Diagnosis: Delayed Gastric Emptying. Experience with this?

[Dark_horse17]

So… my 15 year old WB gelding was just diagnosed with DGE after an ulcer scope that couldn’t happen (because… his stomach was full!)

After 2 spaced-out scopes last week, a bit of tubed coca-cola and a re-scope after 36 hours of fasting, his stomach was still filled with old feed. The vet sent us home with this diagnosis and a modified diet for several weeks, with a scheduled re-scope in 3 weeks.

I’ve been in touch with his former family, who also weighed in that when they had him scoped (2 years ago), this was also the case. At that time, some ulcers were detected (Esophogeal) and some limited views of healed ulcers elsewhere in his stomach. Our latest scope showed healthy tissue.

At our hospital discharge, the vet had a few thoughts – DGE could be due to ulcers unseen OR… this is just how “he is” anatomically – predisposing him to DGE.

The reasons we had him scoped in the first place:
-possible history of ulcers
-teeth grinding, slight girthiness, pacing, edgier/spookier than normal
-in the past, a 28 day trial of gastrogard did seem to make some improvements in behavior

Other than that, he’s been generally asymptomatic – no colicky behavior, a good drinker/pooper.

And so, here we are. He is on a recommended TWO flakes of soft hay daily (this is tough) and 12lbs of complete feed (which we’re experimenting with (Sentinel LS / TC Senior) … he’s pretty picky, and I fear we’re getting much less than 12lbs in him) fed multiple times daily.

So…

Any sympathizers? Anyone from the old threads about this care to chime in?

Though our vet took little stock in supplements, =but do you have any miracle stories or products to share (We’re already on Smart GI Ultra)…

Thanks in advance! I’m shocked at the lack of information online about this condition and hope others here can share what they’ve learned!

[joiedevie99]

My understanding is that treatment is usually Bethanechol Chloride, which can be administered a few different ways with differing efficacy/side-effects, and sometimes psyllium. I’d talk with a vet clinic or hospital that treats it with some frequency.

My horse was not diagnosed, although it is one things we considered as a possibility when trying to deal with his pyloric ulcers.

[keysfins]

What kind and amount of exercise does your horse get?

Did the vet say why the coca-cola was tubed? (Curious because I keep a 2L bottle in my locker; I’d heard that it can help in loosening feed mats in the stomach.)

[Ticker]

I have a mare that was diagnosed with delayed gastric emptying. It turned out to be an adhesion near her stomach opening that caused the outflow to be very slow. Not something you could see with a stomach scope since it was on the outside of the stomach.

Once the adhesion was removed she did not have any further problems and now empties her stomach contents normally.

[About_Time1]

I rarely chime in on any thread but I just had to ask. Why in the world are you feeding 12 lbs of feed and only two flakes of hay?!? That’s recipe for ulcers I fear.

[keysfins]

[QUOTE=About Time;9002073]
I rarely chime in on any thread but I just had to ask. Why in the world are you feeding 12 lbs of feed and only two flakes of hay?!? That’s recipe for ulcers I fear.[/QUOTE]

There are some very valid reasons to feed a complete feed and just a small amount of hay.

A horse may have impaction colic history with a feed/hay impaction, which is why I use a complete feed for my senior horse. I use a Nibble Net to give a token amount of hay to graze on. This management of his diet has worked very well for us.

Another reason may be when horses become aged and lose the ability to effectively chew, they can and do live on a complete feed that provides their forage.

I won’t speak for the OP, but it may be that the OP’s horse is in one of those situations.

[keysfins]

[QUOTE=Dark horse17;9001945]
So… my 15 year old WB gelding was just diagnosed with DGE after an ulcer scope that couldn’t happen (because… his stomach was full!) …

Other than that, he’s been generally asymptomatic – no colicky behavior, a good drinker/pooper.

And so, here we are. He is on a recommended TWO flakes of soft hay daily (this is tough) and 12lbs of complete feed (which we’re experimenting with (Sentinel LS / TC Senior) … he’s pretty picky, and I fear we’re getting much less than 12lbs in him) fed multiple times daily.

