Hi all. I have an ISH that was imported 3 months ago that was diagnosed with grade 1 and 2 ulcers along the margo plicatus 30 days ago. He had some nervousness when touched behind the girth and occasional nasty bucks usually after a jump before treatment. This was much diminished once treatment started though he did buck a few days ago (and not in a playful way). He was on gastrogard and ranitidine (though I’m learning now that there was no point of ranitidine if he was on gastrogard) for 30 days and re-scoped yesterday- there was no change to the ulcers. The vet recommended tapering off gastrogard, keeping him on ranitidine and adding sucrafate along with some diet changes. Curious if anyone else has gone through 30 days of gastrogard with no improvement? And if so, what were the next steps? I know sometimes it takes longer than 30 days but is it worth continuing if there is no improvement? Thanks for any advice!!
There was actually a very good point for using ranitidine in conjunction with omeprazole 
Omeprazole is great for gastric ulcers, but can worsen, or even cause hind gut issues. Ranitidine is useful for both, but especially useful for hind gut issues. It’s often recommended that if you suspect ulcers, but can’t be sure of no hind gut involvement (and you can never be sure), to use both.
I agree with the vet’s suggestion of the drug taper and change.
Some horses need 60 and even 90 days of GG (gulp) to fix their ulcers. Of those stories I’ve read here, I don’t remember if the re-scoping, which prompted continued treatment, showed no, or only small improvements, but hopefully some of those folks will see this and report in.
Sucralfate will actually coat those lesions and give them protection against the stomach acid, wherever they are along the GI tract, so I’d probably just go with that and ranitidine. I don’t remember (but know it’s on the Wedgewood site) if ranitidine is one that can’t be given with sucralfate (which means a lot of different dosing times) or not, but hopefully for you it is, since each should be given twice a day. Ranitidine dosing is 4.5mg/lb for twice daily dosing, 3mg/lb for every 8 hours.
I’ve had a few of these (including one with pyloric ulcers that nothing really touched). That said, 30 days isn’t that long. I’ve got one on Gastroguard (1 tube/day), misoprostol 2x/day, and sucralfate 4x/day. 30 day scope showed some healing, but not healed. Vet said to keep going another month, but up the Gastrogard to 1.5 tubes. 1 tube of Gastrogard is labeled for up to 1250 lbs., and mine is only slightly over at 1300 lbs. - but she’s upped the dose on some lighter horses too based on response, not weight.
I have done Ranitidine and Gastrogard on the same horse at the same time (the one with pyloric ulcers). Some horses respond better to one than the other, and using both was pretty far down our list of options, but we got there.
You also need to take a careful look at his diet and lifestyle if you don’t want the ulcers to recur when you taper the drugs.
Lots and of us out there where it’s taken a lot longer than 30 days! Me and for sure Joiedevie!!! Ours were quite similar (you can search on our names)! Mine took well over a year of treatment and scopes as he also had pyloric ulcers which caused delayed gastric emptying. The gastroguard is for the stomach ulcers and things like sucralfate for any hind gut issues! Mine was also on the same treatment as Joidevie and after nearly 2 years we ended up with a rare last ditch effort of antibiotics…which is NOT the normal course of treatment!
Now 4 years later, after almost having to euthanize my horse, he’s thriving…although still lives on a maintenance dose of omeprazole AND a very carefully monitored diet! It’s not easy, but It can be done and won!
But, basically as Joiedevie stated, 30 days is really not that long! Does your clinic have a good internal specialist? If so, ask for them to take the case…they are an invaluable asset to help with stubborn ulcers!
I agree it’s a great idea to work with an internal specialist. They can really guide you. My horse took well over 6 months. We put him in pasture for the first two and still saw no change while he was getting gastroguard. We added sucralfate and then eventually misoprostol. The three together is what knocked them out. The pyloric were the hardest to treat.
I definitely agree with above, for my horse, it’s been really beneficial for him to have some horse contact and as much turnout as possible. Even just through bars, whenever I check him at night, he’s nose to nose with his neighbor. He also always has hay in his stall. I got one of these corner feeders bc at night he loved to take his four flakes and drag them all over his stall. This was a game changer.
We added aloe vera to his diet initially and now he’s on Enviro Equine Ulcer Plus as well as Enviro Equine Gastro Plus. I make sure to space my shows out. At shows he goes back on gastroguard and sucralfate. And he went back on alfalfa hay. He’s a spooky horse whether or not he gets alfalfa. Bc he gets like 8-10 flakes of hay a day, we don’t actually feed him grain, he just gets a ration balancer. So far it’s working well.
