Stomach Ulcers in Alpacas and Llamas
By Stephen R. Purdy, DVM

Normal Stomach Anatomy

• 3 compartments:
• • C1- 83% by volume of stomach contents (15- 25 liters)
  • C2- 6% by volume (1- 2 liters)
    • C1 and C2 contents freely intermix
    • bicarbonate secreted in ventral saccules of C1 and C2 to buffer pH in C1
  • C3- a tubular structure
    • first 3/4 is glandular ~ saccules of C1 and C2
    • last 1/4 has acid-secreting glands- ph 1.4- 2.0
• peristaltic contractions mix stomach contents with secreted acid
• very little is known about the control of acid secretion in camelids
• protective mechanisms preventing autodigestion of the stomach lining are thought to be similar to other species
• ulcers occur mostly in acid-secreting zone of C3 and upper duodenum

Clinical Signs Of Ulcers: alpacas and llamas are very stoic animals!

• depression/ lack of appetite
• ~1/3 of cases show colic- shifting weight, grinding teeth, frothing at the mouth, rolling, getting up and dow
• not often feveris
• decreased manure production
• may be obscured by other disease conditions which might be the cause of the ulcers

Proposed Mechanisms of Ulcer Formation in Camelids

• stress- serious or chronic diseases increase the incidence of ulcers
  • high incidence with colic cases at referral hospitals
  • found in animals dying of any cause with no premortem signs of ulcers
  • complicated orthopedic problems- pain may predispose to major trauma, e.g. dog bites
  • overcrowding
  • travel- long distance, hot weather, and nervous temperament animals
  • weaning- delay if cria has health problems
  • isolation from other animals- have to see other camelids ( they are herd animals)
• glucocorticoids- cortisones- topical, oral or injectable can cause ulcer formation
• non-steroidal anti-inflammatory drugs such as Bute and Banamine
  • not as often as in horses, but don’t use a long time
• bacteria- not isolated in lamas as in people
• excessive acid secretion- no evidence either way that this contributes to ulcer formation in camelids
• dietary causes?
  • high grain diets?? – seen in cattle
  • low incidence in S. America where little grain is fed
  • small particle size pellets?? – causes ulcers in pigs

Diagnosis of Ulcers

• clinical signs
• no specific blood tests
• abdominal exploratory surgery- A bad idea in an already stressed animal
• dark stools indicating the presence of digested blood are not seen
• decreased bacteria and protozoa in C1 contents sample from stomach tube
• C1 pH < 4.0 on stomach tube sample
• abdominal tap is usually normal unless perforation has occurred

Differential Diagnoses:

• intestinal torsions- rare
• uterine torsion- last 60 days of gestation
• impactions- should see significant dehydration
  • enemas in newborn crias could prevent
• abdominal tumors- rare
• intussusception- rare
• peritonitis- uncommon, except with perforating ulcers
• urinary tract problems- males- ruptured bladder/urethral stones-uncommon
• intra-abdominal abscesses- uncommon- abdominal tap shows increased WBCs, or possibly increased serum globulin level
• toxic plants- Rhododendron
• C1 stasis (lack of stomach motility)
  • in adults off feed greater than 3- 4 days
  • in crias with repeated tubing
• lactic acidosis- overeating grain- C1 stasis- low C1 pH

Management of Ulcers

• Oregon State University Vet School- most occur as secondary problems (this has also been my experience)
• some cases at Colorado State University Vet School have resulted in secondary pneumonia
• ulcers in newborns in New England

relatively high mortality, so treat aggressively!!!

• suppress acid production
  • antihistamines (H2 blockers)
    • Zantac (ranitidine)- perhaps the best drug for treatment of ulcers
      • 0.75 mg/lb IM, subQ, or IV two times daily (once daily for prevention)
      • not effective orally
    • Prilosec (omeprazole)- good orally at 0.5 mg/lb PO BID (once daily for prevention)
      • open capsule into 12 ml syringe (with tip end cut off) with KY and squirt into mouth
• nonspecific C3 protection- sucralfate (Carafate)- 10 mg/lb orally four times a day- not very effective in adults
• stress reduction!!!!!
  • resolve the primary problem
  • cohousing with herdmates
• IV fluids/ prophylactic antibiotics
• preventative treatment when a severe primary disease is present
  • Zantac or Prilosec once daily
  • do not let the treatment worsen the disease