So…

Any sympathizers? Anyone from the old threads about this care to chime in?

Though our vet took little stock in supplements, =but do you have any miracle stories or products to share (We’re already on Smart GI Ultra)…

Thanks in advance! I’m shocked at the lack of information online about this condition and hope others here can share what they’ve learned![/QUOTE]

I do not have a horse with DGE, but I do have a horse who is on much the same diet, due to a history of feed impaction colics. He gets a token amount of hay, about two flakes daily in 5 feedings, soaked in a NibbleNet, and is currently eating Triumph Senior as a mash or soup, four to five times a day.

I have him on Mag Restore, to promote gut motility, SmartSenior SmartPak, and a few other supplements that were recommended by our vet.

The horse will be 24 I the spring and is still in full work, at an intensity that keeps him comfortable. He is in good weight and condition, and has done really well on this feeding plan for about two years, touch wood!

Will be interested in reading other posts in reply to yours, if only for my own education.

[Dark_horse17]

[QUOTE=keysfins;9002049]
What kind and amount of exercise does your horse get?

Did the vet say why the coca-cola was tubed? (Curious because I keep a 2L bottle in my locker; I’d heard that it can help in loosening feed mats in the stomach.)[/QUOTE]

This is most typically the recommended treatment. The Coca Cola can dissolve/pass along matter inside the stomach.

My guy was tubed once, with no success. As he was already a bit distended, they decided not to continue this multiple times and recommended a diet change and re-scope instead.

[Dark_horse17]

That was NOT his typical diet. The high lb of feed (which includes a complete feed, alfalfa pellets, hay stretcher and his supplements) + reduced (and only soft) hay is a diet recommended by the vet to help motility of food through the stomach, while still giving him complete nutrition in very frequent portions. Hay is not digested in the horse’s stomach, and too much of it is sticking around in my guy’s right now.

[Dark_horse17]

Interesting! How did you come to this conclusion? Could you tell via ultrasound?

[eclipse]

My just turned 8 year old gelding was diagnosed with DGE along with pyloric and gastric ulcers as a 6 yr old. As Joiedevie stated, it was a very long term treatment that included Bethanochol Chloride as it’s been found to force the stomach to empty. We also had to use this alongside a full tube of ulcerguard daily and after nearly a year were able to stop the bethanochol, and finally go onto some heavy duty sulfa drugs for the final 3 mths once his vet was happy with his weight and felt he would be able to tolerate any possible side effects (there were none so we are thinking his ulcers were some weird infectious leading to to the Dge as they’d blocked his spynchter).

Sullivans still on daily omeprazole and doing fabulous but he is he is going in
this week for a 6 mth scope and we are hoping his insides look as good as his outside! We found his due to sudden colicing and weight loss as like you his stomach was full of old
feed!

I wish you luck, and will not sugar coat it… it’s a long slow battle! To add… we have sully on all day turnout , unlimited hay at all times (and hay net in his stall), plus he also eats scoop of srs in the morning and at dinner 2 scoops of srs plus a scoop of beet pulp. His only other supplement (besides Omeprazole) is equitop myoplast mixed with unsweetened applesauce! He is thriving on this

[eclipse]

And because I can’t edit… he had monthly scopes plus ultrasound to monitor!

[beowulf]

horses with DGE need a complete rehaul on their management.

I’ve taken care of several, all that came into the facility I managed with the condition. It is a long, slow battle. It’s also very, very expensive.

My vet practice is unanimous on the condition: it is management related, and should be treated as a SYMPTOM, not a cause. Like above, it’s usually the result of either unseen ulcerations (usually in the hind-gut, right dorsal colitis) or it is the result of adhesion. If you do not change the management, the ulcers and DGE will reoccur.

I’ve found DGE horses need full turnout, little to no stall time (as stalling exacerbates ulcers), a consistent work schedule, as much grazing as possible (if not cushingnoid/metabolic). They usually need some form of alfalfa or forage cubes, a complete feed, ulcer medication and palatable food.

