Assessing omeprazole and flunixin meglumine co-administration in treating equine gastric ulcer syndrome in Mongolian horses.
Authors: Guo, Li, Mao, Liu, Yang, Yu, Yang, Gao
Journal: Equine veterinary journal
Summary
# Editorial Summary Flunixin meglumine provides excellent analgesia for chronic lameness in horses, yet its use carries significant gastric risk—a concern that has prompted many practitioners to combine it with omeprazole as prophylaxis. This randomised trial examined whether omeprazole co-administration could mitigate flunixin-induced gastric damage whilst maintaining analgesic efficacy in 18 Mongolian horses with lameness scores ≥3/5, comparing three groups (placebo control, flunixin alone at 1.1 mg/kg IV daily, and flunixin plus omeprazole at 4 mg/kg PO daily) over 15 days with weekly gastroscopy, serum biochemistry and histopathology. Both flunixin monotherapy and the combination reduced lameness equally (median scores of 1.0 versus control's 3.0; p<0.001), yet flunixin alone caused substantial gastric glandular disease (EGGD grade 3.0 versus control's 0.0) and marked elevation of pepsinogen 1 (372.2 ng/mL versus 231.9 ng/mL in controls), alongside reductions in serum albumin, total protein and gastrin-17—indicators of gastric mucosal damage and systemic response. Omeprazole co-administration significantly ameliorated these adverse effects, reducing EGGD grade to 0.8 (p=0.003), raising gastric pH from 2.4 to 7.4 (p<0.001), and lowering pepsinogen 1 to 207.1 ng/mL (p<0.001), with histopathology confirming protection against flunixin-induced lesions.
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Practical Takeaways
- •If using flunixin meglumine for chronic lameness in horses, concurrent omeprazole administration (4 mg/kg PO q24h) significantly reduces gastric ulcer risk without compromising pain relief efficacy
- •Monitor horses on FM monotherapy closely for EGUS development, particularly Mongolian breeds, as lameness improvement masks ongoing gastric damage
- •The combination FM+OME is a practical gastroprotective strategy for working horses requiring extended NSAID therapy for pain management
Key Findings
- •Flunixin meglumine (FM) alone significantly increased EGGD grade (3.0 vs 0.0 in controls, p<0.001) and pepsinogen 1 levels (372.2±33.2 ng/mL vs 231.9±25.2 ng/mL, p<0.001) despite effectively reducing lameness scores
- •FM combined with omeprazole (FM+OME) reduced lameness equally to FM alone but significantly decreased EGGD grade (0.8 vs 3.0, p=0.003) and increased gastric pH (7.4±0.2 vs 2.4±0.3, p<0.001)
- •FM alone reduced serum total protein, albumin, and gastrin-17 levels compared to controls, suggesting systemic effects beyond gastric damage
- •Histopathological examination confirmed FM-induced gastric lesions in Mongolian horses that were mitigated by concurrent omeprazole administration