID and 12 mg/kg sucralfate per os BID where drugs were given 1 h prior to feeding and sucralfate given 60 min after omeprazole; allocation was dependent upon centre. Gastroscopy was repeated at 28–35 days. Evaluators of the gastroscopy images were blinded to the treatments the horses received and images were reviewed independently. Results The most common presenting sign in both treatment groups was poor performance (Overall – 65.1%; M – 60.5% and OS – 75%). Overall healing (P<0.001; OR = 11 [2.8–45]) and improvement (P = 0.006; OR = 11 [1.9–59]) of lesions were associated with resolution of clinical signs. Misoprostol was shown to be superior to combined omeprazole‐sucralfate both for healing (M – 72% [95% CI 43–67] and OS – 20% [95% CI 7–41]; P<0.001) and improvement (M – 98% [95% CI 90–100] and OS – 65% [95% CI 43–83]; P<0.001). Main limitations Relatively small, clinical study, reliance on client questionnaire data, clients not blinded to the treatments the horse received, diet could have affected drug pharmacodynamics although mimics clinical practice and no validated scoring system available for glandular lesions. Conclusions These results suggest that gastric glandular disease does indeed result in clinical signs. In this population of horses, misoprostol was superior to omeprazole and sucralfate and warrants further evaluation in a large scale, multi‐centre trial.

Preliminary investigations into a novel, long‐acting, injectable, intramuscular formulation of omeprazole in the horse

“…Specifically, only 25% of EGGD lesions healed with 28-35 days of omeprazole therapy administered at 4.0 mg/kg bwt by mouth once per day, whereas an ESGD healing rate of 78% was achieved in the same series of studies [2][3][4]. Further, it appears that the response of EGGD to combination therapy with omeprazole and sucralfate is also poor to fair, with healing rates over a 28-35-day treatment period reported to be between 22% [5] and 67.5% [6].…”

Pharmacokinetics and ex vivo anti‐inflammatory effects of oral misoprostol in horses

“…Administering over 400–800 μg misoprostol per day in human subjects is associated with diarrhoea, nausea and abdominal cramping . The dose used in this study (5 μg/kg) is routinely and safely employed in horses clinically , but it is unknown if higher doses of misoprostol would cause episodes of colic. In horses, i.v.…”

“…For treatment of localised lesions, increased systemic exposure may not be necessary. A dose of 5 μg/kg administered orally twice daily has been shown to be effective for the treatment of equine gastric glandular disease (EGGD) , suggesting that it is possible misoprostol effectively inhibits inflammation locally within the stomach.…”

Chronic severe pyloric lesions in horses: 47 cases

“…Equine gastric glandular disease (EGGD) can affect the pyloric antrum and/or pyloric region . A recent study has demonstrated that EGGD is often associated with poor performance but the clinical presentation and outcomes associated with chronic and severe pyloric lesions have not been well described. This report describes a group of horses with chronic severe pyloric lesions including mucosal ulceration, inflammation and/or fibrosis, many of which had evidence of delayed gastric emptying (67% on ultrasonography, 53% on endoscopy).…”