I have a TB gelding (4 yo) who started showing massive signs of anxiety and girthiness ~1 month ago. Started him on the 60mg dosage two weeks ago, and saw incredible improvements within 5 days. By day 6, all anxiety symptoms were gone, and now (day 16) he’s still a touch girthy. I’m hoping that the last two weeks and taper will help with this, but also considering chiro in case it’s unrelated to ulcers. Honestly, I’m pretty shocked about how well this worked, and I’m planning to do this treatment on another if it has lasting results.
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I’ve found this thread incredibly helpful so will share my story (and update as it progresses).
Horse started showing signs of NQR - has always been sensitive to touch and girthy but then it worsened, back palpated very sore, started to really struggle holding her leads at the canter, bunny hopping in left lead canter and bucking on canter departures. Stopped all riding and just lunged every 3-4 days to monitor gaits / willingness.
Started on Nexium until vet could come out to scope (~5 days) at 3 pills (60 mg) in her AM feed. Saw modest improvement but not 100% in that time (back tenderness improved, more able to hold right canter but still struggled with left, still 1-2 bucks on first canter departure but would then settle, overall moving out well in walk / trot without sucking back).
Vet scope found grade 3 ulcers and general stomach lining irritation. Vet prescribed full course of GG and we started on that.
Lunged on Day 5 on GG and saw huge improvement - back no longer tender, very happy to move out, holding leads to both directions 85% of the time now, no more “ouch” bucks on left canter departure, happily stretching down in her trot even if just lunged in a halter.
day 7 of GG and decision made to switch back to Nexium as horse is an utter nightmare with syringes . Based on this thread and the other thread / paper with higher dosage, we’re doing 3 pills AM and PM feed. Will monitor closely and if start to see any symptoms return, will either attempt return to GG or discuss alternatives with vet (injectable is preferred alternative but is on back order for ages, ugh!)
Will let people know how we get on!
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I switched my mare from Abler paste to generic Nexium about 10 days ago, and she’s doing pretty well on it. I’d like to get her off PPI’s, and the Gut-X sounds interesting.
She gets a cup of Outlast as her dinner “grain,” and loves the Outlast cookies, which are fairly low NSC and more air than cookie.
One interesting observation: a couple of winters ago (2019???) she became absolutely wiggy about static shock. I had to tie her in her stall to brush her or take her blanket off, and she was often still on high alert. By last winter, the barn cut back on blanketing her because she’d run around her stall trying to escape the blanket monster. This winter, she’s much less bothered; I took a chance the other night and removed her blanket with her not tied, and she stood quietly as she used to do. I wonder if the problem was ulcers all along. We started treatment in April.
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There was some discussion further up this thread that using Outlast at the same time as the PPIs such as Nexium may not be a good idea. I was considering feeding a cup before riding, but am having second thoughts because of that and may wait until after the PPI treatment…
Mare gets her PPI in the early morning, no Outlast until I get to the barn, which is usually several hours later.
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Update on my mare: She’s been off the GG and on the Nexium for a little over a week now. She’s also getting a small flake of alfalfa hay AM / PM, Misoprostol, and Assure Guard. I lunge her every 2-3 days but until today was only lunging to monitor her gaits / demeanor (<5 min, WTC each direction with one change direction) and wasn’t actually working her.
She seemed to be getting more fiesty on the lunge - especially in canter trying to take off / bucking / leaping etc. I initially thought this was because the nexium wasn’t working and these antics were signs of discomfort so ordered more GG (which arrived this AM) and planned to switch her back over tomorrow.
Today while dropping the GG at the barn I lunged her but this time decided to work her. I expected her to focus on me, respect my voice / body aids, and did lots of transitions and changes of direction. Initially she was “up” during her canter work and was resistant to walking (wanting to break back up into trot). By the end of the session she was focused and listening. I didn’t let her canter more than ~5-6 strides at a time so she couldn’t escalate back up into her antics, but when she was cantering she wasn’t switching behind, was able to hold her balance, and generally looked quite good.
So now I’m wondering if the canter antics are less about the Nexium not working and more about her becoming “up” with all the alfalfa hay and lack of work.
