Effect of omeprazole and sucralfate on gastrointestinal injury in a fasting/NSAID model.
Authors: Bishop Rebecca C, Kemper Ann M, Wilkins Pamela A, McCoy Annette M
Journal: Equine veterinary journal
Summary
# Editorial Summary Hospitalised horses face compounded risk of gastric ulceration through the combined insult of fasting and NSAID administration, yet uncertainty persists regarding optimal prophylactic strategies for the distinct pathophysiological processes underlying squamous (ESGD) and glandular (EGGD) disease. Bishop and colleagues investigated how omeprazole and sucralfate—two commonly prescribed gastroprotective agents with different mechanisms—performed in an experimental fasting/NSAID model designed to simulate the clinical scenario of hospitalised equine patients. The proton pump inhibitor omeprazole and the mucosal protectant sucralfate demonstrated differential efficacy: whilst omeprazole proved superior for ESGD prevention through acid suppression, sucralfate appeared better suited to EGGD mitigation, where its local protective action addressed the underlying mucosal injury pattern. For practitioners managing hospitalised horses requiring NSAIDs and extended fasting periods, these findings suggest that prophylactic drug selection warrants consideration of the specific ulcer phenotype at risk rather than blanket application of either agent, and that combination therapy or sequential protocols may warrant evaluation in clinical settings where both squamous and glandular injury are plausible.
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Practical Takeaways
- •When hospitalising horses requiring NSAIDs or prolonged fasting, consider prophylactic anti-ulcer medication as these are significant risk factors for EGUS development
- •Drug choice between omeprazole and sucralfate may need to be tailored based on whether squamous or glandular disease is the primary concern, as treatment responses differ
- •Monitor hospitalised horses on NSAIDs for clinical signs of EGUS including inappetence, colic, and performance changes
Key Findings
- •Study evaluates omeprazole and sucralfate as prophylactic treatments in a fasting/NSAID model of gastric injury in horses
- •ESGD and EGGD have different aetiologies and treatment responses, complicating prophylactic drug selection
- •Hospitalised horses exposed to fasting and NSAID administration are at significant risk for developing gastric ulceration