Gastrogard response

[Emerson]

@Simkie

Oh! Hi! What’s the timeline on Nexium to scoping to Gastrogard? Did he ever show improvement on Nexium? Was there any indication of pyloric ulcers or delayed emptying of the stomach when you scoped?

The fact he was already on a PPI makes his behavior more interesting. One more piece of the puzzle It could really be worthwhile to perhaps try him on ranitidine + sulcrafate. That will address his stomach AND the hindgut without putting the stress on the hindgut that PPIs can cause. Any chance you can dose him twice a day? (Three would be even better?)

Hi! I started nexium on 1/17 and did 2 weeks of 3 capsules a day with no real results and then booked the scope. The vet had me discontinue nexium before the scope, so I did the weaning off process (2 capsules for a week and then 1 capsule for a week) and then he was scoped last Friday (2/23) and started on gastrogard the next day and has been on a full tube per day since. There were several days during the two weeks of nexium where he had a good day and I wondered if it was starting to help but then he would be right back to the old behavior again, so overall no significant changes and certainly nothing as notable as the huge turnaround he had on his first two days of gastrogard. The vet did not mention anything about delayed emptying when he scoped him, but he did say it was a ‘good fast’ and the stomach was decently empty for the scope compared to some others he has seen, so I would assume that is not an issue. No evidence of pyloric ulcers.

I am struggling a bit because my vet is of the opinion that unless the ulcers are more severe, they would not be causing enough distress to make my horse act the way he does, and he also doesn’t seem to really believe in hindgut ulcers. I brought up hindgut ulcers and possibly medicating for them and he thought it would be a waste of money. He thinks my horse is just an anxious type and this is just his personality and who he is and it won’t be changed. I’m not ready to just write him off at this point, especially knowing that he does have a gastric ulcer, even if it’s small, and I also can’t get past the amazing change in him on the first two days of gastrogard - he was such a happy horse! That makes me think there has to be something going on and I definitely want to pursue the gut issues farther, but after the scope and 10 days of gastrogard the budget is starting to be pretty tight. I could definitely get my hands on ranitidine, and he lives at home with me so I could dose 2 times a day for sure, and would be able to do 3 times on some days. I’m not sure about getting the sucralfate - I did mention that to the vet as well as misoprostol and he didn’t recommend either. He has a generic omeprazole with ranitidine powder that he said he could get for me if I want to continue omeprazole after the gastrogard. I also started him on succeed yesterday. I sure wish the nexium had made a difference for him!

[Simkie]

Super interesting, Emerson!

So, just so I’m tracking: he went back and forth good days/bad days on Nexium. And he had some good days on Gastrogard, then went back to bad days. Right? Were the good days on Gastrogard the same as his good days on Nexium? Better?

WHAT IF his good days after the scope were due more to the fasting than the Gastrogard? If his hind gut is ouchy, giving it a break from long stem fiber could make him feel mucho better. Load up the gut again, and OUCH, he’s cranky again. The fact the stomach is fairly uninteresting on a scope could perhaps support that theory.

Ranitidine is easy to pick up (CostCo for the win, yay!) and you can buy sucralfate from Abler without a script (maybe other places too?) Ranitidine is cool because it helps an ulcery belly BUT doesn’t hammer the hind gut like PPIs and also helps the hind gut.

Since he’s at home, you could also test pulling him off hay and putting him on soaked senior for awhile. A week? See what happens, extend the duration if it seems to be working! Kinda spendy, but not as much as a full course of Gastrogard. If his hind gut is really irritated, you should see some results with that.

And weird your vet doesn’t believe in hind gut ulcers :-/ I think it’s pretty well established that’s a real thing!

[Emerson]

@Simkie

Super interesting, Emerson!

So, just so I’m tracking: he went back and forth good days/bad days on Nexium. And he had some good days on Gastrogard, then went back to bad days. Right? Were the good days on Gastrogard the same as his good days on Nexium? Better?

WHAT IF his good days after the scope were due more to the fasting than the Gastrogard? If his hind gut is ouchy, giving it a break from long stem fiber could make him feel mucho better. Load up the gut again, and OUCH, he’s cranky again. The fact the stomach is fairly uninteresting on a scope could perhaps support that theory.

Ranitidine is easy to pick up (CostCo for the win, yay!) and you can buy sucralfate from Abler without a script (maybe other places too?) Ranitidine is cool because it helps an ulcery belly BUT doesn’t hammer the hind gut like PPIs and also helps the hind gut.

Since he’s at home, you could also test pulling him off hay and putting him on soaked senior for awhile. A week? See what happens, extend the duration if it seems to be working! Kinda spendy, but not as much as a full course of Gastrogard. If his hind gut is really irritated, you should see some results with that.

And weird your vet doesn’t believe in hind gut ulcers :-/ I think it’s pretty well established that’s a real thing!

Thank you for all these interesting and helpful ideas! You are correct about his behavior on nexium, but his good days on gastrogard were way, way better than any good days on nexium. He has always been somewhat fluctuating in having better and worse days, and this was the best I’ve ever seen him by far. He also had a very good day on the gastrogard yesterday, not quite as good as the first two but certainly a big improvement for him over typical behavior. I thought maybe he was picking back up again but then this morning he was a nervous wreck.

Interesting idea about the fasting maybe making him feel better! How does it work with removing all hay from the diet but also managing the gastric ulcer? I’ve always kept him on 24/7 hay to try and keep his stomach happy - if I remove all hay how will that affect his gastric ulcer?

I’m thinking the ranitidine might be a good (and budget friendly) option for when he finishes the gastrogard in a few days. Would it be worth trying ranitidine without the sucralfate or only both together? I’ve heard the dose is 3000mg of ranitidine twice a day, how does that change if I were to do 3 times a day? Would it be better to do 3 times/day on days when I’m able but only twice a day on others, or just stay consistent at twice a day?

Thanks for helping me think through this!

[Simkie]

I’m curious if you’re just looking at a multifactorial problem here–horse had gastric ulcers AND hind gut. Nexium did a pretty good job of treating the stomach, but probably irritated the hind gut…so good days (kinda) and bad days when his hind gut was really kicking up. Then, you fast for the scope, see some minor stuff the Nexium hadn’t quite gotten to, but unloading the gut meant he felt a LOT better for a couple days, until it got all ouchy again from the hay. Gastrogard is (probably, maybe) also less irritating to the hind gut–Nexium is better at stomping on the proton pumps. It’s a good story, anyway :lol:

You can absolutely use ranitidine alone! Dose is 6.6 mg/kg, BID or TID. So for a 1200 lb horse, that’s ~3600 mg, two or three times a day. Do the math for how big he is and adjust. CostCo and Walmart have the best pricing I’ve always used rantitidine twice daily, and had good results, but three times is optimal. Do what you can?

It can be tough pulling hay–and 100% the opposite of what we’re “supposed” to be doing, right? But if you’re treating with ranitidine, you’re treating his stomach. Feed a bucket of soaked stuff as often as you can, and if he’s not piggy about it, just leave it out for him to “graze” on. You can also use hay pellets (not cubes, though, I don’t think.) Since you got such a profound result after the scope, I’d think you’d know pretty quick if pulling him off hay is worth the effort. This is the kind of diet you’re aiming for–obviously your horse isn’t this bad, but it’s a similar sort of deal to let the gut rest.

[Thoro]

Wondering what came of OP’s situation? Any updates?