Got an earful about GastroGard this morning

[DawgLady]

This morning, I was talking to a very trusted, very experienced professional about ulcer treatment.

In her opinion, UlcerGard/GastroGard aren’t the best ulcer treatment choice. It inhibits the production of acid for a while, but then it comes raging back (rebound effect) once you stop the Omeprazole. I knew this already, but I thought a product like GutX or Visceral could curb rebound effect. She said no, not entirely.

Instead, she treats exclusively with Sucralfate. When a horse in her barn is diagnosed with ulcers, it goes right on a treatment dose of Sucralfate 3x/day. Her most ulcer-prone horses live on a maintenance dose of Sucralfate. She also feels strongly about the horses living on Succeed. She thinks, with this approach, their gut maintains an environment that is more ulcer-resistant in the long term.

Now please don’t flame me if you disagree, because I don’t have an opinion here. I’m just trying to learn. But I know there are a lot of very knowledgeable COTHers and I’d like to hear your take.

[Texarkana]

She’s not wrong about how stopping omeprazole can cause a rebound effect of increased acid production. However, weaning off omeprazole by slowly lowering the dose tends to be effective in preventing that.

Sucralfate interacts with absorption of some medications. Long term use means a lot of aluminum the body has to clear, which is generally tolerated fine in short term, but horses aren’t meant to live on it. Personally, I find any medication I have to give more than 2x daily to be a major inconvenience, as I work away from the home.

If a horse needs to live on ulcer medication indefinitely, something is wrong. I don’t say that to shame anyone; sometimes we can’t figure out exactly what is wrong despite our best efforts. But it is not normal. And if your whole barn needs to live on ulcer medication, maybe you need to re-evaluate your practices to see what can be changed.

[IPEsq]

The usual protocol is to taper off Gastrogard to try to minimize the acid rebound effect. I have found Sucralfate to be helpful for some horses especially during this weaning period. I don’t think I’d want to use sucralfate long term either because it can block absorption of things, but it might be safer to use long term than Gastrogard (based on what we know about long term PPI use in humans) in certain situations (for example my horse going through months of stall rest gets Sucralfate 1x a day separated from his other supplements as a preventative).

[Willesdon]

Off on a tangent as the question was specific but:

Meds have their place but the most successful treatment for ulcers is to change the environment and/or management to be less stressful. There is ever increasing research about the importance of social interaction between horses, the importance of forage and roughage in diet, feeding patterns, stable design etc etc and even small changes can make significant improvements to the well being of the horse.

[PNWjumper]

I’ve posted about this a lot over the years…mostly in regard to my GP horse who is a very stereotypical OTTB and an internalizer of stress. But I have two other “worrier”/ulcer type horses who I also manage very carefully.

I will only use omeprazole as a short term solution. I’ve posted a lot over the years about my aforementioned TB who colicked badly twice due to what we believe was omeprazole sensitivity. So I often put a couple of my horses on omeprazole at shows, but always always with a hind gut support product (smartdigest ultra, Stomach Happy, and/or Ulcer Eraser), and then use the non-omeprazole product to “wean” them off of the omeprazole after the show (meaning I cut the omeprazole cold turkey, but keep them on the alternate products and taper those off).

And for the ones who are prone to ulcers, they live on the alternate products (Ulcer Eraser or SDU), plus alfafa, plus apple cider vinegar and only go on the omeprazole when we head to a week+ long show.

I agree that very few horses need to live on long term omeprazole. There are better ways, in my opinion, to manage day to day stress and stomach issues. But I don’t agree that Sucralfate is automatically better than omeprazole. I think with any drugs there are trade-offs you’re making somewhere along the way (or in other words, as my favorite vet has always reminds me “even water has side effects”).

[McGurk]

I would love to access the COTH hive mind on this subject.

I have a sweet, wonderful, lovely, useful horse whom I acquired because he had a horrible ulcer history that could not be managed at his previous barn.

By temperament, he is an anxious, worried horse, and he is very sensitive to his turnout situation.

He came to me on Omeprazole and with a bottle of Sucralfate with instructions for the Sucralfate to be administered before anything stressful. Six months after I got him and he was in an ideal ulcer management protocol - 24/7 turnout with good forage available, one, low stress turnout partner that he liked, alfalfa in his ration, I tried to wean him of Omeprazole. Three weeks off of the Omeprazole, symptoms returned - girthy, grumpy while being groomed, “freezing” under saddle.

So he went back on the Omeprazole, and switched him to the extended release “pop rocks” formulation.

Everything’s peachy. He moves to another barn with an EXCELLENT ulcer protocol (24/7 turnout, lots of available forage, alfalfa in the ration, beet pulp - the only difference is he’s in a bigger herd, without a “buddy”) , starts a different career and is a rock star. So much so, that we tried to wean him off of the Omep again. This time it took 8 weeks for the symptoms to recur.

At that point I was pretty sure I was just gonna keep him on the Omep for life. But what I’m hearing on this thread is that might not be such a good idea? Can you elaborate and/or propose some alternatives?

[Texarkana]

@McGurk

I would love to access the COTH hive mind on this subject.

