Half Dose of GG for Treating Ulcers? Can someone point me to the studies?

[newhorsemommy]

I’m doing a week (maybe 2) of GG on my mare to try to determine if she has ulcers. I may end up scoping her, I’m not sure yet.

I keep seeing references here to a study or studies that showed a half tube is as effective, or nearly so, as a whole tube. Can anyone point me to those studies so I can share them with my vet? She’s not a fan of compounded meds, and given my mare’s extreme bitchiness, I’d rather just use the GG because I really want it to work. But any way I could save money on it would also be helpful!

Thanks!

[Simkie]

I think people might be referring to the Australian study, which actually proves nothing of the sort.

It was done with a product that isn’t available in the US at all and is an enterically coated granule in a paste. Enterically coating omeprazole makes it more bioavailable than the buffer used in GastroGard. The study also showed that a portion of the horses in the study with ulcers in the glandular section of the stomach got worse with the lower dosing. We had a few threads about it at the time, but I think this was the first:

http://www.chronofhorse.com/forum/showthread.php?448306-Study-Shows-that-1-4-Tube-of-GastroGard-works-just-as-well-as-a-whole-tube

So, if you could get your hands on that particular omeprazole product and your horse has ulcers in the “right” section of the stomach, perhaps you can use 1/4 of the regular dose and still have healing. Barring that, though, it’s just a giant gamble to try that with GastroGard. And even at the lower cost of 1/4 tube/day, it’s not like the Merial products are CHEAP. I sure wouldn’t want to do that for a month only to scope again and find out nothing has changed or things have gotten WORSE.

The study is interesting, but rather meaningless to us in the US. You could perhaps extrapolate to Ablers “pop rocks” but even that is a leap since the method of administration is different and the coatings may be different.

[Tonkafriend]

My vet suggested we start my horse on ranitidine (Zantac) tablets to see if he feels better just by having less of a sour/irritable stomach. It seems to have helped a lot, so I’ll be putting him on the legendary Blue Pop Rocks, I guess. Generic Zantac is much cheaper than GG.

[CHT]

OP, have you considered getting the Succeed test done? I had it done on my younger mare and she came back positive for fore and hind gut ulcers. After treatment just low positive for hind gut ulcers.

I want to test my older mare, but she will NOT poo at a convenient time. I may have to load her in the trailer just to get a sample at a good time (as the vet clinic won’t let me run the test myself, so I have to get it to them)

[newhorsemommy]

I thought I had run across one of the GG studies that said something like 90% of the horses’ ulcers healed with a full tube and 73% or so healed with a half tube. Those numbers are off the top of my head, but it was something like that. I can’t seem to find the study again…

I think I can see some small signs that it’s helping, but I’m hoping when we take her out tomorrow for a lesson, I’ll really see a difference.

I may just suck it up and either pay for the whole month. I’ll ask my vet what she advises after that as far as tapering, switching to a preventative, etc. I’ve already decided that she’s going to need to eat a small amount of food while tacking up whenever she’s worked. I may not be able to feed hay while tacking up (I board and the logistics of doing so are complicated), but I can give her a pound of two of soaked alfalfa pellets so she’s got something in her stomach.

[Simkie]

Well, if you’re looking for less $$, a LOT of people here report great results with the Abler products.

There are also compounded preparations out there with fans. I have a vet who’s done pre and post scopes with the Precision Pharmacy paste, for example, and seen healing equal to the Merial products. I’ve gone that route several times and it’s been about $300 for the month.

There’s also straight up ranitidine.

There are really a lot of options out there, and nearly all of them are less shocking cost wise than GastroGard

I, personally, wouldn’t be okay with experimenting with a partial GastroGard dose as it’s still a LOT of moohlah to be forking out for “I read somewhere this works.” But if you do go that route, be sure to scope pre and post and report your results to us here :yes:

[SLW]

An equine vet I worked for said he had read studies that ulcers healed after 2 weeks on a full dose of Ulcergard/GG. He recommended 2 weeks at a full dose and 2 weeks at the preventative dose level to heal ulcers. That seemed to work for the clients horses, including one of mine.

To answer your question, I do not have a link to whatever study he read.

[joiedevie99]

I’d really recommend scoping. Mine went in for his first scope 30 days ago. He had grade 4 bleeding ulcers. He spent 30 days on Gastroguard (and the first 14 also on Misoprostol and Sucralfate). At 30 days, he showed evidence of healing, but his ulcers were still grade 4. We anticipate 3-4 months before he is clean. If I hadn’t scoped, I would have thrown money away on the first 30 days and he’d still be in pain.

[eclipse]

[QUOTE=joiedevie99;8201473]
I’d really recommend scoping. Mine went in for his first scope 30 days ago. He had grade 4 bleeding ulcers. He spent 30 days on Gastroguard (and the first 14 also on Misoprostol and Sucralfate). At 30 days, he showed evidence of healing, but his ulcers were still grade 4. We anticipate 3-4 months before he is clean. If I hadn’t scoped, I would have thrown money away on the first 30 days and he’d still be in pain.[/QUOTE]

i second this! Sullivan was scoped 28 days ago and we found Grade 3 ulcer, at the vets recommendation we did the full 28 days of GG and he goes back today for his rescope tomorrow. Within a week I noticed a huge difference in Sullivan’s entire look and appetite (his eyes were brighter, he was cheeky again and he will now eat all of his feed and hay - he’s still a slow eater but now loves his food again) I don’t feel like I’ve wasted any money by doing the full dose GG!

