Has anyone had a horse that just can’t be off ulcer meds?

[KendraLW]

My horse was diagnosed with SEVERE squamous and glandular ulcers over a year ago. I have worked with 3 vets in that time and have used omeprazole, sucralfate, and misoprostol. He has had several scopes and we have gotten him to scope clear or almost clear twice. But the second I stray to reduce the omeprazole his symptoms flare back up. I have just been keeping him on a full dose but would love to at least be able to taper him down to a maintenance dose.
We have gone over every inch of his body, diet, and lifestyle and have found no reason for him to be so ulcer prone aside from having PSSM-1 which is well managed and I do regular blood work to make sure his numbers are good. My vets have never had to keep a horse on a full dose of omeprazole this long. Curious if this has happened to anyone else.

ETA- I’m not really concerned about the monetary aspect. Of course it would be nice to not have to spend as much on meds but mostly I’m just concerned for his health and well being. He’s a pretty special guy that I’ve had since he was 10 months old so I just want him to live a happy healthy life. If that means being on meds forever that’s fine.

[Go_Fish]

What’s his job?

[stargzng386]

I’d also add what’s his boarding situation? If he’s not turned out 24/7 with hay and/or grass 24/7 and I truly mean available all of the time that’s where I’d start.

[KendraLW]

Not much. He had the fall/winter off due to ulcers and started light training 2-3 days a week about a month ago. He is very green so just learning the basics.

[KendraLW]

Yes he is out 24/7 (except a few hours mid-day to eat his lunch) on a 100 acre pasture with some great friends.

[SLW]

No answers and that’s a long, expensive treatment.

Is alfalfa part of his daily diet?

[KendraLW]

No, unfortunately alfalfa triggers his PSSM symptoms so he can’t have it, but he is on a supplement with added chelated calcium.

[SLW]

@KendraLW

No, unfortunately alfalfa triggers his PSSM symptoms so he can’t have it, but he is on a supplement with added chelated calcium.

Oh dang, your options aren’t broad at all. This is a tough one.

[fivestrideline]

There was a thread a while back where someone had this issue and ended up testing the gastric fluid for something and treating that fixed it. I can’t recall the details (bacterial issue?) but I can look for the thread.

Yes I’ve heard of horses who just can’t seem to get off the meds. I would assume, given appropriate lifestyle and nutrition, that there is an underlying issue outside of stress that’s causing the ulcers. I know one ex UL jumper that lives on sucralfate even now in retirement.

[Cowgirl]

My 3 year old went to a nice boarding barn for colt starting and got ulcers immediately that never went away and needed gastrogard/ulcergard the entire time he was there. He stopped eating grain, dropped a bunch of weight, became spooky and nervous and got a sore back. I brought him home at 2-1/2 months because of this and kept him on ulcer meds for the first month, tapered him off and he has been doing great at home since, eating and happy and relaxed and his sore back went away. This is not the first horse I’ve had problems with ulcers in a boarding situation. They all do better at home with plenty of (group/herd) turnout, a nice stall with a run attached (and I have strip doors so they can go in and out at will). I don’t have an indoor arena though and I have to just cope with that.

[Pico_Banana]

My mare was one of those while we boarded. Although I could get her down to one Nexium per day to maintain.

I eventually bought my own place and she’s been fine since then. Not an option for everyone though.

[McGurk]

Me! I have one!

Even when perfectly managed, 24/7 turnout, lots of forage in the diet including alfalfa, job he enjoys, etc, if he is off omeprazole for any period of time symptoms recur.

I just thought it was kindest and easiest to keep him on the omeprazole forever.

[KendraLW]

Oh finally another one! Do you have to give him a full dose or less?

[KendraLW]

That’s where my boys started was at the trainer, but he’s been back home since the fall of 2022. He has 100 acres and a herd he gets along well with.

[cnd8]

I wonder if a simple, inexpensive, U-Gard would keep symptoms at bay?

[Critter]

I have one that looks like he’s going to be on it for life…had grade 3 ulcers, treated (found cause of broken ribs). Weaned off after clearing the ulcers but kept on sucralfate (scoped to confirm). Few months later he was being fussy about life again…scope and bleeding ulcers with delayed emptying. So much for the sucralfate alone! Treated again…this time we also found EPM/Lyme as an issue (very, very high titers). Treated those…and have kept on ulcer maintenance.

He has 24/7 turnout in a herd, access to alfalfa…so as low stress as we can, other that his medical issues!

We’ve been doing a half dose of omeprazole…switched over to the Abler granules and he seems to be doing fine on those. I’m a bit hesitant to wean him off given his history. Maybe eventually…but not right now.

I did have one who lived on ulcergard for a few years (his was also pain mediated - S1 nerve root inflammation). He was on UG 1/4 tube daily for probably 3-4 years…he now just gets UGard. But it was a few years before I could pull him totally off of it.

[McGurk]

Full dose. I order the “pop rocks” from Abler Equine, that’s the cheapest source I’ve found.

[jherold]

I read and article that from a large vet hospital in Florida that suggested a connection between ulcers and EPM. Most of it was above my head but some connection between the nerves that regulate acid production. It did explain my my mare that enjoys constant pasture turnout developed ulcers along with her epm. 2 yrs later and I maintain her on u-guard.

[McGurk]

The first time we tried to wean him off the Omeprazaole, symptoms returned in 3 weeks. The second time, the pasture was lush and green, and it took 8 weeks for symptoms to return. I suspect, come green grass time this spring, he could be weaned off it successfully at least for the summer months.

But it doesn’t make sense to me to try. If he’s happy and doing well, why would I risk the return of symptoms?

[Amy3996]

@jherold

I read and article that from a large vet hospital in Florida that suggested a connection between ulcers and EPM. Most of it was above my head but some connection between the nerves that regulate acid production. It did explain my my mare that enjoys constant pasture turnout developed ulcers along with her epm. 2 yrs later and I maintain her on u-guard.

There’s some evidence that stress from illness/injury can trigger or worsen clinical symptoms of EPM. Ulcers are tricky, painful buggers so I would believe that. I also wonder if it might be a bit of a chicken and egg situation - if being compromised neurologically from the EPM causes pain and stress which creates the perfect storm for ulcer development.