You’ll just have to email him and ask. I don’t keep up on his daily work or ask what state his research is in.
2 Likes
Ha! What? You can’t substantiate your claims, so you’re telling me to?
I know you think I’m an asshole for asking for data, @JB, but saying “Sykes says you don’t have to taper” is really missing a whole lot of his recommendation–which is even discussed in the video you linked!–and ignoring a massive recurrence rate. Sykes simply doesn’t just say you don’t need to taper–he has several other recommendations on how to support the horse once discontinuing the PPI. And there are so many unanswered questions–what’s the recurrence rate with no taper and the support he recommends? What’s actually going on in the stomach vs the serum gastrin? Are there other mechanisms that could contribute to rebound gastric hyperacidity in equines or ulcer recurrence that we don’t see in humans?
Let’s talk about what he does say in the 15 minute video published to the very well respected journal of…Facebook.
This begins about 7 minutes in, this is where he discusses tapering the omeprazole dose.
Here’s the image he shows. I recognize this from one of his papers investigating dose, but haven’t yet pinned it down to exact paper. He says it’s from his PhD.
From the video:
But, @JB, he never actually tapered these horses. He NEVER started at 4 mg per kg and maintained that and reduced the dose to see what happened. He never compared a taper to no taper in outcomes. He never investigated differing tapering regimens. He looked at two different doses individually. Yes, there is a dose dependent variable. Yes, horses respond to omeprazole in different ways.
But we still don’t know how horses (in general) or horses (specifically as individuals) respond to a taper. This data of “horses respond differently” seems to at least suggest that YES, absolutely, there are indeed some horses out there that might benefit from a taper. Some horses may not. There’s probably no way to know which you’ve got without stuff that most owners aren’t interested in. At the least, there is likely little harm in tapering, and some potential for benefit. The gastrin data seem to suggest a taper does not need to be terribly extended. (I’d also like to point out that Sykes is NOT including this “there’s no dimmer switch” concept in this sort of paper.)
A recurrence rate of 83% is jaw dropping. Treating for 4 weeks and sudden discontinuation with no post med support = more than 4 out of 5 horses popping ulcers in THREE DAYS. When you say “Sykes says you don’t need to taper,” that’s what you’re telling people to do. If you’re going to continue to summarize this all down into one bullet point, at least include what else he says about post treatment support.
This is hardly settled science, and there’s so much work yet to be done.
10 Likes
I just heard about using nexium for ulcers in horses. I have read through a lot of the posts here and have a couple things to think about
The capsule holding the drug is not the enteric coating. The coating is on the little pills inside. The capsule is a gel which is just used as a delivery method
And also, if it needs to get to the hindgut unaffected, how does Ulcergard or Gastrogard paste accomplish this.
If the horse has an ulcer, not scoped, will the dose recommended here heal the ulcer?
Because those pastes are buffered so the omeprazole itself survives the stomach.
Scoping doesn’t make or break healing, what does is whether you’re using the appropriate drug for the type of ulcer. (Es)omeprazole works best for squamous, but not glandular or pyloric.
I’m not sure which dose you’re referring to, but if you’re talking about the 40-80mg (2-4 otc esomeprazole capsules) then lots of horses have scopes showing that dose did, and did not work. Some needed a much higher dose, like 12-14 capsules (for an average 1000-1200lb-ish horse). Sometimes 60 days is needed, not just 30. So there’s no guarantees with esomeprazole, or even omeprazole.
3 Likes
Thank you!
Continuing with this long thread…
I have read all 945 on here and feel (relatively) ready to give this a go. First a few clarifications:
-
The first study was the least amount and that is where the 40mg comes from. Then an extra 20 in case one doesn’t get through (bitten).
-
We want to do the smallest dose of Nexium possible, mainly because these meds can cause issues with the hind gut including hind gut ulcers.
-
We know the pH is above 4 at 6 hours at this dose but we don’t know what it is at 12 hours?
-
Some say don’t add a buffering supplement (like Purina’s) with it bc too much buffering but some say to do so if you are concerned about the Nexium being absorbed? Clarification anyone?
-
Results vary. Research is showing more and more that different horses absorb at different rates.
-
If my pony gets worse, he probably has hind gut ulcers not stomach ulcers.
-
Some people do both Nexium and a hind gut treatment at the same time. Why?
-
Generic seems to work as well as brand name.
-
I think that’s everything but I’ll add later if something comes up.
My new pony… I’m not convinced he has ulcers but I do think he has something going on with him.
He’s a cribber and very nervous. Just “not right” but I don’t know what “right” looks like for him.
Eats pretty well, no diarrhea. Suggested to me he may have ulcers so I am going to give the Nexium a try, with a blessing from my vet who is hugely curious regarding how this is going to work out.
I am guessing he weighs 800-900#. Deciding whether to try 40 2x a day or 60 once a day. I’ve already ordered them. Thanks Xanthoria for the link!
