Gastric (Stomach) Ulceration

Age group	Any age group can present with a stomach ulcer. However they are more significant in lactating sows and grower pigs older than 8 weeks. The condition can occur in 100% of groups of pigs with levels of 50% of sows and 60% of growers being commonly seen.
Clinical signs
Peracute	Death or collapse of apparently healthy animals. The animal may be pale
Acute	Animals weak and wobbly on their legs. The animals are anaemic with increased respiration. They may grind their teeth and wag their tail in pain. Animals lie down and fidget trying to find a comfortable position. The animal passes bloody tarry faeces (melaena). Vomiting may be noted. The animal is generally anorexic. The rectal temperature is normal, however, if subnormal it generally indicates a poor prognosis. The animal may be pale.
Chronic	Either presents as an extended duration of acute symptoms with weaker animals. This may be misdiagnosed as pneumonia in growers.
	In some chronic cases the oesophageal entrance become narrow and a stricture occurs. The pigs vomit shortly after feed and run off rapidly.
	Or no symptoms and the lesion is found as an incidental finding at post-mortem
Pathogenesis (how diseases occur)
General	While bacteria and fungi are often found in association with ulcers no specific infectious cause has been confirmed in pigs. Note in man Heliobacter pylori are associated with ulcers. Other associated conditions may be copper and zinc toxicity, stress/psychological reasons in particular starvation (for only 12 hours), transportation, crowding and mixing with unfamiliar pigs.
Feed related	It is important to minimise the number of small particles in the feed below 500 mm (0.5 mm). Whey may be associated with gastric ulcers. Feed with high concentrations of unstaturated fatty acids especially together with a vitamin E difficiency are particularly prone to gastric ulcerations. Mycotoxins may also play a role in gastric ulcers. Other factors that have been associated are a low protein diet, a high energy diet and diets containing more than 55% wheat. Note the wheat type may also have a role as high yielding wheat can have sharp spicules.
No feed	Pigs which do not eat are very likely to develop stomach ulcers, especially if the period exceeds 24 hours. The effect of fine ground feed may be more significant in the maintenance of ulcers rather than their cause.
	Feed examination
Post-mortem findings
Normal oesophageal entrance Gastric ulcer in a weaner Ruptured stomach blood filled abdomen Chronic ulcer with scarring of oesophageal entrance, this can lead to a stricture of the oesophagus and the pigs vomit shortly after feeding In peracute/acute cases the stomach may be filled with dark/black blood sometime with a large blood clot. In the more chronic cases there may be black streaks in the stomach contents. The large intestine is full of black tarry faeces. The ulcer varies from a mild erosion to a large ulcer with a thickened scarred wall boundary. Note chronic ulcers may bleed more than the acute looking ulcer due to capillary blood vessels oozing blood over a long period of time. Acute death is associated when the ulcer invades an underlying large blood vessel
Diagnosis
		Clinical signs. Necropsy finding. Blood in faeces -melaena.
Treatment
Individuals		Treatment with aluminium hydroxide or magnesium silicate can help to line the stomach and protect the ulcer from the stomach acids and thus healing can take place. Feeding straw/hay may help to increase the fibre content and may help to heal the ulcer. The use of injectable painkillers may relieve some of the pain. In expensive individual pigs H2 blockers or alternatives may be useful but are unrealistic in commercial situations. Get the pig to eat – use milk/rice/beer mix to encourage eating
Herd		Vit E may be helpful at 100 g/tonne. Check feed sieve size not less than 3.5 mm. Ensure feed is clean and stored adequately. Reduce stress factors. Increase straw in diet. Increase body condition of sows. Increasing the feed size to a mean of 750 mm for 2 weeks may help the ulcer to heal. This may be useful to consider for new gilts as part of their introduction/isolation protocol.
Common differentials
		Swine dysentery, Salmonella choleraesuis, PIA, torsion of intestine, warfarin poisoning, copper poisoning, other cause of sudden death.