I have a sweet, wonderful, lovely, useful horse whom I acquired because he had a horrible ulcer history that could not be managed at his previous barn.

By temperament, he is an anxious, worried horse, and he is very sensitive to his turnout situation.

He came to me on Omeprazole and with a bottle of Sucralfate with instructions for the Sucralfate to be administered before anything stressful. Six months after I got him and he was in an ideal ulcer management protocol - 24/7 turnout with good forage available, one, low stress turnout partner that he liked, alfalfa in his ration, I tried to wean him of Omeprazole. Three weeks off of the Omeprazole, symptoms returned - girthy, grumpy while being groomed, “freezing” under saddle.

So he went back on the Omeprazole, and switched him to the extended release “pop rocks” formulation.

Everything’s peachy. He moves to another barn with an EXCELLENT ulcer protocol (24/7 turnout, lots of available forage, alfalfa in the ration, beet pulp - the only difference is he’s in a bigger herd, without a “buddy”) , starts a different career and is a rock star. So much so, that we tried to wean him off of the Omep again. This time it took 8 weeks for the symptoms to recur.

At that point I was pretty sure I was just gonna keep him on the Omep for life. But what I’m hearing on this thread is that might not be such a good idea? Can you elaborate and/or propose some alternatives?

This is my two cents, and I’m a nobody on the internet so take this with plenty of skepticism.

It’s REAL that some horses have continuous, even lifelong problems with ulcers. There really are horses who develop ulcers even in a textbook perfect low stress lifestyle with an ideal diet. Why? Who knows! Underlying pain the horse masks well? An allergy? A genetic disorder? An internal conformation defect?

But that isn’t normal. My pet peeve is when people say things like “I keep all horses on ulcer meds for their health” or “it’s NBD that some horses need ulcer meds forever.” Because ulcer meds do have side effects, and often they are hidden side effects that don’t present until the related problems have become quite serious.

When I’ve been in your situation, I try to give breaks from the medication as I can. I’ve experimented with OTC supplements, not to treat, but to try to use in the interim when the horse is off medication. I have played with techniques to reduce pro-ulcer situations, like feeding hay or even Tums immediately before a ride. I can’t say anything works every time, but the less I need to rely on medication, the better. Every horse I’ve had with chronic ulcer problems also had them resolve as mysteriously as they began.

Sorry for the long post.

[McGurk]

Extremely helpful, thank you.

I would love for this horse to be off meds. Expense wise, logistics wise, for his long term health wise.

So I will wait until all the stars align again and try to wean him off again.

I just hate it when symptoms recur and I feel like I’m torturing my horse for no reason.

[PNWjumper]

I fully agree with Texarkana.

There are horses out there who require a myriad of things that aren’t ideal nor “normal” per se. I just think that a lot of people jump on a bandwagon with the thought “it can’t hurt and it might help”. In my experience, things that aren’t “supposed” to hurt absolutely can! My examples include omeprazole (which did help my TB a lot, by the way, which is why he was on it long term in the first place) and his later bout with kidney failure courtesy of Osphos (which is a known possibility, just not something the vet who administered it thought would be a risk…in hind sight that wasn’t the case!).

My ulcer-prone horses have done well with protocols that don’t include omeprazole or sucralfate. But that certainly doesn’t mean every horse will. I just think there are many options outside of those that “can” work for more than they don’t work for. My mainstays, as mentioned, are apple cider vinegar, alfalfa, and supplements along the lines of Succeed, SDU, Stomach Happy, Ulcer Eraser, etc. So far I’ve managed to keep my ulcer-prone ones happy that way. But I’m as aware as anyone, that it will likely be the next horse for whom nothing but omeprazole works!

[Simkie]

If I could like Tex’s posts more than once I would! I’d also like to point out that this…

@DawgLady

She thinks, with this approach, their gut maintains an environment that is more ulcer-resistant in the long term.

And this…

@DawgLady

Her most ulcer-prone horses live on a maintenance dose of Sucralfate. She also feels strongly about the horses living on Succeed.

Don’t really jive. Sucralfate is a drug. Using it long term doesn’t “maintain an environment that is more ulcer resistant in the long term”…it is literally treating the horse for ulcers with pharmacology, and comes with it’s own raft of potential adverse effects, just like omeprazole. Having the whole barn on continuous ulcer treatment definitely does suggest a management issue.

[PNWSunnyDay]

@McGurk Does your horse recieve pelleted feed? We had a few ulcery horses. One specifically had reoccurring issues every winter despite being on ulcer meds. We switched to soy-free feed and she hasn’t had any issues since and has not needed ulcer meds. The other ulcery horses seemed more comfortable as well. Just an antidote.

[Highflyer1]

We do some layups and I’m seeing misoprostol recommended a lot more recently, mostly in combination with omeprazole instead of sufalcrate.

[McGurk]

No. Right now he’s on beet pulp and hay pellets, both soaked.

[sascha]

I had zero success with omeprazole. If anything my horse got worse. Put her on Sucralfate for a LONG time and eventually stopped, using only for anything stressful.