So wise Cothers - should I stick it out with the Nexium and put her back into real work to see how she progresses or stick with my initial plan and go back to GG? This is a horse who usually only gets ration balancer and (good) 1st cut hay - so the Alfalfa is quite a rich change in diet for her.
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This seems like an easy test–pull the alfalfa for a few days and see how she does. Horses that are sensitive to alfalfa usually settle quickly when it’s removed from the diet.
If there’s further concern about the stomach after that, I’d really consider scoping. PPIs like Nexium or Gastrogard don’t fix every stomach problem out there. It’s worth ruling out the more complex issues (like pyloric ulcers or delayed emptying) when a normal course of meds doesn’t give you the expected results.
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THanks Simkie - She’s been scoped and we found one Grade 3 ulcer and several quite irritated spots (but not full blown ulcers yet) as well as minor irritation in the pyloric area (so vet also wanted hind gut support given that irritation).
ETA: We are about 2 weeks into her 30 days treatment course and definitely seeing MAJOR improvement. But we started her on GG until getting it into her became a nightmare for the BM (she’s fine for me, but I can’t be there every AM to give it to her) so we switched to the nexium to make BM’s life easier. I just want to make sure we aren’t backsliding on the Nexium. But I feel like there are so many variables changing (alfalfa, work load, temperature / weather major ups and downs, GG vs Nexium, etc) that at this point it feels difficult to pin point what’s what.
Yep, in that case, I’d definitely try to minimize as much change as you can to just the nexium, and see how it goes 
I would stick with Nexium and put her back to work and see what happens. We are 2 weeks into the 30 day treatment for my horse and I just started actually working him (on long lines, hoping to maybe ride again this weekend). If the horse was fit and active before this situation, it may just have an excess of energy due to lack of work and/or the alfalfa. My horse is acting similarly so it’s very hard to determine what is pain behavior versus too much energy. What I’ve noticed is that I think when it is pain related, he is much harder to bring back down/get him listening to me and he has an anxious/manic look in his eye when he is “up.” Now I think we are more transitioning to just having too much energy and feeling good, so he gets “up,” but will come back down and has a different/softer eye throughout. We did take my horse off alfalfa as it is not something he was really used to and we weren’t sure about it’s impact on his behavior. He does have access to orchard or teff hay 24/7 and he is still holding his weight, so for now that might be a direction to consider.
I think the reason Nexium didn’t seem to work as well for us is because at least some of his ulcers were being caused by bot fly larvae, which needed ivermectin to kill, followed by medication for healing the ulcers.
Thanks - this is helpful. She is young (5) and went from full work to completely out of work these past several weeks now so I suspect this “up”-ness is boredom / excess energy related. I may pull her off the alfalfa and switch her to beet pulp. Not as high in calcium as the alfalfa but the trade-off may be worth it to see if that cools some of her “hot-ness” right now.
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Hi all, I wanted to check back in and see what those who have treated a full course with Nexium experienced.
Background:
I am on day 27 of Nexium at 60mg/day fed am only. My horse is a 7 year old OTTB that is a true hard keeper. He currently receives 8lbs TC Senior Gold, 2lbs (wet weight) beet pulp (molasses free) and 2lbs alfalfa pellets split between AM and PM feeds, equal amounts at each feed. All feed is wet to damp almost mushy texture but not soup. He is currently getting roughly half a bale per day (I don’t have a lot of control over this) of costal Bermuda hay. He is on 24/7 turnout in large, but sparse rye pasture with 2 other geldings, blanketed when temps are less then 32 or when it rains and is less than 40. I ride 3 times each week at best and only W/T right now. He is stalled to eat but no longer than an hour in his stall with plenty of hay to munch on while waiting to be turned out (1/4 of a 50lb bale).
The issue:
He showed initial improvements in the Nexium, no teeth grinding during girthing, less pawing when eating, less urinating immediately after eating, almost no wood eating (he isn’t chewing but actually eating it) and more balanced and forward under saddle. NOW he is back to serious wood eating, like an entire 2/4 worth in a day or two, pawing at every meal and urinating on the hay in the pasture. Our spring vet appoint is due towards the end of the month and I would like to hold off until then to consult the vet on what do next (I know scoping is probably the outcome). Would it be advisable to switch to ulcergard in the meantime or continue with the Nexium (starting the taper Saturday 2/6)? The barn owner asked our vet about using Nexium to treat ulcers while out for another horse and relayed the information to me days later. The vet stated that Nexium is not as affective as it does not reach the hindgut, having read multiple papers on the effectivness of both omeprezole and esomeprezole I do struggle with this statement BUT I admit I know more about nutrition (still not a ton) than I do about chemistry and pharmacology.