My vet feeding recommends the following protocol for any DGE horse that came into the facility’s care:
Wellsolve Well-Gel 1 cup soaked, 2x day
B-Chlor
‘Free-feed’ hanging haynet of tim/alf mix - 1-2lb every meal
Complete feed (if weight is needed) OR ration balancer: NO Sentinel LS, Fibremax, Strategy, etc - avoid feeds with corn and try for low NSC - starch through oats is OK.
Crushed or rolled oats every feeding (usually .5lb-1lb feeding dependent on work)
Timothy OR Alfalfa cubes, hot-soaked every meal.
Omeprazole (GG daily)
Sucralfates (every meal)
Raniditidine (3-4x a day, 30m before each meal)
1 pump Ulsershield every meal
Hind-gut ulcer preventative of your choice

The plan was to eliminate as much grain as possible, incorporate oats (thought to help with hind-gut digestion), soak all food, add as much digestion aid as possible.

The management protocol is very challenging and not every facility can house a DGE horse. My vets firmly believe that DGE is the result of a horse that has an over-stressed and upset digestive tract – usually by ulcers – and ulcers are usually caused by environment. The best thing for these horses seems to be as much turnout as possible with as much natural grazing as possible. My vet prefers to see these horses turned out with other horses, but that’s also not always possible in boarding facilities. Stalling is to be avoided.

Good luck. It’s a long, slow road for sure. With one DGE horse we took care of, it was simply a matter of changing the management while treating the pyloric ulcers & hind gut ulcers. Once the ulcers resolved we were able to wean him off of ulcer medication and Well-Gel. He is doing great now on an almost fully-soaked tim/alf cube diet with ration balancer, oats, and grass in T/O.

[Dark_horse17]

[QUOTE=beowulf;9002404]
horses with DGE need a complete rehaul on their management.

I’ve taken care of several, all that came into the facility I managed with the condition. It is a long, slow battle. It’s also very, very expensive.

My vet practice is unanimous on the condition: it is management related, and should be treated as a SYMPTOM, not a cause. Like above, it’s usually the result of either unseen ulcerations (usually in the hind-gut, right dorsal colitis) or it is the result of adhesion. If you do not change the management, the ulcers and DGE will reoccur.

I’ve found DGE horses need full turnout, little to no stall time (as stalling exacerbates ulcers), a consistent work schedule, as much grazing as possible (if not cushingnoid/metabolic). They usually need some form of alfalfa or forage cubes, a complete feed, ulcer medication and palatable food.

My vet feeding recommends the following protocol for any DGE horse that came into the facility’s care:
Wellsolve Well-Gel 1 cup soaked, 2x day
B-Chlor
‘Free-feed’ hanging haynet of tim/alf mix - 1-2lb every meal
Complete feed (if weight is needed) OR ration balancer: NO Sentinel LS, Fibremax, Strategy, etc - avoid feeds with corn and try for low NSC - starch through oats is OK.
Crushed or rolled oats every feeding (usually .5lb-1lb feeding dependent on work)
Timothy OR Alfalfa cubes, hot-soaked every meal.
Omeprazole (GG daily)
Sucralfates (every meal)
Raniditidine (3-4x a day, 30m before each meal)
1 pump Ulsershield every meal
Hind-gut ulcer preventative of your choice

The plan was to eliminate as much grain as possible, incorporate oats (thought to help with hind-gut digestion), soak all food, add as much digestion aid as possible.

The management protocol is very challenging and not every facility can house a DGE horse. My vets firmly believe that DGE is the result of a horse that has an over-stressed and upset digestive tract – usually by ulcers – and ulcers are usually caused by environment. The best thing for these horses seems to be as much turnout as possible with as much natural grazing as possible. My vet prefers to see these horses turned out with other horses, but that’s also not always possible in boarding facilities. Stalling is to be avoided.

Good luck. It’s a long, slow road for sure. With one DGE horse we took care of, it was simply a matter of changing the management while treating the pyloric ulcers & hind gut ulcers. Once the ulcers resolved we were able to wean him off of ulcer medication and Well-Gel. He is doing great now on an almost fully-soaked tim/alf cube diet with ration balancer, oats, and grass in T/O.[/QUOTE]

This is incredibly helpful. Thanks.

