Comparison of aloe vera and omeprazole for treatment of equine gastric ulcer syndrome

[SuckerForHorses]

Interesting study on the comparison of aloe vera juice and omeprazole for the treatment of ulcers…

http://onlinelibrary.wiley.com/doi/1…743078B.f04t01

Summary

Background

Anecdotally, aloe vera is used to treat gastric ulceration, although no studies have yet investigated its efficacy in horses.

Objectives

To test the hypothesis that aloe vera would be non-inferior to omeprazole for the treatment of equine gastric ulcer syndrome (EGUS).

Study design

Randomised, blinded clinical trial.

Methods

Forty horses with grade ≥2 lesions of the squamous and/or glandular mucosa were randomly assigned to one of 2 groups. Horses received either aloe vera inner leaf gel (17.6 mg/kg bwt) twice daily or omeprazole (4 mg/kg) once daily for approximately 28 days, after which a repeat gastroscopic examination was performed to determine disease resolution. Horses with persistent lesions were offered a further 28 days of treatment with omeprazole (4 mg/kg bwt once daily) and were re-examined on completion of treatment.

Results

Efficacy analyses were based on 39 horses that completed the trial. Equine squamous gastric disease (ESGD) was observed in 38 horses and improvement and healing rates were 56% and 17% respectively for aloe vera and 85% and 75% respectively for omeprazole. Healing was less likely to occur in horses with prolonged gastric emptying. Equine glandular gastric disease (EGGD) was less common than ESGD (n = 14) and numbers were too small to perform meaningful statistical analyses. The hypothesis that aloe vera would be non-inferior to omeprazole was not supported.

Main limitations

No placebo control group was included. Limited numbers to be able to comment on efficacy of aloe vera for treatment of EGGD.

Conclusions

Treatment with aloe vera was inferior to treatment with omeprazole.

[btswass]

I noticed some ulcer signs in my horse this winter. He would kick his belly with his back leg when doing up the girth. That was really the only sign. I started him on aloe juice and definitely improved by not 100%. He’s now on cavalor fiberforce and the kicking stopped completely. I agree aloe works but not as well as other treatments

[SuckerForHorses]

Considering there was a 17% healing rate for those horses administered aloe juice, I’d say its not a very effective “treatment” choice.

And what little healing was noted in those horses could’ve been due to a number of factors not related to the administration of the aloe vera itself.

[Palm_Beach]

I can’t believe some people actually buy into the holistic crap that has no science behind it.

[Angela_Freda]

@Palm Beach

I can’t believe some people actually buy into the holistic crap that has no science behind it.

I agree.
I have ulcers from time to time myself.
If you only gave me aloe juice for them… :mad:

[SuckerForHorses]

@Angela Freda

I agree.
I have ulcers from time to time myself.
If you only gave me aloe juice for them… :mad:

Yeah…I had ulcers (right around the time my first mare was diagnosed with them… lol) and I can tell you that when double dose omeprazole wasn’t touching it, aloe juice would have been a joke. I can’t imagine

[MissAriel]

Thanks for the information!

[x-halt-salute]

Frankly it isn’t surprising that a substance like aloe vera, for which the mechanism of action in healing ulcers is poorly understood (but is probably through anti-inflammatory or cytoprotective properties), would perform worse than a PPI in resolving gastric ulcers. But it’s great to see research on something like this where the potential for low cost treatment exists but is very difficult to assess on the basis of anecdotal evidence and personal experimentation. Even if the research design is imperfect it provides evidence that can be used in making decisions about horse care.

I’m actually rather encouraged by the results as far as aloe being a useful tool in the ulcer arsenal. The rates of improvement and healing at 28 days are higher than what has been reported for placebos (though it’s unclear how to interpret results across studies without knowing more about how the samples and designs compare). The improvement of ulcers after aloe treatment suggests to me that it may not be totally inappropriate for the sorts of uses I’ve seen horse owners put it to – specifically, as a long-term preventative measure in combination with other feeding practices, or as an auxiliary treatment in addition to omeprazole. It won’t put Merial out of business, but it’s interesting to see evidence that it does have some effect.

I find the results of the second round of treatment troubling, though. Rates of ulcer healing were lower, and more of the second round horses came from the aloe group than the omeprazole group. They don’t report how many of the prolonged gastric emptying horses were in the aloe group vs. the omeprazole group, so it is difficult to know whether this could have impacted the results. Hopefully this one small sample study won’t be the only one that gets published on this topic.

[JB]

Excellent post/analysis x! I totally agree.

There are many horses who appear to benefit from aloe in their diet to help keep them more comfortable. There are just too many for it to be a placebo effect of a few owners. And these are horses who clearly demonstrate differences when on aloe vs not. Is that due to foregut issues, or hind? I don’t know - not enough scoping of those horses being done.

I’m not surprised either it’s not very good at healing - maybe it can with really minor ulcers, but ulcers are just buggers to deal with.