I look forward to you all’s responses. Lydia
5 Likes
Very cute guy! What a nice picture!
Something else that does seem to be shown in the literature is that dosing as close to an empty stomach as you can is beneficial. That doesn’t mean you’ve got to fast your horse, but dosing when they’re less likely to have a stomach full of hay is more likely to have a positive result than if you dose after they’ve had their fill.
I manage this easily by dosing with dinner. My horses mill around the gate in the evenings rather than graze. By the time they come in, they haven’t eaten in awhile.
Best of luck, hope it helps!
5 Likes
I assume you put it in their dinner?
Thanks for this wonderful thread.
Personally, since we don’t have good data on longer term effect (aka past 6 hours), I’d do twice a day if possible. But as this thread has shown, we are extrapolating from minimal research and everyone is doing that slightly differently. Do what seems best to you!
Anecdotally, I had the outward signs of success treating 2x a day with a higher dose (12 pills), and outward signs of failure treating 2x a day with a lower one (6, and 3 pills). Now, since I didn’t scope, who knows what other factors were at play. However, a round of Abler pop rocks gave me a better result following the lower dose failure, so 
. This was all on the same horse, FWIW.
3 Likes
Yep. I put it in top with the goal of it going down first.
Has worked very well for me for years (since the start of this thread!) over multiple horses. Hope you have just as much success!
3 Likes
To add to the anecdotes, I used 3 pills once a day (poked into half a nutrigrain bar), given at turn in (emptiest stomach other than right away in the AM) for my ~#900 small horse. His mild symptoms cleared up in the first week. I ended up treating for ~45 days. He’s been off the pills for about a week now and doing fine.
7 Likes
Adding to the anecdotes with a longer term success, horse has had ulcers confirmed by scope and treated with gastrogard twice, so I am fairly confident identifying his symptoms. 2 years ago he was unenthusiastic about grain, backsore, etc. for several days shortly after a big cross-country haul. After 2 doses with 3 pills once a day in a handful of treats his symptoms were completely resolved. One day about a week in I was 5h late with his dose and he was reluctant to eat grain again that day, but was 100% fine for the remainder of a 3wk treatment with 3 pills, then 1wk taper at 2 pills, 1wk at 1 pill. This year in the spring we had a severe cold snap after he lost his winter coat and found him shivering in sudden snow a couple times… same backsore, leaving a little grain, girthy symptoms developed soon afterwards. By 24h after the first dose his symptoms were completely resolved, followed the same treatment regimen and they haven’t recurred at all in the last 3 months. Both times our results were at least as good as when I treated with gastrogard.
5 Likes
Wanted to pop in and give another update on my preventative use over the winter. This winter I did the same dosage and administration as the previous winter. Overall, it worked really well. He didn’t go off his feed and seemed quite comfortable(at least as far as his tummy, he’s got other issues). There was one day in March where I was worried the ulcers were back. He didn’t finish his grain and did a cat stretch while grooming, but otherwise was behaving normal. Might have been something else making him feel off that day because that was the only time it happened.
I pulled blood again this spring to check his blood calcium and it was WNL, so that’s great. Definitely liking this approach better than the yearly GG he needed before.
3 Likes
Curious if anybody has thoughts on this. I have my horse on Nexium right now. We have been dealing with some body soreness so he was put on Equioxx and Zycosan. He was also spooking at the time so I thought it wouldn’t be a bad idea to treat for ulcers. It’s been 15 days.
But I came out today and he had gotten kicked. He was sound but we did clean and wrapped and I just texted my vet about antibiotics. So she has not seen him but she is giving him a course of antibiotics based on the pictures/location.
My question is it okay to give him the antibiotics while on the nexium? I would ask my vet about that but she’s not a fan of nexium and she’s a firm believer in gastrogard. Which I respect but nexium is cheaper to try anyway…
I had a horse who dealt with a couple rounds of cellulitis, which requires antibiotics. I would start Nexium while giving antibiotics to prevent tummy upset, so yes, I’d continue the Nexium.
1 Like
Yeah, I give nexium on top of antibiotics all the time. No issues.
3 Likes
Okay! I can’t remember if I’ve ever given them together or not in the past. I hate to stop halfway through!
1 Like
I tried the Nexium with my mare…she had been on the Abler pop rocks and doing great. I thought the Nexium would be a bit more affordable. Tried her on the 3 capsules instead of the 2 scoops of Abler. Within a week she started chewing the fence like crazy (despite having a field of grass to eat). Also got spooky and reactive to ride (she normally is not spooky at all). Back on Abler and within another week, she was back to her happy self and the fence chewing has stopped. It was also not her heat cycle (as she is easy to track and we were mid cycle).
It was worth a try…guess I’ll be using up the Nexium I bough since I am on the prescription equivalent myself! LOL
3 Likes
Maybe she needed twice a day or once with a higher dose. So hard to tell. At least you found something that really works, even if it is more expensive.
4 Likes