[Ticker]

If your horse has an adhesion no amount of change management will fix it…it needs to be removed if it is involved in blocking the outflow of the stomach.

If your horse does not improve with dietary changes i don’t know of any diagnostics that can find an adhesion short of an exploratory…maybe there is something that can detect adhesions now or perhaps Orthoscopic removal.

Hope it works out for you. FYI my mare was under constant supervision including a stall camera. She would become uncomfortable while eating and would stop suddenly , shift her weight for a few minutes, then go back to eating.
Her adhesion was discovered during emergency surgery. I had discussed an exploratory with my vet but he didn’t want to open her up unless he really needed to. He really needed to!

[Dark_horse17]

Here’s a question (one I plan on asking my vet, but just in case any of you know the answer)…

Does giving Omeprazole during DGE treatment actually inhibit the progress of stomach emptying?

Here’s my train of thought… Omeprazole is a PPI, thus shutting off (or limiting, in a prevention dose) stomach acids that help break down and move along ingesta.

So, would giving Omeprazole to a horse with known DGE actually slow treatment?

[eclipse]

Sully saw an internal specialist during his treatment and they absolutely insisted he stay on ulcer guard! He did have ulcers that cleared up
but remained around the pyloric sphincter and they did not want any acid building back up and having his ulcers reoccur… he also had them in both areas of his stomach (glandular and non glandular)! Personally I wouldn’t discontinue until you can absolutely rule out ulceration causing the DGE!

[Dark_horse17]

For those who have gone through the feed change associated with this condition (i.e., less hay, increased complete feed, etc.) How did your horse’s manure change? Did you note any noticeable changes?

We’re 4 days in, and I’m noticing a bit more loose manure than normal. This is also about 4 days after our diagnosis. I’m also wondering if this change might coincide with the length of time it takes food matter to empty/digest through from mouth to manure (2-3 days for a normal horse).

[keysfins]

[QUOTE=Dark horse17;9006289]
For those who have gone through the feed change associated with this condition (i.e., less hay, increased complete feed, etc.) How did your horse’s manure change? Did you note any noticeable changes?

We’re 4 days in, and I’m noticing a bit more loose manure than normal. This is also about 4 days after our diagnosis. I’m also wondering if this change might coincide with the length of time it takes food matter to empty/digest through from mouth to manure (2-3 days for a normal horse).[/QUOTE]

When we changed over to a complete feed diet, my horse had been at the clinic for an impaction. So we were glad to see ANY manure! It was much better in consistency and water content, because it WAS moving through, not sitting in the small or large colon having water resorbed from it.

For the last couple of years, the manure has stayed fairly consistent. Smaller volume, more frequent, good consistency and moist.

He gets either his Senior soup or nibble net every three hours or so. His first feed is at about 5 AM, and his last feed/snack of hay is around 9 PM. IME, the small frequent feedings he now gets stimulate the gastrocolic reflex, one of the physiological reflexes that controls gut motility, and keeps everything moving through.

If your horse now has more loose manure than “normal” for him, contact your vet and let him/her know this is a change. Has your vet made any suggestions about probiotics? When we change a horse’s diet, consider that the gut bacteria also need to adapt to the new feeding program/material to digest.

ETA: transit time, from front end to rear end, can be observed when mineral oil is given. In a normal horse, the oil can be seen 12-24 hours after it was given by NG tube. I do not know what might be “normal” for a horse with DGE; that’s probably another question for your vet.

[eclipse]

Like keysfins we were just glad to see Sully eating and passing poop, but no his are normal! He’s not a big pooper but everything is nice, firm and not too smelly. Our hay is a Timothy/alfalfa mix and the higher the alfalfa the better he does!

He he had a scope today (almost a yr since his last one) and the vets are thrilled with his outward appearance. Due to his known fight with this, they were also happy with his insides although he will probably go for yearly scopes and it will always be an ongoing battle. No new gastric ulcers, but he does have keratosis between the glandular and non glandular areas (they’ve been biopsied previously so they believe it’s just him!) the pyloric area is no worse so we keep with what we are doing! My advise… make sure you have a good internal specialist and do everything they advise! It’s a battle but it can be managed