Gut care and long-term omeprazole

[blob99]

I have a pony who came to me with some pretty severe ulcers. He was put on a 90 day treatment of omeprazole and then i started tapering off slowly. About halfway through the tapering process he begun showing signs of being ulcery again. Vet had me do another 60 days at full dose and then go down to half dose and suggested keeping him there for a couple months before tapering down further.

So far he seems to be doing ok, but, of course he has now been on omeprazole for quite some time. And I’m concerned about his hindgut.

I tried him on ritetrac but he wouldn’t eat it. Tried equishure, hoping that maybe it was something in the combo part that was turning him off. But no luck with the equishure either. I don’t think he’s a particularly picky eater, but the powder just fell to the bottom of his feed bin and then he had no interest in it.

I haven’t yet tried succeed, but wanted to get other’s thoughts on options to support hindgut and overall digestive health.

I don’t know much about ranitidine but I know it’s another ulcer treatment option–perhaps that it is better for longer term use than omeprazole?

He’s currently doing 30 days of sucralfate. I suppose I could continue the sucralfate for as long as he’s own the omeprazole. But in the long long term, I’d prefer to get him off both if possible.

[Palm_Beach]

How much hay and grass does he get? You want something in front of him 24/7. Use muzzles and slow feed nets if he is overweight.

[blob99]

@Palm Beach

How much hay and grass does he get? You want something in front of him 24/7. Use muzzles and slow feed nets if he is overweight.

He’s out 5pm to 7am in pasture with grass. In the winter the pasture has a round bale. And he has plenty of hay when he’s in his stall during the day. He has a slow feeder to stretch his hay, mostly grass hay with one flake of alfalfa. He’s actually on the skinny side, so no worries about weight at the moment.

[JB]

was he originally scoped?

I would try weaning off the omeprazole while staying on the sucralfate, and if that goes well, keep the sucralfate for a bit longer, then stop that and see what happens.

What’s his diet? Has colitis been ruled out?

Misoprostol is another option and works better than omeprazole for certain ulcer locations (I can’t remember offhand if it’s the glandular or non). Also, a course of metronidazole may be warranted for hind gut issues.

[JB]

I just saw your post about the diet. Seems good. Can he get more alfalfa, even if it’s in the form of pellets ? Do you know the approximate weight of the flake of alf?

[blob99]

@JB

was he originally scoped?

I would try weaning off the omeprazole while staying on the sucralfate, and if that goes well, keep the sucralfate for a bit longer, then stop that and see what happens.

What’s his diet? Has colitis been ruled out?

Misoprostol is another option and works better than omeprazole for certain ulcer locations (I can’t remember offhand if it’s the glandular or non). Also, a course of metronidazole may be warranted for hind gut issues.

He was originally scoped with fairly bad ulcers, which is why the vet suggested 90 days right off the bat. He has not yet been rescoped.

I replied about his forage above. He’s on half a scoop of nutrena proforce fuel 2x a day for grain. And for supplements he’s currently on magnesium only (other than the stomach meds).

the alfalfa flake is around 4lbs. And yes, he can get more either as pellets or just additional flakes.

he’s not quite 14.1 and is a finer built pony. We’re still working to get him to a good weight and muscle. I got him in bad body condition, ulcery, wormy, bad teeth, and incredibly nervous. So the process has been slow.

[Fharoah]

My horse had moderate glandular ulceration in winter of 2017. WSU recommended 30 days full tube of gastrogard, 2 weeks at 1/2, then a 1/4 tube after that. I did a repeat scope and his stomach was perfect. However follow up scope was done at a different hospital and that internal medicine specialist suggested taking him off of gastrogard without weaning, but adding relyne GI. He looked fabulous but I had to check anyway he had the start of three small erosions after a month of being off gastrogard. He did not even have true ulcers but opted to do another month of gastrogard and wean the dose and stay on a 1/4 tube of gastrogard. The relyne GI from Haygard gave him a glorious coat with no clinical signs of ulcers though. He is stayed on 1/4 tube of gastrogard ever since and is doing well. The vets in my area have no concerns about using PPI’s long term. I have a friends horse whom uses 1/3 a tube of gastrogard daily for the last 3 years. However gastrogard is so expensive in Canada that I would like to take my horse off of it. My horse has never shown a sign of hind gut ulcers.

