I’m (obviously) a huge fan of Nexium. I’ve used it repeatedly over the years in various horses in various situations and find it effective.
This horse is not a candidate. While gastrogard alleviated his symptoms, it apparently didn’t cure anything, hence the quick return of symptoms when you dropped the dose.
If you’re giving Abler omeprazole, you’re already giving more esomeprazole than the low dose discussed in this thread. You’re not finding it effective. Why do you want to drop the dose even further?
It sounds like this guy needs to come out of training, have his issues worked up, treated, and a management plan established for when he can return to training. And perhaps you can find a trainer you trust to medicate him as you request?
If you’re just really wedded to trying Nexium, I’d match the dose that was effective at making him feel better, which would be 2 mg/kg, or about 57 20 mg capsules a day. I don’t think that saves any money over gastrogard, but could be wrong.
Quoting myself here: I started 14 caps per day and in just a few days noticed a difference. Kept the mare on it thru 2 shows and tapered off. Seems to have done the trick! Not scoped though.
To prevent ulcers next year, I plan to give 14 caps/day for several days leading up to a show and during the show. Anything wrong with that?
For daily training is there anything I can give pre ride to prevent ulcers? Short of keeping her on omeprazole type meds forever.
She has a slow feeder with grass hay always available and is fed loose grass or alfalfa 3x a day too. She lives out 24/7 and gets about 3# Tribute Kalm Ultra mixed w 3# beet plus vits/mins of which she sometimes leaves some in the bucket. Might just skip the Tribute going forwards as she’s a high energy mare.
A few pounds of alfalfa hay will provide an anti-splash mat on top of her stomach, and the higher Ca will help buffer the acid
A few pounds of alfalfa pellets will do a faster job of buffering the acid, but no mat This might be the better (and faster-eaten) option since presumably she’ll go to work having just eaten regular hay already
Purina Outlast or Tribute Constant Comfort (pellets) will raise stomach pH pre-ride
KU is a bit high in sugar and starch, so I’d replace that and the v/m with Tribute Essential K at the higher feed rate, and you can keep some of the beet pulp. The lower starch especially will be less of a problem on the stomach lining
Have you tried herbs?
They have worked wonders for me. I give Marshmellow Root and Slippery Elm.
The Marshmellow Root stopped my cribber from cribbing completely. In a matter of a week or two. I give it now to all my horses. Slippery Elm helps the ucler prone horses.
There are also products for sale that contain marshmallow root and slippery elm, in appropriate amounts. Just as with omeprazole and esomeprazole, some horses respond well and some don’t on different products. I ended up with Visceral+ from Mad Barn, which has marshmallow root and slippery elm, and also magnesium, which helps with lowering stress. And of course stress is one of the things that cause ulcers and other gastric distress. Just sayin - I take magnesium too and it does help keep me on an even keel (ohmmmm). It also has other beneficial ingredients. Visceral+ is not cheap, but it made a big difference in my young gelding’s Ulcer-like behavior, so he is on it. And he can be on these ingredients for the long term, which you can’t do with omeprazole and esomeprazole. Plus the nutritionist at Mad Barn can help you with your feed program - just send what you are feeding and she can help you decide what your horse needs. She’s pretty good.
My 26yo OTTB is having a rough time right now and I suspect it’s ulcers. Again. Over the years he’s been treated with a variety of drugs, largely omeprazole of some kind. He’s not been scoped because with treatment it would resolve. He would go years in between flare ups. He’s been retired for many years now and has had no flare ups. This summer he did go to the vet college for a few days for an impaction colic that resolved. Vets said likely dehydration. Since then he has been back to normal and put weight back on, all was well. I board him and now live 2.5 hours away and work insane hours. Which makes this all very hard.
He has been on Prevequine for around 1.5 years. He had a fairly long race career and is a bit creaky.
Nov 23 vet was called out for a puncture wound on his elbow. At this point it was badly infected. Vet said stop Prevequine and prescribed the following:
SMZ suspension 30ML 2X/day for 10 days
Metronidazole 30 tabs 2X/day 5 days
Banamine 5ml 2X/day 2.5 days
Compounded omeprazole 22ML/day 21 days
Wound was cleaned by vet twice. X-rays done. Blood work done. Nothing remarkable.