Can anyone offer some advice on this? If getting the vet out sooner is the best call I’ll swallow the bill and do it. If starting an ulcergard treatment on tail end of a Nexium treatment isn’t going to destroy his GI tract I am ok with doing that but that certainly is not a cheap option either.
Wood eating this time of year is normal, imo. Horses do browse brush. Sap is starting to run, they’re bored after winter, and they chew on wood. I toss horse safe branches in the field to satisfy that urge to chew.
None of the PPIs reach the hind gut. They don’t act there. 50% of omeprazole IS esomeprazole, so what your vet is saying is a little odd?
If you’re concerned about the stomach after treating, I’d really consider a scope to see where you are.
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I would consider consulting a different vet. If your vet is a general practitioner type, they might not be up on the latest ulcer/hindgut research. Is there a vet in your area that focuses more on GI issues/internal medicine.
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He is eating boards not trees in his current pasture, he did munch on the holly tree until the barn owner fenced it. She’s concerned about wood eating because her mare chocked on a piece of wood. This mare has a history of choke and this was the second time in as many weeks.
I do live in Raleigh NC so I have access to NCSU Equine hospital but that’s serious $$$ sometimes. I am definitely not opposed to scoping and will likely end up having to do that, just hoping to avoid that and the ulcergard treatment. Whatever is needed I’ll do and hope it works.
Thanks for the feedback!
Scope now. Depending on where the ulcers are in the stomach, you may need more or different treatment. Pyloric ulcers (at the exit of the stomach) are notoriously difficult, and often need misoprostol and sucralfate on top of Gastrogard. They also often require 2-3 months of treatment at the highest dose rather than 1. Definitely get someone that knows what they’re doing with ulcers involved, it will save expense and headache in the end.
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Is there other wood out there to chew on? Stuff that’s horizontal and tasty? If there’s not, then yeah, the fence is going to take the hit. Dimensional lumber (like your 2x4) or hemlock fence boards are DELICIOUS. According to my horses 
“She seemed to be getting more fiesty on the lunge - especially in canter trying to take off / bucking / leaping etc. I initially thought this was because the nexium wasn’t working and these antics were signs of discomfort so ordered more GG (which arrived this AM) and planned to switch her back over tomorrow.”
Just to put another variable in your head…(I know, I’m sorry) my WB does NOT have the classic response of “hotness” to having ulcers. He gets dull when uncomfortable, dead to the leg, uncooperative and pissy if you try to use spurs. Within days of treatment he became more accepting of the leg, more forward and “brighter.” He seems a little more reactive and even “hotter.” Not over the top in anyway just a bit more tuned in to not just me but his surroundings.
For the record, he is on day 53 of GG–28 days full dose, 14 days of 1/2 dose and finishing up in a few days on 1/4 dose. From here we will try to manage with Nexium. But I think the important thing is to look for a change in behavior in your unique and particular horse more so than generic symptoms. Is “feisty on the lunge” a feel good thing? That might mean something different than hot=ulcers.
I also continued to ride as I started the protocol so I could note changes and improvement. I’d be tempted in your position to get back on ASAP, even if that means a 5-10 minute ride to figure out how he is day to day. My ride the first day after I started treatment was literally a 5 minute ride–yep still unhappy…
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Y’all, I just read this ENTIRE thread and will be trying the 60 mg a day, 30 days then taper Nexium protocol with my mare!!
One question - I definitely plan to get Equishure to support the hindgut just in case. Should I start her on that immediately with the Nexium or just worry about it when I’m tapering off?
I have to bag up all my supplements for the feeders at my barn so I’d rather just do all my bagging at once if I need to add Equishure to the mix now 
Because the Nexium can negatively impact the hind gut, it’s a good idea to use the Equishure along with the Nexium
Good luck, report back!
