Interesting. I was planning to move my mare to beet pulp and a ration balancer along with the alfalfa hay. Perhaps I will add a serving of Outlast to that. I wasn’t aware it worked for that long.
I read this thread when it first appeared years ago and just skimmed it now, but wondering if anyone (@Simkie) has any thoughts:
-24yo Shetland gelding 500lbs
-“fecal water” for a significant time (long story)
-colic symptoms, resolved but I opted for as full of a work up as possible in my area w/new and good vet
-noted inflammation of stomach on ultrasound (ulcers? Irritation from oral banamine given to treat colic? Issues from poor teeth not allowing hay to be chewed properly?)
-noted inflammation of lymphnodes upon rectal exam
-floated poor teeth (another long story)
He’s being treated w/Sucralfate every 8hrs and has a Rx for prascend that I haven’t received yet.
Would like to add (with vet’s blessing) a treatment for possible stomach ulcers.
Options
-GG/UG, $$$
-abler paste or granules (I’ve had luck w/both and vet said sometimes she sees these products work, sometimes “ulcers get worse.”
-nexium (concerned about potential hind gut impacts)
Talk me through this.
Personally, I’d consider a 500# animal too small for Nexium treatment. A full dose for a 1200# horse is 40 mg (2 capsules) and we add a third as insurance. A full dose for a 500# horse is one capsule (or less) and you have no ability to taper.
I’d recommend ranitidine, but it’s no longer available 
You might investigate alternative H2 antagonists, like cimentidine or famotidine? Or use the abler omeprazole granules.
I’d treat the hind gut regardless of what you use. Succeed has a nice challenge program where you get your $$$ back of it doesn’t work, or equishure isn’t crazy expensive.
Also, this fb group has a long thread about fecal water syndrome. Might be worth joining (if you’re not already a member?) for some additional ideas on how to manage him 
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Thanks @Simkie. I was afraid of that with regards to the Nexium dosage, but was hopeful that since some people were doing a 14 pill dose that there was some leeway towards a larger dose.
How do we feel about the efficacy of Abler omeprazole granules? I haven’t seen anything lately either way. Last time I used them they seemed to work, but I’m a little spooked by my vet’s anecdote.
I am a member of that group and will look there for more ideas. My vet did mention that he may need to go on an all soaked diet for a while, which is such a daunting idea for me. Also the vet is 3hrs away so that makes things complicated as well, as I can’t just get her out for a quick farm call.
Add in that I’m starting Prascend this week (1/4tab tapering up to 1/2) and I’ve read enough about that to be anxious as well. When it rains it pours!
If you’re looking for something that’s a little more…hmmmm…legit? than the abler stuff, I’ve had great results with the compounded paste from Precision Pharmacy. My vet did a scoping study with it and found as effective as gastrogard. You do need your vets buy in, because it’s rx. Last time I used it (it’s been awhile!!) it was about $300 for a month of treatment for a full sized horse. But certainly one more thing for you to consider.
Thanks. I just looked into Succeed and the FB group.
I’m definitely feeling overwhelmed and confused after reading the FB page.
It feels a little disingenuous to do the succeed challenge because they make no mention of resolving fecal water—and that’s really the only way I think I’d know if it was “working” on him— plus he’d only need 1/2 dose. Maybe I’ll call. Not sure.
I would LIKE abler granules to be the answer. 
FWIW, Gut-X (Gut X?) is showing some really interesting and pretty quick results with enough people now to really get on my radar. Maybe worth looking into
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Just thought I’d share my experience. A few weeks ago, I began to suspect my new horse had ulcers. 19 days ago, I started him on 60mg generic Nexium per day. There was some initial signs of improvement but not as much as I was hoping/expecting based on prior experience with horses with suspected ulcers. Horse is insured, so today I had him scoped. He still has some active ulcers, but also signs of healing ulcers. Interesting. Horse will now receive 28 days Gastroguard and Sucralfate and then be re-scoped.
Edited to add: The active ulcers observed during the scope were documented as Grade 2.
Edited to add: He also had bot fly larvae attached to his stomach lining. These may have caused some, or all, of the observed ulcers. They may also explain why he didn’t respond as I expected to Nexium - obviously he needed ivermectin to kill the bots before real healing can occur.
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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.
