Duodenal & pyloric ulcers - treatment options?

[Lieslot]

Sorry folks, I posted a question about Gastrogard administration yesterday, because my vet was convinced my horse was going to be sent home from hospital with GG, but that is now not the case.
Last night the internal medicine specialist called me and said the scope showed pyloric & duodenal ulcers, but nothing in the higher non-glandular part nor upper glandular part.
He feels GG is not effective for such and he has been put on sulcrafate only.

Anyone else had a horse with such and how did you treat?

A friend of mine, kindly forwarded me this article, so now I am wondering if on my own accord I should add
misoprostol to the sulcrafate.
I will discuss with my vet as well, since he was surprised GG was not recommended.

https://www.ncbi.nlm.nih.gov/pubmed/…ykA9NzhZGlyFKA

[joiedevie99]

Yes (pyloric). Gastrogard, Misoprostol, and Sucralfate. For one horse this worked like a charm and he was great at his ~5 week follow-up scope. We stopped the misoprostol after 2 weeks, and the sucralfate after 4. Then we tapered the gastrogard until he was off it.

For the other, nothing handled his pyloric ulcers and we basically gave up. You can find the thread on here (Drug-Resistant Ulcers). Don’t fret though, most horses aren’t him

[Madison]

This article summarizes a lot of the treatment options and recommendations for the pyloric ulcers https://www.magonlinelibrary.com/doi/full/10.12968/ukve.2018.2.S1.3 They can be a challenge to get rid of in some horses.

[eclipse]

Mine took over a year to clear BUT he also had glandular and non glandular ulcers, as well as pyloric ulcer …sigh… but he’s now sassy and healthy so it can be done, although he will always be on omeprazole!

Basically he was on gastroguard, misoprostal and sucralfate for the year and then at the end, as a last ditch effort…antibiotics (they generally aren’t indicated to help but they did with him…every case is slightly different!) . Most though, will clear up a lot quicker than my horse, but omeprazole, misoprostal and sucralfate are the normal procedure!

the treatments in Madisen’s link is basically exactly what we did!

[Lieslot]

Thank you all. Great article Madison, very helpful!
I read your thread Joiedevie, quite a story, I sure gleamed a lot of useful info from it.
Wow, eclipse, over a year… I hope my guy won’t have to be treated for that long. Which antibiotics where used and how did they determine those were the ones needed?

What symptoms did you have that lead you think your horse had ulcers?
My guy just wasn’t keen on working and he’d get tired way faster than he should for the little we asked of him. He is a very good eater, but oh boy does he drink a lot of water, hence I suspected upper stomach ulcers, but was really surprised to hear the problem was in the lower part. I suspect he’s had them for quite a while and I just didn’t realize it :sadsmile: .

Would you folks continue with the Succeed, Equishure and Outlast during treatment? Thx.

[eclipse]

@Lieslot

Thank you all. Great article Madison, very helpful!
I read your thread Joiedevie, quite a story, I sure gleamed a lot of useful info from it.
Wow, eclipse, over a year… I hope my guy won’t have to be treated for that long. Which antibiotics where used and how did they determine those were the ones needed?

What symptoms did you have that lead you think your horse had ulcers?
My guy just wasn’t keen on working and he’d get tired way faster than he should for the little we asked of him. He is a very good eater, but oh boy does he drink a lot of water, hence I suspected upper stomach ulcers, but was really surprised to hear the problem was in the lower part. I suspect he’s had them for quite a while and I just didn’t realize it :sadsmile: .

Would you folks continue with the Succeed and Outlast. Thx.

My horse started to drop weight fast, refused to eat anything (including hay and his beloved beet pulp) and colicing, so we scoped and voila, ulcers everywhere!

