Gastric Ulcer Prophylaxis in the Critically Ill Equine Neonate

Introduction Gastric ulcer disease has been recognized in foals and adult horses. It is a complex disease and lesions vary in anatomic distribution, severity and cause. In the neonatal foal (<30 days of age) gastric ulcers and mucosal desquamation have been documented in clinically normal foals [1-4]. Due to this finding many clinicians feel it is necessary to treat critically ill neonates prophylactically with anti-ulcer medications, probably due to early reports of catastrophic rupture of unrecognized gastric ulcers in neonates being treated for other problems. Recently the pathophysiologic mechanism of gastric ulcer development has been described as an imbalance between protective and aggressive factors [5,6]. The cornerstone of treatment for gastric ulcer disease remains suppression of gastric acid, although in the clinically ill neonate prophylactic treatment to suppress gastric acid production may not be beneficial. This section contains old information on gastric ulcer disease in foals, but provides new concepts in gastric ulcer disease in the critically ill neonatal foal. Gastric ulcer disease in the neonate may very well be a distinct clinical entity, with a different underlying pathophysiology from gastric ulcer disease in the older foal.