As long as I am smart about remembering everything that is stressful (1 dose of Banamine, 2 doses of bute, 2 weeks of Previcox, trailering, clipping, sedation, moving stables, etc.), I am able to put her on it for the day or a few weeks at a time with no issues. If I forget to start Sucralfate within the 2 week grace period I get for a round of Previcox, then I’m going to end up with a longer treatment period. If I start in time, I can get away with just a couple of days after the Previcox is done just to be safe.

Knock on wood, I’m about 7 years into this protocol with no issues.

[Amy3996]

@Highflyer1

We do some layups and I’m seeing misoprostol recommended a lot more recently, mostly in combination with omeprazole instead of sufalcrate.

A combination of misoprostol and GG was the key for my OTTB’s pyloric ulcers. Instead of just having a “band-aid” effect like Sucralfate, it supports the development of a healthy mucosal lining in the stomach.

[JB]

@DawgLady

In her opinion, UlcerGard/GastroGard aren’t the best ulcer treatment choice. It inhibits the production of acid for a while, but then it comes raging back (rebound effect) once you stop the Omeprazole. I knew this already, but I thought a product like GutX or Visceral could curb rebound effect. She said no, not entirely.

Dr Ben Sykes (ulcer guru) is actually doing some research now on the rebound effect. I can’t wait to see his results.

That said, it’s not hard to wean off the drug, it’s not “don’t ever use it” or “just cold turkey stop”.

Supplements don’t have anything to do with reducing acid production, so she’s right in that sense. Some of them help improve the integrity of the stomach linining, or provide some acid buffering by raising the pH of what’s already there.

@DawgLady

Instead, she treats exclusively with Sucralfate. When a horse in her barn is diagnosed with ulcers, it goes right on a treatment dose of Sucralfate 3x/day. Her most ulcer-prone horses live on a maintenance dose of Sucralfate. She also feels strongly about the horses living on Succeed. She thinks, with this approach, their gut maintains an environment that is more ulcer-resistant in the long term.

Studies have shown that misoprostol is more effective than an omeprazole/sucralfate combo for healing glandular ulcers.

Your friend might want to read this about regular use of sucralfate, down in the Findings section
Comparison of Omeprazole and Sucralfate in Equine Gastric Disease - Veterinary Medicine at Illinois

@McGurk

At that point I was pretty sure I was just gonna keep him on the Omep for life. But what I’m hearing on this thread is that might not be such a good idea? Can you elaborate and/or propose some alternatives?

It’s really not the best idea. Have you tried things like Purina Outlast, or Triple Crown Stress Relief? Or something like Gut-X, or Jeremiah’s Ulcer Repulser?

It’s been found that just 3 weeks on omeprazole started affecting calcium absorption
Study: Omeprazole Administration May Reduce Calcium Digestibility In Horses - Horse Racing News | Paulick Report

Link to the study Omeprazole Reduces Calcium Digestibility in Thoroughbred Horses - ScienceDirect

[StormyDay]

I am extremely cautious about using pop rocks or omeprazole. A few years ago I did some deep dive research into the effects on horses and what I found wasn’t great. There’s been a lot of mysterious liver failures and colics in horses given omeprazole. Some of the people on this board actually reached out to me to share their stories.

Just like any medication, you have to weigh the benefits to the potential risks. However, a lot of people push it as a ‘risk free’ medication, which isn’t true. I now only give it if I believe my horses’ quality of life is suffering from not having it. I no longer give it preemptively for shows as I did in the past and as is en Vogue right now for many people traveling with horses.

[eightpondfarm]

maybe i’m just ignorant of symptoms, but my horses don’t have ulcers. How can that be? All these horses with ulcers…it sounds like the majority of them, have or have had ulcers, so the chances of at least one (of 19) having ulcers is high. I must not be observant, or clueless about the ailment. (not sarcasm, i really am perplexed)

[sascha]

Signs of ulcers are many. Just some of the weirder/not as well known ones are playing in water buckets/troughs, casting themselves (lying upside down), becoming higher strung the longer worked.

More commonly, off feed (just grain, just hay or both), multiple ‘mild’ colics, gassy colics, abdominal discomfort (reaction to being touched in certain areas), and reactiveness under saddle can all be signs that ulcers are present.

Most people wouldn’t know that a very high percentage (sorry no time to find the actual numbers right now) of dairy cows and calves have ulcers - but it’s high. They generally don’t show any obvious signs at all until they are ready to pack it in for good and need urgent care. As a horse person who has become somewhat conditioned to seeing signs in horses, I caught a few ahead of time when I worked in a dairy barn … but my bosses thought I was nuts until they had one I noted try to die on them.

Anyway, I’m sure others will chime in to make the ‘watch for these signs’ list even longer.

[PNWSunnyDay]

Symptoms I’ve seen:

• acting irritated anticipating feeding time
• girthy
• touchy about grooming on belly or heartline
• starts calmly in work but shows irritation as work gets more strenuous (fine at W/T but then gets very forward at the canter or during jumping- behavior like kicking out, dolphining/crow-hopping, or running out)
• going off of feed or hay (as stated above)
• general “stressed” demeanor
• biting at sides, kicking at belly