The antibiotics were absolutely a last resort! After trailering to the clinic every month for a resope and never seeing much in the way of healing around the pyloric area, my internal specialist decided as a latch ditch, to try “Sulfa” antibiotics. After belly taps also showed excessive H pylori bacteria (unusual i think in horses they thought “just maybe that might be causing issues…hewas used in a study that I believe is ongoing at our university , although one of the vets have developed a new pill type camera that the horse swallows from this clinic…I’ll post the link). By this time Sullivan had started to eat and had put on enough weight to justify trying them, as they can cause all kinds of issues! He was on 14 pills, twice a day for 6 weeks…no bad side effects happened and when we scoped, there was evidence of the pyloric ulcers healing. So, we again put him on 14 pills twice a day for two more months…rescoped and more healing…enough we stopped the antibiotics, and haven’t scoped since! This was almost 4 years ago now…vets thought we were at almost euthanasia it was so bad and now he’s thriving! It was a long, hard, expensive but very unusual case! He now lives on a daily dose of generic liquid omeprazole, unlimited hay and his diet closely monitored. I can tell instantly when his ulcers are bothering him, as he gets “girthy” and angry …so we back off him for a few days!

https://phys.org/news/2019-03-camera…horse-gut.html

[Lusoluv]

Hmmm…that is really interesting! I was told that horses can’t be on long term PPIs like omeprazole, but obviously that’s what’s working for you ^^.

[Lieslot]

Wow that camera thingy is super interesting, never heard of.
Glad to hear you horse is doing so well after struggling for so long.

Do you feel beetpulp is advantageous for ulcery horses? I know the previous owners had him on Speedi-Beet, I never bothered, but now thinking I should add this to his diet.

[eclipse]

My internal specialist highly recommended soaked beet pulp, and we feed it anyway at my barn! (We use the non molasses added) …he’s also on seniors feed, and equine power (supplement).

https://ker.com/equinews/gastric-ulcers-horses-beet-pulp-prevention/

The camera is new…they just finished testing this year!

[eclipse]

@Lusoluv

Hmmm…that is really interesting! I was told that horses can’t be on long term PPIs like omeprazole, but obviously that’s what’s working for you ^^.

Every case is different…mine absolutely has to be on it!

[greysfordays]

We battled pyloric ulcers for 6 months. The gastroguard really didn’t do much. Environment made a big difference as well as adding a full flake of alfalfa hay at lunch. I was hesitant bc he is pretty spooky already but it hasn’t made him spookier.

At this point he just gets Gastro Plus and Ulcer plus from enviro equine. At shows, he gets sucralfate and gastroguard. He’s been doing well but any time he is slightly different, I get all kinds of worried.

[Lieslot]

Thx greysfordays, 6 months is a long time. Seems the consensus is that GG on its own is not the way to go for pyloric ulcers.

I’m planning on adding alfalfa, he’s been getting TC Alfa-lox for over 3 months now, but clearly that didn’t help. That being said I just found out they are changing the formula and will be adding butyric acid to the Alfa-lox, so maybe I’ll continue with the improved formula
I searched high and low for a butyric acid supplement, found one in the end, called GI Calm by Stride. Butyric acid has been very helpful for myself so I wondered why no use in horses.

There are so many gastric/gut supplements out there, it’s hard not to get lost and not fall prey to the marketing spiel they all come with.
The GastroPlus sounds interesting, will consider.

[IPEsq]

Barn manager / trainer I know had a couple horses like this in her care and is a big advocate of scoping for this reason. IIRC they did use Gastrogard but it took many months with several scopes to assess healing. I can’t recall if they also used other medication…but for some reason I think not.

[EmilyM]

i had luck with misoprostol. cleaned up in 4 weeks.

[Fharoah]

I cleared up a pyloric ulcer with 2 months of gastrogard.
I do wonder if off label nexium could be stronger than omeprazole. There is a thread on it. Is this study they used the equivalent dose to gastrogard https://onlinelibrary.wiley.com/doi/…1/evj.47_12732

https://thehorse.com/19385/two-poten…ions-analyzed/

[Lieslot]

Sorry another question, so what is the deal with Misoprostol, one should wear gloves handling that medication?

He’s home again since last night, his stool test showed increased protein which I was told indicative of colonic ulceration as well.
He had a bad first night, pawing/rolling/kicking/circling… He looks more comfortable out on the grass right now, fingers crossed.

He’s on so very many pills, also on Minocycline, after coming off Dox for the high fever he spiked a week ago.

I was told to syringe the meds, but we’re struggling with this.
Looks like I can get him to eat the capsules & tablets as a whole in thick gooey brown sugary oatmeal.
I hope there’s no contra-indication to that, because he’ll be having 4 to 6 sachets of brown sugar oatmeal for the coming weeks :(.

