#egus

Aloe Vera for Equine Ulcers?

- Anthony Blikslager, DVM, PhD, Dipl. ACVS

TheHorse.com  | 29 March, 2017

Q. My mare has a history of equine gastric ulcer syndrome (EGUS). She’s currently at a training barn where several horses receive aloe vera juice (administered orally) to treat ulcers. The trainer would like my mare to be on it too. I visited the Mayo Clinic website and it lists several serious side effects caused to humans by taking aloe vera, which include bleeding, metabolic issues, diarrhea, and stomach cramping. These all seems like they would be bad for a horse prone to gastric ulcers. Is there any research that shows aloe vera is safe to administer to horses or that it helps EGUS?

A. This is an interesting question, and generally brings up the theme of evidence-based medicine and use of supplements for horses. Overall, any standard of care should include “do no harm” as a principle, followed by a hopeful therapeutic or preventive effect.

In the equine industry, we are frequently in a position of not having a great deal of information about treating horses, so many things are done off label or with limited evidence from other areas of medicine. The use of aloe vera for treatment or prevention of stomach ulcers falls into the latter category—we have limited evidence of effect of Aloe vera, primarily in lab studies. For example, Aloe vera has been shown to limit ulcer formation in rats in response to ethanol administration. This type of study is a preclinical trial, indicating that it’s not yet ready for clinical use until issues such as dose, dose form (i.e., gel, liquid, tablet), and side effects are worked out.

Using PubMed as my search tool, I found no studies in horses in the mainstream medical literature, no information on the dosage for horses, and no information on the dose form for aloe vera. Lab studies indicate that there are side effects, exactly as mentioned in the reader’s Mayo Clinic link, suggesting that there are dose-dependent irritating and adverse effects of aloe vera.

Overall, I doubt that your horse would be receiving enough of a dose to see side effects, but I would certainly caution that you would be in the dark as to the possible effects, either positive or negative, of aloe vera.

My opinion is that if you suspect ulcers, have your horse endoscoped. If there are ulcers present, the proton pump inhibitor (PPI) labeled for use in horses is the standard of care. A PPI at a lower dose is also the standard of care for prevention of ulcers. From more of a practical point of view, I think you can best avoid ulcers by maximizing forage (such as grass and hay) intake and minimizing soluble carbohydrate (as found in sweet feed). Pelleted feeds that also contain some roughage are preferable. It helps to remember that horses have a gastrointestinal tract designed for relatively consistent intake of forage and, therefore, produces gastric acid consistently throughout the day.

It’s a running joke in some popular horse groups on Facebook…maybe it has ulcers…needs turmeric. It’s funny because people on the internet immediately jump right to these conclusions with every post with uncertain conditions. I laugh and joke, too; it does seem ridiculous. But just because it’s a joke doesn’t make it completely untrue. The fact is…many horses have ulcers. Working horses,…

10 turkey and 4 chicken, we shall try again my children.

Equine Gastric Ulcer Syndrome is a result of disequilibrium between mucosal aggressive factors and mucosal protective elements. Since mucosal protective factors are a lot more developed inside the glandular mucosa of the horse stomach as compared to the squamous mucosa, different causative systems could end up in ulceration within of these areas. Ulcers in the squamous mucosa are primarily because of extended exposure to hydrochloric acid, pepsin, bile acids or even natural acids. The degree of peptic issues might be related to length of time of acid subjection.

Ulcers in the glandular mucosa are mainly due to hindrance of blood circulation and reduced mucus and bicarbonate release, which ends up in back diffusion of hydrogen ions and damage to underlying submucosa. Inhibition of prostaglandins may play a tremendous role in the pathogenesis of gastric ulcers inside the glandular area of the equine stomach. Gastric ulceration inside the squamous mucosa is proportional to the degree and seriousness of gastric acid subjection. To understand why horses are susceptible to ulcers, it is necessary to understand some horse anatomy. Holding just about 4 gallons, the horse’s stomach is smaller compared to people.

It’s split into two specific parts. The non-glandular portion also called the esophageal spot is lined by cells similar to the lining of the wind pipe. The glandular portion is layered with glandular cells, which produces hydrochloric acid as well as pepsin, an enzyme required for the digestion of food. This section of the digestive system also creates elements to protect the stomach from the negative effects of the acid and enzymes. In people, eating stimulates the production of hydrochloric acid. In the horse, however, hydrochloric acid is consistently being produced. So, if a horse doesn’t eat, the acid builds up in the stomach, and could start to irritate the stomach, especially the non-glandular portion.

Acid acts as a powerful irritant in the mucosal coating of the stomach, quickly eating away the mucosal surface, and produce ulcers. What makes this even worse is when horses are working out typically on an empty stomach. The stress produced inside the stomach when horses are exercising seems to force the acid levels further up onto the unprotected mucosal coating in the stomach, exposing highly delicate parts of the stomach lining which usually would not be in contact with corrosive acid, to acid activity. In summary, not keeping food in the stomach at all times, irregular feeding patterns, hard exercise, and high grain and concentrated diets with low levels of roughage, are all compound that allow gastric acid to produce ulcers very rapidly.