Drug-Resistant Ulcers?

[joiedevie99]

Horse was diagnosed with grade 4, bleeding, ulcers at the pylorus. Two biopsies came back clean.

Horse has been on Gastroguard, Misoprostol, and Sucralfate for 5 months, as well as one month of Doxy.

Ulcers have shown minimal to no improvement.

Horse already has a slow feed hay net, gets soaked alfalfa cubes 30 minutes before each meal, and is on an approved diet. Turnout time is being increased. Barn is small and quiet.

Several vets and vet hospitals are involved.

I’m wondering if anyone else out there has been in this situation? Has anyone had luck with a non-traditional treatment? Like double-dose Gastroguard, or Gastroguard and Ranitidine at the same time?

[Simkie]

This is the kind of horse that I think would be terribly interesting to culture and see if perhaps a bacterial cause could be identified. There’s no evidence, I don’t think, that equine gastric ulcers are caused by a bacterial agent (like in people) but it may be worth investigating, anyway, as you have an odd presentation that’s not responding to anything else. Finding something would be literature-worthy, so perhaps you’d be able to find a vet willing to give you a discount through it all for the possibility of getting a really interesting paper out of the deal.

If you’d like to try an omeprazole/ranitidine combo, Precision does compound them together. Unsure of your feelings on a compounding pharmacy, but it would offer significant savings over name brand.

Best of luck–I recall reading about how long you’ve been working on this issue, and I cannot even imagine how frustrating it’s got to be.

[joiedevie99]

Thanks! We’ve already gone to compounded Misoprostol because of the price doubling - so I think my vet would be willing to do the compounded one. I’ll ask on Monday.

We were thinking bacterial - which is why we did the month of Doxycycline. I guess its possible that its a bacteria that Doxy isn’t effective against. I’ll ask about that too.

[eclipse]

I am going through this exact same issue and am on month 5! A month ago we decided to try Bethanchol Chloride along with the Gastroguard. We give Sully the Bethanchol Chloride 3 times a day via oral syringe and as of his last scope, the ulcers between his none Glandular and glandular region had healed and the ulcers around his pyloric sphincter finally showed slight improvement… They were less vascular and angry. The Bethanchol helps with the stomach emptying (it’s usually for bladder emptying but they’ve found it also works on the stomach), so the vets are hoping that if they can keep the food moving, the acid will not sit in there and thus the ulcers will start to heal… It’s been a very long haul and the last biopsy again showed no cancer so we are hoping this will finally work (nothing else has)

we will scope again at the end of October and are hoping that this is now working. Next up, if it’s looking better, we will wean off the Gastroguard, but probably keep him on the Bethanchol and hopefully things stay good! Since we’ve started Sullivan of the Bethanchol, his appetite is much better and weight is going back up. I’ve also, under vets advise, put him on only one supplement “Equitop Myoplast” as they had good results using it with post colic surgical horses and it seems to be working well and it’s the only supplement mine will eat (he will even eat it straight out of my hand)!

edited to add :my horses culture shows pockets of bacteria that is present in humans with ulcers but has never been linked to causing ulcers in horses as usually the acid flushes it out (sorry I cannot remember the bacterial name)… Antibiotics didn’t help but made him worse!

[SolarFlare]

[QUOTE=eclipse;8343200]

edited to add :my horses culture shows pockets of bacteria that is present in humans with ulcers but has never been linked to causing ulcers in horses as usually the acid flushes it out (sorry I cannot remember the bacterial name)… Antibiotics didn’t help but made him worse![/QUOTE]

h. pylori Just happened to read this thread and for some reason I remembered this!

[joiedevie99]

Thanks so much! I will run that drug past my vets. I’m so excited that something is working for you eclipse!!

[flyracing]

I’ve had a horse that showed no improvement after 8 weeks of gastrogard. However, he also showed mild delayed gastric emptying. The most likely conclusion was the omeprazole was being destroyed in the stomach before reaching the small intestine (where it is absorbed). He was switched to ranitidine 3 times a day and was supplemented with slippery elm bark powder and aloe juice. The next scope was clean.

I know many vets that will put a horse with significant ulcers on a minimum of 3 days of ranitidine (plus sucralfate) to reduce the acid enough to allow the gastrogard to begin to be effective, by helping it through the stomach intact and giving it time to reduce acid to a therapeutic level. Gastrogard is “protected” by an antacid similar to tums which has a limited duration of action (about 2 hours). If this time is not sufficient for the entire dose to reach the duodenum or if the amount of antacid was insufficient to raise the pH, then the drug will not work.

[Manni01]

well my recommendation would be different… I would just turn out this horse in a nice pasture and not touch it for 6 months… I know its probably not practicable, but it would be less stressful for everybody. Sometimes just an out time will help

[IPEsq]

Metronidazole? Aloe juice?

[imissvixen]

Hey, not sure you know, but doxy is just brutal on a stomach. It put my son in the hospital when he was taking it for acne. I have given it to my horses for lyme disease but if they had ulcers to start with there is no way I would do it. My stomach is cringing just thinking about it.

[Texarkana]

Add me to the club of folks watching this thread. I also have one who continues to show ulcer-like symptoms despite months upon months of treatment (gastrogard, “off brand” omeprazole, sucralfate, ranitidine, succeed, equishure…) and a green grass/full turnout lifestyle.

