So much goes into stress beyond grain and access to forage. Housing, herd, shipping, training, pain…probably a whole host of things we don’t yet understand.
I’d look to what precedes his need for treatment to identify what’s setting that off. You may be able to make changes in advance to mitigate, or you might not be able to do that, and the only option is to treat.
Not every single horse out there is going to be able to avoid ulcers 100% of the time.
Yes, of course, Simkie–just wanted to share the diet aspect since I knew it would be the first question asked.
Right now there seems to be no real pattern as to when he needs treatment, that doesn’t mean there isn’t one, just not one I have been able to identify. He is a nervous horse by nature and has a very sensitive stomach (why I pulled him off grain). He has not done well on any of the gut support supplements I’ve tried, though my hope had been to find one that would act as a preventative. But If I need to treat him from time to time, I am ok with that. One of our vets suggested keeping him on a very low dose of omeprazole/esomeprazole at all times. But I think treating at first sign might be the better route.
Do you have a link to that study? I know of the one done on Relyne, but that was a bit sketchy as there wasn’t a control group. I know Alimend is a similar formulation, but wasn’t aware it has a study of its own.
I 100% agree that ulcers are never black and white. All the right drugs don’t heal all ulcers, and some ulcers heal with benign neglect, ie Dr Green, removing the source of the stress, etc.
My PSA for the day - this is not the definition of a white paper 
A white paper is a non-peer reviewed informative piece on an issue for which the author believes clarity or education is needed, and frequently offers a philosophy, perspective, or opinion. It should still be fact-based and very well cited, and, at least for medical white papers, is typically written by experts in the field such as scientists or clinicians.
What you’re describing is simply called a peer-reviewed article
No worries, and not trying to be pedantic, just trying to minimize confusion for folks Science literacy is such a challenge in todays world as it is!
I have a couple questions for those in the thread who have used esomeprazole/Nexium.
I had my horse 60mg for 10 days in December before tapering down to 40mg then 20mg for 10 days each. However, symptoms returned once the dose went down to 40mg. I would’ve bumped the dose back up but had to go back to school so I wouldn’t have had time to do the taper if I stayed at full treatment dose for longer than 10 days.
My vet ended up prescribing compounded sucralfate in January and we have been using it a little over a month for twice a day but have seen no change in symptoms. We’re currently thinking it’s glandular, hence the sucralfate. However, if anything the symptoms have gotten worse, definitely no improvement.
Currently thinking of going back on the esomeprazole since at 60mg, I had my horse back for the first time in months. However, we’re still finishing up the sucralfate and so my vet said I’m supposed to do a washout period before doing another medication. Does anyone know how long I need to wait in between the compounded sucralfate?
Also, I know that people mostly have used the esomeprazole for squamous ulcers. However, I did see this study that mentioned use of esomeprazole treatment for glandular ulcers. Has anyone in the thread used esomeprazole for glandular ulcer treatment?
For those that did see their horse’s symptoms return when esomeprazole dosage was lowered, were you eventually able to taper off of the esomeprazole? Is there a pelleted supplement that would be able to help with phasing out the PPI once I finish treating? I know Equishure and Succeed are popular but any supplements that aren’t pelleted are very difficult to get my horse to eat.
Lastly, it seems that tapering PPIs is somewhat subject to debate based on this thread I saw. I guess it’s because horses react differently to the tapering vs. humans, thoughts?
Ten days of any PPI is not long enough.
Sucralfate can be given concurrent with a PPI, just not dosed at the same time. Separate by a couple hours.
Yes I was definitely aware that I wouldn’t be able to heal them within 10 days but I only had 30 days in in between semesters to give the medication so I thought I’d do 10 days of 60mg, 10 days of 40mg, and then 10 days of 20 mg to make sure I’d have time to taper before figuring out a solution in the interim.
Edited to add for clarity: In December I was mostly just doing a brief trial of the esomeprazole to see if it made any difference at all
tapering omeprazole or esomeprazole doesn’t do anything, and because symptoms returned, it just means you haven’t allowed the ulcers to heal
Dr Ben Sykes research on omeprazole (and I’m definitely extrapolating to esomeprazole, since they affect the proton pumps the same way), showed that it’s only when you STOP the drug that there’s a bit of a rebound, and even that’s short lived, 24-48 hours or so depending on what sort of dose you were using (preventive vs treatment). It doesn’t slowly start coming back when you lower the dose, it doesn’t start producing higher acid until you stop. So tapering just pushes out that small rebound period.
It’s not that horses react differently from people to tapering, it’s that horses react differently, and unreliably, to the processes that shut down the proton pumps, and to several other mechanisms that are responsible for the rebound. In horses, those other mechanisms recover very quickly which means the rebound period is very short-lived and you can’t prevent it.
Ahh okay that makes sense, thank you! I think maybe I’ll just add the Nexium back in then as I’ve almost finished with the compounded sucralfate since that’s not doing anything.
Doesn’t Abler suggest treating with both Sucralfate & Omeprazole for best results? Fed at different times as you noted.
If you haven’t scoped, or you suspect a potential hind gut issue, or you have multiple types of ulcers, OR you’re also using an NSAID for some reason, it’s always a good idea to add in sucralfate. It will coat lesions all along the GI tract. But it needs a stomach environment separate from omeprazole, as noted.
Just fyi, you can get your vet to write a script or in some states the drug store will sell over the counter, for lower dose Nexium packets.
My son just got prescribed the lower dose Nexium. packets that mix in water. They have 10mg and 2.5mg.
A lower does just means more volume of medication
I assume that luv is suggesting a lower dose for taper or prevention, not using it to achieve a full treatment dose.
I have a 600 lb pony, the lower dose would be awesome to taper and be able to use a lower dose when traveling, etc.
The point is, via the thread I posted about Dr Syke’s recent research, is that tapering is useless because the rebound effect doesn’t happen until you totally STOP the drug. And even then, 48 hours or so is about it, so just give your horse some downtime, extra buffering (some added alfalfa for example), and then go on with life.
I wouldn’t even worry about a smaller horse. Why?
The lowest studied does was only evaluated for 6 hours for how long it increases pH. Maybe it keeps it high enough for longer, but they didn’t study that. The higher doses were measured for up to 23 hours. So just use a higher dose which is still not a lot for a pony, and hedge your bets on actually being able to heal things.
One single study has suggested tapering isn’t necessary. Has that data been published yet? Can you link the paper? What omeprazole product was even used? Drawing conclusions from one study with small sample (I assume, because damned near every equine study has a small sample size) using a different product and prep is perhaps a stretch.
It’s hardly settled science. Let’s see more data and research before saying unequivocally that tapering is worthless.
Dr. Ben Sykes talks about the the research in this video.
Dr. Tania Sundra also did a study with esomeprazole treating glandular ulcers. I reached out to her and she said she did not taper during the course of the study so I’m not sure how it impacted the results.
I don’t really know enough about tapering to say much else than posting these links
Do you have the full text of this one? I’d love to read it if so. Couldn’t find it online or at scihub. Thx!
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