12/13 BO reports doing well, poops good, eating ok
12/14 last day on omeprazole.
12/20 rhino flu vax
12/21 not eating well. BO says sneaking prevequine into stud muffin
12/23 explosive diarrhea, not interested in grain
BO says she has been giving him some sort of probiotic paste.
This is what I have pieced together. He’s also doing some chomping and grinding of his teeth which was always a pretty good indication of a flare up.
I think the prevequine needs to stop asap. I ordered Nexium from Amazon and it will arrive at the farm tomorrow. I’m going to ask them to give 3/day in am.
I have asked for a full report on what they are currently trying to feed him. No answer yet.
I do know he is on Mad Barn: W-3 oil, Omneity and Visceral+. He’s been on those supplements for a few years now and done well.
I ask that he’s fed wet alfalfa cubes and salt.
I do not know what they are feeding for grain but likely a senior feed of some sort.
I am thinking sucralfate may not be a bad idea but worry about it being administered correctly.
I wonder if the Prevequine hasn’t helped and all it took was the drugs to treat the wound to trigger this flare up.
Any advice on feed and treatment would be greatly appreciated. I’m in Canada so I can no longer buy from Abler (had success with pop rocks years ago) which stinks.
I’m feeling so guilty and horrible right now that I can’t be there with him
Explosive diarrhea does not immediately scream gastric ulcers. I would be more concerned about his hind gut…like a right dorsal colitis or bacterial overgrowth issue. A proton pump inhibitor like Nexium may be counter indicated.
I’d really get the vet back out for a work up and a game plan.
If anyone is looking for inexpensive esomeprazole magnesium capsules, this place has bottles of 200 that work out to just under $0.10 per capsule, compared to $0.30-40 per capsule elsewhere. Has anyone use this company?
I’ve purchased this brand through Amazon - no complaints. There were a few broken pills in the bottle, but not enough that it was a big deal. I can’t find them on Amazon anymore so thanks for the reminder to order through their website!
I started nexium tonight. 3 caps 1x a day. Did 14 days of UG, then a week of sand clear but my guy is getting grumpy again, not eating well again, and standing funny again (like an elephant on a ball). We’ve been battling his health issues for a couple years now. I do believe now that he has ulcers. He was remarkably better while on UG and his funny stance went away! For a couple years now we thought that stance was due to hind end joint issues, but after seeing the difference I believe it’s from ulcer pain. I will report back in a week and let you all know how it’s going! Thank you so much for this info! A friend told me about it!
I have a horse just down to his last 5 doses of GG. We begin to start tapering off. Does he still need to fast before and for an hour past feeding the GG?
No need or benefit to tapering, there’s no dimmer switch in horses, per Dr Ben Sykes. And the rebound is not only short-lived, like 2-3 days, it doesn’t even start until the drug is stopped.
“Collectively, the findings of the recent work suggest that a brief period of RGH [rebound gastric hyperacidity] might occur within a 48–hour window following the administration of the last dose of omeprazole, but that the effect is not prolonged. As such, the authors currently do not recommend tapering of omeprazole for treatment durations of ≤8-weeks. Instead, the authors focus on the 24–48-h period following the administration of the last dose of omeprazole, making sure that horses are provided with appropriate roughage during this time, and that they are not exercised nor transported during the expected, albeit brief, RGH event that might occur in this window. Further studies are needed to evaluate the impact of longer duration treatment on serum gastrin and CgA concentrations with tapering recommendations adjusted accordingly.”
So while he does not recommend a taper based on this single research study comprising a handful of horses, he does have recommendations for the period after discontinuation, and states that further study is necessary to determine if this applies to extended treatment durations.
To sum up the two papers published about this study: (the first is published here.) The cohort was a small group (14 horses) and a very homologous population; all geldings, all housed the same, all fed the same, and all trained the same. While that helps with keeping outside factors from muddying the data, it DOES make it more difficult to apply these results to different populations.