[PossumHorse]

I am in the process of trying out the lower dose ulcerguard treatment. I can say that at half dose my horses symptoms have disappeared.
I figure I may have to use the same quantity of ulcerguard, but the cash flow will be easier if I don’t have to buy it as often.

[J-Lu]

Perhaps you are thinking of this?

BE AWARE, the first author BW Sykes owns BW Sykes consulting agency, and his agency performed these studies.

Equine Vet J. 2015 May;47(3):285-90. doi: 10.1111/evj.12287. Epub 2014 May 29.
[h=1]A comparison of three doses of omeprazole in the treatment of equine gastric ulcer syndrome: A blinded, randomised, dose-response clinical trial.[/h]Sykes BW1, Sykes KM, Hallowell GD.

[h=4]Reasons for performing the study[/h]A previous study demonstrated that a dose effect between 1.6 and 4.0?mg/kg bwt of omeprazole per os s.i.d. is present in the treatment of equine gastric ulceration. In the same study, healing of glandular ulceration appeared inferior to healing of squamous ulceration. However, several limitations were recognised in that study and further investigation is warranted.

[h=4]Objectives[/h]To further investigate the presence of a dose relationship in the treatment of gastric ulceration under conditions that may favour omeprazole efficacy such as administration prior to exercise and after a brief fast, and potential differences between the response of squamous and glandular ulceration to omeprazole therapy.

[h=4]Study design[/h]A blinded, randomised, dose–response clinical trial.

[h=4]Methods[/h]Sixty Thoroughbred racehorses with grade ?2/4 squamous and/or glandular ulceration were identified by gastroscopy. Horses were randomly assigned to receive either 1.0, 2.0 or 4.0?mg/kg bwt of enteric coated omeprazole per os s.i.d. 1–4?h prior to exercise. Gastroscopy was repeated at approximately 28 days.

[h=4]Results[/h]The lower doses studied (1.0 and 2.0?mg/kg bwt) were noninferior to the reference dose (4.0?mg/kg bwt) in the treatment of squamous ulceration. Healing was greater in squamous ulceration than glandular ulceration (86% vs. 14%; P<0.0001). Improvement in ulcer grade was more likely in squamous lesions than glandular lesions (96% vs. 34%; P<0.0001). Worsening of the glandular ulcer grade was observed in 36% of horses.

[h=4]Conclusions[/h]The results of this study suggest that, under the conditions studied, where omeprazole is administered before exercise and following a brief fast, doses of omeprazole as low as 1?mg/kg bwt per os s.i.d. may be as effective as higher doses. The proportion of glandular ulceration that heals with 28 days of omeprazole therapy is less than that of squamous ulceration.

In 2014 the group published this:
Equine Vet J. 2014 Jul;46(4):416-21. doi: 10.1111/evj.12191. Epub 2013 Nov 24.
[h=1]A comparison of two doses of omeprazole in the treatment of equine gastric ulcer syndrome: a blinded, randomised, clinical trial.[/h]Sykes BW1, Sykes KM, Hallowell GD.
Abstract
[h=4]REASONS FOR PERFORMING THE STUDY:[/h]Studies on omeprazole have reported that doses as low as 0.7?mg/kg bwt per os are potent suppressors of acid production. Yet, to date, no studies have compared treatment efficacy of different doses in clinical cases of equine gastric ulceration. Furthermore, no studies have been performed to compare the healing response of the squamous and glandular mucosa to acid suppression therapy.
[h=4]OBJECTIVES:[/h]To compare: 1) the efficacy of 2 doses of omeprazole in the treatment of primary squamous and glandular gastric ulceration; and 2) the healing response of primary squamous and glandular gastric ulceration to acid suppression therapy.
[h=4]STUDY DESIGN:[/h]A blinded, randomised, dose-response clinical trial.
[h=4]METHODS:[/h]Twenty Thoroughbred racehorses with grade ?2/4 glandular ulceration were identified on gastroscopy. Seventeen horses also had grade ?2/4 squamous ulceration. Horses were randomly assigned to one of 2 groups. Horses received either 2.0?g (high dose: 4.0?mg/kg bwt) or 0.8?g (lowdose: 1.6?mg/kg bwt) of oral omeprazole per os once daily. Gastroscopy was repeated at 28-35 days.
[h=4]RESULTS:[/h]Time and dose significantly affected grades of squamous (P<0.0001, P = 0.02) and glandular (P = 0.006 and 0.005) ulceration. Data analysis did not support our hypothesis that the lower dose would have similar effects (i.e. be noninferior) to the higher dose when considering ulcer healing and ulcer improvement. Improvement was more likely with the high dose for the squamous (P = 0.05) but not glandular (P = 0.4) mucosa. The percentage of glandular ulcers that improved was less than squamous ulcers (P = 0.02).
[h=4]CONCLUSIONS:[/h]The results suggest that a dose-response exists for the treatment of both squamous and glandular ulcers. Improvement of glandular ulcers was not as complete as observed with squamous ulcers and current equine gastric ulcer syndrome treatment recommendations may not be appropriate for glandular disease.
© 2013 EVJ Ltd.

[J-Lu]

I agree with others who recommend getting your horse scoped so you know what you’re dealing with. You could very much be throwing your money away if you are "lowballing’ the dose and not helping any.

Be aware that GG has a “time release” component to it that the blue pop rocks don’t have.

[Simkie]

[QUOTE=J-Lu;8202057]
Be aware that GG has a “time release” component to it that the blue pop rocks don’t have.[/QUOTE]

Nope. Sure doesn’t. GastroGard is omeprazole and a buffer. No “time release” component at all.