[eclipse]

Sugar is not good for horses with ulcers BUT if it’s the only way to get meds into them, and it’s not a lot, my internal specialist was ok using a small amount of molasses when we dissolved Sullivan’s antibiotics to syringe into his mouth! We broke the pills in half and issued them in hot water then added a small amount of molasses, shook everything up inside the large syringe and he gobbled it like candy! Just keep shaking so it doesn’t congeal, and make sure the water is HOT to dissolve the pills!

[Lieslot]

Thanks eclipse! I am back to syringing, but really struggling getting the abx in him.
All the other meds (sulcra, miso, GG and probiotics) I’m doing okay administering, albeit timing with regards to absorption etc is quite difficult.
We continue to have really soft cowpatty manure.

I was given pro & pre-biotics with glutamine & beta-glucan at the hospital. But I question the use of probiotics.
I know in humans it’s now thought that taking probiotics following abx actually slows down the re-population of the gut and one is better to re-store good bacteria without the use of probiotics.

So hard to know what is causing the cow patties, he did not have that prior to going to hospital.

[LookmaNohands]

So I am just learning about ulcers because me 22 year old gelding had a mild impaction 12 days ago and ended up spending 5 days at the local vet clinic. He was not feeling better after two days there so the vet scoped him and found a grade 3 pyloric ulcer. She said it was probably caused by the impaction. This horse is also insulin resistant and has Cushings. He is not fat but wears a GG muzzle when turned out at night because of the sugar in the grass. He is retired because of unsoundness so does not get ridden.

He is now on Gastro guard and Sucralfate for 26 days after which he is supposed to be scoped again. Which is not going to happen right then as I will be out of town. Not sure what to do but from reading here, I will go get some alfalfa pronto. Except he probably will only get a flake a day unless the alfalfa has been tested–I will see what I can find.

Again, I am completely new to ulcers. Except the horse I bought in March and brought up from FL to VA, started acting incredibly spooky and finally, one vet out to see one of my other horses who tried to do himself in, suggested he might have ulcers and that feeding him alfalfa before I ride him might help, so I got some chopped alfalfa and it worked!
I have not had him scoped but just plan to manage him.

I was hoping a could find another way to manage the 22 year old’s ulcers that wouldn’t involve gastro guard since it is a pain in the butt to administer properly as well as expensive. I will be talking to a vet who does Chinese medicine for her take on this. Anyway, my horse is happy and appears to have fully recovered. No discomfort, normal poops etc.

Anyone have experience with alternative meds for this issue?

[joiedevie99]

@LookmaNohands

So I am just learning about ulcers because me 22 year old gelding had a mild impaction 12 days ago and ended up spending 5 days at the local vet clinic. He was not feeling better after two days there so the vet scoped him and found a grade 3 pyloric ulcer. She said it was probably caused by the impaction. This horse is also insulin resistant and has Cushings. He is not fat but wears a GG muzzle when turned out at night because of the sugar in the grass. He is retired because of unsoundness so does not get ridden.

He is now on Gastro guard and Sucralfate for 26 days after which he is supposed to be scoped again. Which is not going to happen right then as I will be out of town. Not sure what to do but from reading here, I will go get some alfalfa pronto. Except he probably will only get a flake a day unless the alfalfa has been tested–I will see what I can find.

Again, I am completely new to ulcers. Except the horse I bought in March and brought up from FL to VA, started acting incredibly spooky and finally, one vet out to see one of my other horses who tried to do himself in, suggested he might have ulcers and that feeding him alfalfa before I ride him might help, so I got some chopped alfalfa and it worked!
I have not had him scoped but just plan to manage him.

I was hoping a could find another way to manage the 22 year old’s ulcers that wouldn’t involve gastro guard since it is a pain in the butt to administer properly as well as expensive. I will be talking to a vet who does Chinese medicine for her take on this. Anyway, my horse is happy and appears to have fully recovered. No discomfort, normal poops etc.

Anyone have experience with alternative meds for this issue?

There are some eastern medicine products that have gotten good reviews for prevention, like Happy Stomach, which is prescription from Dr. Xie’s brand, but I don’t know anyone who would tell you to rely on those products for treatment.

If you want something less expensive, look into ranitidine or esomeprazole (nexium) or generic omeprazole. Understand that a large part of the battle is getting the drug to survive the journey through the GI tract to the point in the intestines where it can be absorbed, without being destroyed by the acidic stomach juices. The carrier is what makes GastroGuard/UlcerGuard patented/popular.