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.
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.
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.
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…
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!
Sorry, one more question… I just realized how expensive Equishure is 
I’ve seen many people on here suggest dac Cool Gut, SmartGut Ultra, and Uckele GUT. Are any of those worth trying before going straight to the Succeed/Equishure route, as basically just a preventative / precautionary measure for hindgut problems? It seems like the cheaper options just have “prebiotics / probiotics” which I know is somewhat of an inexact science…
My horse’s ulcery symptoms are a lot more mild than some of what I’ve read on here, but I’m still concerned that the hindgut could be involved:
But she definitely still has a ravenous appetite, remains pretty relaxed and no real behavior problems other than getting slightly lazier!
I would say that all that is screaming red flags for ulcers–really wouldn’t consider those symptoms mild at all.
I don’t recall Equishure being all that expensive? Smart Gut Ultra is $2.50 a day, is Equishure really MORE than that now??
Succeed has a great challenge program. Buy 60 days of product through them, keep a little weekly journal, and if it doesn’t help your horse, you get your $$ back.
You could also check out sucralfate from Abler…?
Given that you’ve got some symptoms that are pretty suspicious for the hind gut, I wouldn’t be comfortable using a PPI without something to provide some coverage there. In the before times, you could use ranitidine, but that’s been off the market for quite awhile now. Maybe investigate the other H+ antagonists, like cimetidine or famotidine? No idea if there’s research in equines, but might be worth exploring for you.
Oops, you’re right, Equishure’s actually cheaper than SmartGut Ultra.
I’ve been trying to figure out her symptoms as far as hind gut vs. gastric but besides the poop I’m not sure what else would be different? I read in a bunch of places that the primary sign of hindgut problems is a loss of appetite which she definitely doesn’t have.
The Succeed challenge involves a 30 day supply of oral paste which I can’t do because 1) I can’t be there every day to administer it and 2) she is evil for stuff like that and I foresee it becoming a problem. I’ll just go ahead and get the Equishure and suck it up! Love horses <3
Quick recap on my situation: Mare scoped positive for ulcers, started on GG but had to switch away because she’s a nightmare for the BM for oral syringes. Switched to Nexium (6 pills split between AM / PM feed to hedge between the two research paper findings) and doing well. Vet prescribed Misoprostol for the first 2 weeks of treatment and then to switch to Sucralfate (started this past Thursday)
Question: Since THursday she’s been getting her 3 Nexium pills and 2 scoops of Sucralfate in her AM and PM feed. On a whim today I decided to research Sucralfate and read that it shouldn’t be given with other medications as it can limit effectiveness. Do I need to split out the Nexium and Sucralfate? Does it matter which gets fed first (I’ll probably have them feed her a first breakfast and then a second breakfast ~20-30 min later).
Yes, absolutely. Nexium first. At least 30 mins before sucralfate.
Sucralfate should also be fed on as empty a stomach as possible, so ideally not with a bunch of grain or other feed. My vet didn’t seem concerned so much with which medication was given first in any given day, but sucralfate needed to be on as empty a stomach as possible, and gastroguard needs to be 30-60 minutes before feeding. Of course, this is tough if you free feed hay (which is good for ulcer-prone horses) so my vet recommends just doing the best you can, knowing when my horse eats the most hay and working the medication around that. I totally understand how hard it is in a boarding situation. I can only get the sucralfate fed once a day but my vet still thought it was worthwhile and I absolutely saw improvement from adding the sucralfate to his gastroguard.
Thanks Leheath - this is helpful. Fortunately my mare gets very little in the way of grain, <1 scoop RB so she thinks she’s getting breakfast with everyone else. So the plan I build with the BM today is that she’ll get her nexium with breakfast and then ~45 min later I’ll be able to swing by the barn after daycare drop-off and give her sucralfate with a small glob of beet pulp. 15 min after that she’ll get turned out with access to hay.
It’s not perfect, but it’s the best we can make work based on my schedule, barn staff schedule, and her needs. sigh
Fingers crossed it’s enough!
That sounds like a good compromise - as my vet said, you do the best you can with what you have available and hope it works. Even she said that the only way to really meet all the stringent requirements for multiple medications is to have the horse in the regimented environment of the vet hospital. Like you, I’m hoping what we are able to do is enough and, if it isn’t and my horse isn’t healed when we re-scope, then we will have to reconsider the situation.
This has been really informative. My sweet little horse started pinning his ears and generally being pissy about everything. After reading this thread, I started him on omeprazole and we are in the taper-down period now. He seems to be back to his old self, although the weather has been so crappy I haven’t been riding.
I just saw this article today and wondered what folks think about it.
Chiming back in with my update as mare is just about finished with her Nexium course (we’re down to final tapering step of 1 pill AM/PM). I was going to have mare re-scoped but honestly, she feels so good I don’t think I need to pay the $$ to confirm her stomach is looking better. She’s back to her snuggly loving self, no longer girthy or weird about her blankets, and isn’t reactive to leg aids under saddle.
While I think the nexium made a difference, the real change happened shortly after starting the Sucralfate so I suspect that her front-gut ulcers were uncomfy but that she had real hind gut ulcers that were the true problem.
Keeping her on assure guard, beet pulp, and going to try her on an ongoing “gastro elm” supplement that seems to get good reviews.
Thank you Coth for saving me hundred with this thread!
Nexium is only dosed once per day so you are still at a high level FYI.
I based my dosing on a combination of the two studies - lower dosage was only tested on a 6 hr window vs high dosage on a 23 hr window. Instead of going to the full high dose (which felt very high) I decided to dose at the lower level but AM/PM to hedge against possibility that effectiveness wears off shortly after the 6 hrs. Our final taper week will be 1 pill in the AM (I do 2 weeks for all other taper levels)
ETA: Seems to have worked for us so far, but we’ll see how she does once fully off the pills and if we have any rebound effect
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