Stomach acid level was monitored not directly in the stomach but by blood level. In humans, we can monitor stomach acid levels via serum gastrin and serum CgA, so Sykes also used those markers here. Gastrin levels rose (inversely correlated to stomach acid level) at the beginning of treatment, stayed high through treatment, then fell below baseline upon discontinuation of omeprazole. Gastrin returned to baseline within 2-4 days. CgA did not rise, so that doesn’t seem to be a marker we can use in horses, unlike in people. Validating how serum gastrin relates to stomach acid in the equine wasn’t done here in this paper, perhaps it was done elsewhere. I did not see an obvious cite regarding that.
Sykes also says in this paper:
A rapid reccurrence of ESGD in 83% of horses within 3 days of omeprazole withdrawal has been reported [by Sykes, in the paper discussed below]. In humans, the occurrence of rebound symptoms and reccurrence of gastric disease have been observed after omeprazole withdrawal, considered to be the result of hypergastrinemia and RGH. Increased serum gastrin concentration in response to omeprazole treatment observed in our study might contribute to the short‐term development of RGH and help explain the rapid reccurrence of ESGD. However, further investigation of serum gastrin concentrations each day after omeprazole withdrawal using concurrent gastroscopy is required to determine this outcome.
Sykes states that the gastroscopy portion of this study is published here.
This paper describes treating horses (the same population as above) with omeprazole for 28 days, then 3 days unmedicated, then treatment resumed for another 28 days, then another 1 day withhold. Horses were scoped at day 0, 28, 31, 59, 62.
They also tried a similar set up with 21 days treated, two days withhold but with a OTC buffer, followed by one day with nothing.
Withholding for 3 days saw an increase in ulcers across the board. Pictures say it best:
Everyone had ulcers on day 0. 40ish% had ulcers pre one day withhold, slightly lower post one day withhold. 25% had ulcers pre 3 day withhold, 75% post 3 day withhold.
About 55% had glandular ulcers at day 0. 30% pre and post 1 day withhold. 30% pre 3 day withhold, 55% post three day withhold.
It’s apparent that it takes very little time to redevelop ulcers following treatment–as little as three days. This is also the window of “rebound” per the serum gastrin data Sykes published, which is presumably driving his recommendation for no hauling, no riding, and “appropriate roughage.”
None of these papers discuss what happens with tapering, and Sykes does not cite any data regarding that. If he’s researched that, he is not referencing that work here, even as “unpublished data.”
@JB you’ve stated repeatedly that Sykes has done that research and that “rebound doesn’t start until the drug is stopped.” Do you have a paper in which that work has been published and undergone peer review? I haven’t seen that published.
Regardless, even if that’s true, the tapering/not tapering question is a lot more complex than “Sykes says you don’t need to taper” and it’s–at best–grossly over simplifying to boil down an entire avenue of very nascent research to a single sentence.
Hmmmm, some? We went from 20-45% with a 3 day hold with an OTC buffer, compared to 25-75% without.
It can’t hurt, and might help
Sykes sums of his caveats about it here:
The use of a commercial nutraceutical supplement during the RWP appeared to reduce the rate of recurrence of ESGD in the present study. This is consistent with a previous study that evaluated the effect of a near-identical formulation over a 28-day period following the discontinuation of omeprazole treatment, in which protective effects for both ESGD and EGGD were demonstrated [17]. However, an important limitation of the present study was that no control group was used in Part 2 of the study, with the results from Part 1 being used as the control instead. Although the horses were otherwise managed under identical conditions, the different durations of treatment (21 days in Part 2 vs. 28 days in Part 1) might have influenced the likelihood of RGH as a contributory factor. The authors consider this unlikely as the magnitude of hypergastrinemia, the main driver for RGH does not differ between 3 and 4 weeks of omeprazole treatment (unpublished data). Given these limitations, further study using an appropriate control group is required before firm conclusions can be drawn. Other nutraceuticals have been demonstrated to have protective effects against ESGD under similar conditions [33]. As such, the strategic use of specific nutraceuticals during RWPs or following the discontinuation of omeprazole might be useful in reducing the risk of recurrence of ESGD.
The supplement this study used was GastroAid Recovery, and it was dosed twice daily.