[joiedevie99]

Update: The team has decided to totally switch things up for a month and see if we can make a difference. He’s now getting Gastroguard first thing in the morning, Ranitidine 3x/day, Aloe Vera Juice 3x/day, and we’re waiting for some special potion that I don’t know the name of to be shipped up from Hagyard.

If that doesn’t show any improvement, we’ll add the Bathanacol (although my vet is thinking maybe SubQ instead of oral).

I’ll update again in 4 weeks when we have some new images.

[joiedevie99]

Update (again): We’re not sure what to make of it yet, but we ran a full allergy panel on him just to see if anything jumped out. He came back high positive for Alfalfa, Timothy and Fescue. Throughout his ulcer treatment, we’ve increased his alfalfa exponentially - he now gets cubes and pellets a total of 7 times per day.

I’m not sure it’s real, but I think I’m going to pick up some orchard grass pellets and substitute those for his alfalfa for the next month. It can’t hurt.

[Texarkana]

Oh snap! Interesting results!

What do you do with a horse allergic to alfalfa, timothy, and fescue? Bejeezus!

[flyracing]

[QUOTE=joiedevie99;8351198]

If that doesn’t show any improvement, we’ll add the Bathanacol (although my vet is thinking maybe SubQ instead of oral).

I’ll update again in 4 weeks when we have some new images.[/QUOTE]

Bethanechol? What would be the purpose of adding Bethanechol? It is usually only associated with negative effects in horses. Drooling, watery eyes, anorexia, diarrhea, colic (severe, potentially fatal if the horse develops an obstruction while being treated with Bethanechol).

[joiedevie99]

[QUOTE=flyracing;8351987]
Bethanechol? What would be the purpose of adding Bethanechol? It is usually only associated with negative effects in horses. Drooling, watery eyes, anorexia, diarrhea, colic (severe, potentially fatal if the horse develops an obstruction while being treated with Bethanechol).[/QUOTE]

I understand it’s more commonly used in horses with urinary retention and other bladder evacuation issues. I’m told that some people believe it works equally well on the smooth muscle in the digestive tract - to treat horses with delayed gastric emptying.

I understand it is not well tolerated by many horses, especially when given SubQ. Although it is more well tolerated orally, is not well absorbed orally. Maybe that is why Eclipse is dosing three times per day?

Eclipse may know a lot more than me, since her horse is on it now. My vets and I would have a bit more learning to do before we decided to go down that path.

[joiedevie99]

[QUOTE=Texarkana;8351852]
Oh snap! Interesting results!

What do you do with a horse allergic to alfalfa, timothy, and fescue? Bejeezus![/QUOTE]

Well… a few weeks later I can actually answer your question. He’s eating oats 4x a day, and has an XL NibbleNet stuffed with Coastal hay. The only oat-balancer we could come up with that doesn’t contain any alfalfa is Grand Vite, so we went with it. He also gets SmartLytes, which thankfully do not contain alfalfa.

[eclipse]

[QUOTE=flyracing;8351987]
Bethanechol? What would be the purpose of adding Bethanechol? It is usually only associated with negative effects in horses. Drooling, watery eyes, anorexia, diarrhea, colic (severe, potentially fatal if the horse develops an obstruction while being treated with Bethanechol).[/QUOTE]

i had to watch sully for colic etc but he has tolerated the Bethanchol exceptionally well. Because his pyloric spyncter is ulcerated so badly his stomach cannot empty and he would experience colic that when they tubed, they would get buckets of food and liquid (how his stomach didn’t burst was amazing) but he did suffer with a bad left displacement and when we scoped we discovered severe grade 3 ulcers and the ulcers around his spyncter.

after 5 mths of all other treatments it was decided Bethanchol might be a last ditch attempt to help his stomach empty, thus moving the acid and bacteria sitting there and maybe the ulcers would heal. So far it’s looking positive and my vet has a few horses that have been on the liquid oral Bethanchol for delayed gastric emptying for 2 years with no ill effects at all. Because their stomachs don’t work “normally” it seems this med doesn’t cause the colic and other side effects that “normal” horses get. So far I’m very happy. Sully has piled on weight and next week he gets scoped again so hopefully I can update with more good news!

[joiedevie99]

UPDATE: We had our 7 month scope last week. We’re finally seeing minor improvements. The areas around the pylorus are less bright red and more dull red, and some are starting to scab over.

So… We’re dropping the Gastroguard to 1/2 tube per day (since we actually have no evidence of it helping at all). We’ve also maxed-out his insurance, so it’s all out of pocket now. We’re sticking with Ranitidine 3x/day, Relyne GI from Hagyard, Aloe Vera Gel, and strict adherence to the no-alfalfa diet and the 24/7 full NibbleNet. We’re also continuing to feed Tums before riding.

He goes back in late February, and there’s a lot more hope amongst his team than there was after the last scope

[eclipse]

That reyelne GI is the new med I had to try sully on last mth!! Expensive so I’m interested to see how things look at his next scope in January. He’s put a lot of weight on but the ulcers still weren’t healed as well as they’d hoped. So he’s on Reylene, Bethanechol and generic Omeprazole (insurance ran out and so are $$!) so far he’s still looking great !