I am considering aloe vera. Aloe Vera did improve ulcers scores and a higher dose may be more effective https://ker.com/equinews/exploring-a…astric-ulcers/

[Palm_Beach]

@Absolut Equestrian

While this recommendation absolutely makes sense on many levels, it may not be the best approach for horses that are being treated for ulcers. The latest research suggests that a period of fasting prior to omeprazole treatment actually improves efficacy.

He did 90 days then another 60, so you’re a bit late. And I was responding to the OP’s post, not making a blanket statement on treating ulcers.

“I haven’t yet tried succeed, but wanted to get other’s thoughts on options to support hindgut and overall digestive health…He’s currently doing 30 days of sucralfate. I suppose I could continue the sucralfate for as long as he’s own the omeprazole. But in the long long term, I’d prefer to get him off both if possible.”

[JB]

@blob99

He was originally scoped with fairly bad ulcers, which is why the vet suggested 90 days right off the bat. He has not yet been rescoped.

I replied about his forage above. He’s on half a scoop of nutrena proforce fuel 2x a day for grain.

How much by weight? At 20% NSC, that’s probably not the feed I’d have this horse on. The whole ProForce line is in the 18-120% range. What other brands do you have access to?

Even if the scoop is 3 quarts, 3 quarts of the Fuel per day is not a whole lot of food for a horse who could use some weight. But, it’s also not a feed I’d be increasing, or even still using, for an ulcer-prone horse. I’d be going with something a LOT lower NSC.

the alfalfa flake is around 4lbs. And yes, he can get more either as pellets or just additional flakes.

he’s not quite 14.1 and is a finer built pony. We’re still working to get him to a good weight and muscle. I got him in bad body condition, ulcery, wormy, bad teeth, and incredibly nervous. So the process has been slow.

I’d add alfalfa to the tune of about 30-40% of his total forage, at minimally 2% of his desired weight. How much hay is he eating now?

[blob99]

JB,

yes, I know, not a fan of the feed. But my choices are that or nutrena safe choice, which is about the same.

I’d made another thread about my concerns with this feed for both of my two awhile back (you were very helpful!).

but it’s because of the high ncs content i’ve kept on a pretty low amount of the grain. It’s 1.5lbs of the grain he’s getting 2x.

I can easily up his alfalfa. Right now his grass hay is being replenished as he eats it when he’s in his stall. On average he goes through about 20lbs of grass hay. When he goes out it’s all grass, so that would be the majority of his foragage.

Fharoah,

gastrogaurd is expensive and a pain to give! That’s why i’ve been using the poprocks.

[Sansena]

Ah, see I’ve known folks who’ve done the pop rocks without any success for several treatment cycles. Switched to GG and within a few days they see a difference and horse scopes clean.

[Fharoah]

https://onlinelibrary.wiley.com/doi/full/10.1111/evj.47_12732

if you not going to use gastrogard maybe try Nexium it may be more effective than pop rocks in this study Nexium was effective against glandular ulcers. Glandular ulcers are hard to get rid of you might want to repeat the scope to make sure they’re completely healed.

[blob99]

I’ve had good success with the poprocks on past horses and the pony definitely showed a big difference after being on them, it was only after he was being weaned did symptoms come back.

I can look into nexium–but right now I’m inclined to first try weaning him off the omeprazole again, while keeping him on the sucralfate.

We will repeat the scope, but no point in scoping now when we know there are issues.

[Fharoah]

You might get better results giving it to hours before breakfast. And feeding breakfast two hours after the omezaprole. https://thehorse.com/19385/two-potential-equine-gastric-ulcer-medications-analyzed/
min this study horses on a all hay diet were less likely to heal than horses on high grain low fibre diet.Which is contrary to all management.

[DinkyDonk]

For my ulcer prone gelding (also PPID) I’ve seen the best results feeding alfalfa pellets, timothy pellets, MVP Mega Cell, flax, Diamond V Yeast, plain white salt along with pasture and grass hay in slow feed (2") hay nets, and 2 teaspoons of slippery elm bark with 3 oz aloe vera juice mixed into his evening bucket. The slippery elm made a huge difference. He started scarfing his evening bucket down once it was added.

[DinkyDonk]

…and beet pulp