My go to is 60ml aloe Vera gel 2xday and 20ml Sucralfate 2xday and for a month, then back off to 1xday for another month or so, and then back off to aloe only.
That said, I have seen really good results with aloe only. So if $$ are a major concern, it might be worth a try.
And plus it works.
I have ulcers. If I was told to use Aloe Vera juice instead of my PPI, I would not be a happy camper and my ulcers would not resolve.
As a preventative? Sure. But once one is well underway? Nope.
In my experience, keeping an ulcer-prone horse healthy is all about management.
They need treatment first, of course. There are lots of threads on here and research studies out there that can you help you select the best medication based on cost, potential side effects and risks, what type of ulcers they treat, etc. Iāve used GastroGard, but have had equally good results with ranitidine and esomeprazole. The treatment has to be consistent enough ā dosing at the same time(s) of day, not missing doses, treating for a long enough time period. However, I donāt think long-term preventative medication use does the horse any favors.
The management changes will keep the horse on the right track when he comes off the treatment:
Meh. I had zero results with Omeprazole on my personal horse. Switched to Sucralfate and had huge and immediate results. Added in aloe to tide her over between needing actual meds once she was done her initial treatment. Rarely ever needs her actual meds now.
The other super weird thing I saw was with a Very Nasty Horse whose owner didnāt want to spend $$ on drugs. She put him on aloe alone and he had a huge personality change. You could actually walk into his stall and pet him a week on. Before that it had been absolutely dangerous and god forbid anyone ever took his halter off because you had one chance to kind of fling it at him after you opened the door to take him out for morning turnout.
And not that many years ago, I was told by a good vet that Sucralfate was a waste of money, so, again, meh.
And all that said, you better believe I keep a bottle of Sucralfate on hand at all times in case of stress causing a flare up because I donāt trust aloe that much for my own horse 
That tells me hind gut issues were there either instead of or in addition to gastric issues (since I donāt know if you scoped).
Omeprazole isnāt a guarantee, and that link wasnāt about whether omeprazole WILL be effective. It just shows that while some horses do respond to aloe, they responded much better to omeprazole when there were squamous (non-glandular) ulcers,
And not that many years ago, I was told by a good vet that Sucralfate was a waste of money, so, again, meh.
The science of how sucralfate coats open lesions in mucus membranes would beg to differ
Does anyone have a good guesstimate on how many pounds of alfalfa pellets would equal a good sized flake? I donāt have access to alfalfa hay, but I can get pellets to help manage my horseās issues. Iām hoping this would be a better approach vs a small scoop of an expensive gut management supplement?
There is no universal weight of a flake of alfalfa, as itās entirely dependent on how big the bale is and how tightly packed.
But if you want some sort of guesstimate, itās common for a flake of alfalfa to weigh 5lb give or take.
As maintenance after the ulcers are healed or to prevent themā¦ Yes.
Iād say read the package, and start adding them to feed slowly.
My mare was imported in June, and since the beginning of August, Iāve had her on 2 treatments of generic esomeprazole as we suspected ulcers due to weight loss during her travels and a few other symptoms (touchy when brushed). This was a temporary measure to judge whether her symptoms would decrease. Sheās put on a lovely amount of weight on the esomeprazole, so a scope was planned for last week to confirm.
However, due to an unexpected financial squeeze I had to put off the scope so what Iām doing until I reschedule it is: 3 scoops daily of Herbs for Horses Ulcer Mix (chamomile, fenugreek, licorice, marshmallow, meadowsweet, slippery elm, omega 3 oil), got her out on grass for 6 hours/day (sheās boarded so I was able to score her a newly-built grass paddock), and Iām going to start slowly adding alfalfa cubes to her diet. Sheās also been on a supplement made of anti-inflammatory phytochemicals, along with a vitamin E and selenium supplement (we have very low levels of selenium in the soil). She gets a ton of hay to get as close to free choice as possible, which is of course very difficult to emulate. Iām also trying to get her a buddy. Ideal wouldāve been to scope first and then start the ulcer supplement, but alasā¦
I never scoped my geldingāto do so would have meant an hour trailer ride to a university, and horse is HORRIBLE in trailersā¦if he didnāt already have ulcers, he would have had them by time I got him to the U. He had all the classic symptomsāhard to keep weight on, wouldnāt eat anything but hay, teeth grinding, sensitive to brushing, and would try to bite me if I went to put a blanket on him.
Omeprazole is comprised of a two compounds that are a pair of non-identical mirror images. Esomprazole is one of the two molecules, the so called S-enantiomer, hence its name.
We had one of those gastro clinics at our barn today where a representative and a vet from Boehringer show up along with your vet and scope horses for $150 plus sedation. Great deal if the OP could find one of those. Here are a couple of things that I learned today. If youāre using Gastro/UlcerGard short term as a preventative, a quarter of a tube is fine and going to a half tube wonāt have any additional effect. They brought a plasticized horse stomach (from a 1000-lb race horse) and the horseās stomach is alarmingly small when you consider both the size of the animal and the amount of food you serve it. The alfalfa also serves as a physical barrier if you feed about a quarter of a flake about 40 minutes before riding as it sits on top of the stomach contents and helps to prevent acidic fluid from splashing on the top part o the stomach that has no acid protection.
Then there is the matter of how the alfalfa buffers HCl in the stomachā¦ The rep said calcium neutralizes the acid and I noted that calcium is at best a weak acid. Tums, which is calcium carbonate was then brought out as proof that calcium neutralizes HCl and I noted that itās the carbonate, not the calcium, and that just because both Tums and alfalfa help with stomach acid and both contain calcium does not mean that itās the calcium thatās neutralizing the acid. I believe that thereās a protein in the alfalfa that works as a buffer? If anyone can point me to actual scientific proof that calcium neutralizes stomach acid, Iād love to see it. All Iāve found are glib statements and one article that noted that calcium increased the production of acid, which would be a physiological effect as opposed to a chemical one. Meanwhile Iām tempted to get out a pH metersome HCl, Tums, and calcium nitrate and see what happens.
Incidentally, my stalled horse who is turned out alone in a dry lot for 30-60 minutes three times a week, is in moderate training, and eats zero alfalfa was judged to be Grade Zero in the ulcer department. The vet noted that they donāt see that a lot and that I should keep doing what I was doing.
There are likely no studies because the source of calcium for horses are the two options: Tums, alfalfa
Whether itās the calcium or notā¦ the way to get it into them are those options, and spending $$ to do a study to determine which it is will not really change that.
Havent read thru all the comments but if he has hindgut ulcers which are common with reg ulcers. You may want to see if your vet will call u in a misiprostol (sp?) Script. Mine called it into cvs for me bc if helped great, if not im just out 120 bucks lol. See if your vet will try it? N then get a gold rx card before u pick up the script itll save u about 100 bucks!!! My 120 was after the discount. But it got my mare eating n feeling better in under a week!!!
Doesnāt anyone have any intellectual curiosity? :winkgrin:
If the calcium isnāt doing anything, then there is zero point in getting it into them. So far the logic I have seen is that since alfalfa and Tums both help with ulcers and both contain calcium, that it must be the calcium that helps with the ulcers. This is faulty logic, given that both Tums and alfalfa contain substances in addition to calcium and that Tums contains a known acid-neutralizing substance, carbonate ion. Itās like seeing two different blue cars that are being driven erratically and concluding that blue paint causes cars to be driven erratically.
My gelding developed ulcers every fall when the weather patterns went from summer to winterādue to his hock arthritis flaring up. Vet put him on firocoxib (Equioxx/Previcox) and no more ulcers.
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