Chronic Glandular Ulcers

I would love insight on additional questions to ask or things to look into surrounding glandular ulcers.

Visit 1:
Diagnosis: grade 3 squamous, grade 4 glandular
Treatment protocol: full dose of Gastrogard, sucralfate 3x/day, misoprostol x/day, 24/7 turnout, no work, Gut-X, Contribute Omega-3, outlast 3x/day

Visit 2 (6 week follow up):
Diagnosis, squamous ulcers resolved (YAY!), grade 3 glandular
Treatment protocol changes: 1/4 dose of Gastrogard, misoprostol 2x/day [number of pills increased], 12/12 turnout (true free access hay when indoors), marshmallow root powder, slippery elm bark, prozac*

Visit 3 (12 week follow up):
Diagnosis: squamous still healthy, grade 2 glandular
Treatment protocol: pending full write up

Visit 4 (16 week follow up):
Scope #4 recommended.

*We started the Prozac at week 9 in case her inherent nervy nature was contributing to an unhappy stomach.

I know that pain can be a component with chronic ulcers so we have also done a full lameness exam at each appointment, 1 neuro exam, full neck and back x-rays, hoof x-rays, and have continued body work despite being out of work and daily carrot stretches.

Is there more I should be doing for the glandular ulcers? Better questions I can be asking back to my vet? Research articles to consider?

Are samples of gastric fluid being taken for pH testing at each scope? My guy had a very similar situation and treatment protocol last summer. His squamous ulcers resolved and the glandular/pyloric ulcers hung around for a while.

We tweaked his protocol when we discovered that his pH was less than 2.

Having gone through a few years of persistent, recurrent ulcers of both varieties, I can only say from my experience that until I figured out where the pain was coming from, things did not get better. I did all the work-ups you did, but also added in ultrasound of major muscle groups. Found significant (previously unidentified) muscle inflammation in a few places. Treated that, and things did get somewhat better.

I think overall, however, what made the biggest difference was gut motility. My horse was very uncomfortable when I put a halter monitor on and started seeing heart rate spikes regularly every day and night. Nothing obvious externally, just high heart rate spikes.

The story goes on and on, but gut motility drugs have helped him blossom again. No ulcers, no grinding, no gut pain, and a delight under saddle.

Just two other things to think about.

Fantastic question! Thank you. That seems like a really reasonable thing for us to do but it has not been brought up. Would you mind sharing what you tweaked with that information?

I’ve been trying to stay in the “hear hoofbeats think horse” mindset rather than Zebras but as we enter week 13, I think some zebra conversation is warranted. Looking in the review mirror were there any subtle signs of the gut motility that you can pinpoint?

A halter monitor is not invasive so that’s definitely something I’d be willing to explore. I wonder if there are any companies that rent them…off to research.

He had grade 4 pyloric ulcers so we started with just misoprostol alone. The vet initially didn’t think GG would be indicated. We rescoped 30 days later and found almost no improvement. At that point we were using our local vet instead of the university equine hospital. Local vet pulled fluid for pH testing and found that it was 1.6 when normal is somewhere between 4 and 5.

We started him on GG and miso together and he went from grade 4 to grade 1 in 30 days.

Depending on your current treatment, pH testing might not alter your protocol, but it’s useful information nonetheless!

Yes, Nightwatch ‘rents’ these halter monitors. They have been fantastic to deal with at a very, very trying time.

What did I notice. Externally? Not much. Manure had changed - that was something that I had noticed happening a few months earlier. It was puffier, less formed, but again - that didn’t seem to alarm anyone. He was less interested in his breakfast and dinner, although there were so many supplements in there I thought that was it. Under tack he was quieter, but I attributed that to simply being happier in his work. Looking back, one thing that was clear is that he was not playing/galloping around in the fields. I can say now that his gut was not comfortable and probably had not been for some time. It is worth noting that I had SO many gut ultrasounds, every blood test you could imagine, and nothing showed up. Oh, one thing that was definitely zebra was putting him on ceterizine for potential inflammation. There was no lab test that suggested it would help, but it’s super cheap and available from Amazon.

More info is needed. pH can be as high as 7.0 way at the top, and as low as 1.5 way down at the bottom. 1.6 pulled from down near the pyloris is normal.

Sample was pulled near the center of the stomach, not directly at the surface of the gastric fluid or down by the pylorus. 1.6 was abnormal given that.

Again, I’m only speaking on my horse’s case and the information I was given by his vet.