Long term gastrogard or Omeprazole

[kashmere]

@iJump

I’ve scoped before and after… with results (ulcerations pretty much non existent after). 30 days Gastrogard, 1 tube per day.

I was told by many vets that it’s the only one that will treat hind gut ulcers.

What are your thoughts?

It sounds like you might be mixing up hind gut vs gastric ulcers. GG/UG are the only approved drugs for treating/preventing gastric ulcers in horses. The carrier agent of GG has been approved as something that successfully protects the active ingredient - omeprazole - from the acidic environment of the stomach and allows it to be absorbed, thereby allowing its action to go to work (it is a PPI so inhibits acid production).

GG/UG are not approved for managing hindgut issues in horses and there is evidence that they can actually exacerbate those issues. One doesn’t scope (as far as I know) to diagnose hindgut ulcers.

[iJump]

@JB

Scoping doesn’t see the hind gut.

My thoughts are as per above, which are based on the science and facts of omeprazole. Omeprazole is a PPI (proton pump inhibitor) which causes the PPs for the stomach acid production to lower their production. That’s the stomach, aka gastric section of the GI system. The hind gut is way on back there, and the effect of lowering acid production up front, means more food gets less of a head-start on digestion up front, which makes the hind gut have to do more work, and it’s not designed to do some of that work (well). This is what can lead to hind gut issues.

I don’t know who is telling you this, but either they don’t know know what “hind gut ulcers” really means, or don’t at all understand how omeprazole works. Or both.

And if that really is "many vets’, that’s just one more reason I distrust most vets when it comes to things of this nature, until they prove to me they do know. And in a case like this, the labeling of Gastro/Ulcergard is full of mention of gastric acid and gastric lesions and healing of ulcers in the stomach.

I am not a professional when it comes to the full anatomy of the horse but, isn’t the small intestine typically categorized as hind gut?

I have had horses scoped that the pyloric sphincter could actually not even close (due to ulcers), giving insight to a good portion of the first part of the small intestine, which was also covered in ulcers.

In regards to the GG/UG treating hind gut… this has come from a vet/vets so I didn’t think to ‘fact check’.

Always learning

[JB]

@iJump

I am not a professional when it comes to the full anatomy of the horse but, isn’t the small intestine typically categorized as hind gut?

No, the hind gut is the lower GI tract - cecum and large intestine and, arguably, the latter portion of the small intestine

I have had horses scoped that the pyloric sphincter could actually not even close (due to ulcers), giving insight to a good portion of the first part of the small intestine, which was also covered in ulcers.

The duodenum is the first portion of the small intestine after the pyloric sphincter, but even that is about a meter/3’ long, so you might see a little bit of that, but not all of it, and for sure nothing behind it where the hind gut is.

[iJump]

@JB

No, the hind gut is the lower GI tract - cecum and large intestine and, arguably, the latter portion of the small intestine

The duodenum is the first portion of the small intestine after the pyloric sphincter, but even that is about a meter/3’ long, so you might see a little bit of that, but not all of it, and for sure nothing behind it where the hind gut is.

So how do you diagnose hind gut ulcers? And what is the treatment?

I’ll be doing some Googling this evening but also curious on your take. You seem well versed.

I’m curious now, definitely something new to talk with my vet about.

[JB]

The idea that hind gut ulcers is actually a thing. The idea is that if there are actually ulcers, then you have really serious issues, like RDC (right dorsal colitis). Of course RDC has range of severity, from minor all the way to death.

What is likely going on most of the time is some hind gut acidosis - overly acidic environment from inappropriate fermentation of foods that aren’t meant to be digested to any real degree in the hind gut. That’s how PPIs (proton pump inhibitors, omeprazole, esomeprazole) can cause problems back there, by decreasing acid production which increases the amount of food that is less digested, getting back to the hind gut, especially when talking about non-hay/grass foods.

You can diagnose RDC via ultrasounds. Or, diagnose in hindsight with treatment which resolves the problems.

[fanfayre]

@JB

…

You can diagnose RDC via ultrasounds. Or, diagnose in hindsight with treatment (which is not omeprazole) which resolves the problems.

Agree with everything you wrote, @JB , but just added to it so there can be no confusion (intentional or not)

[JB]

@fanfayre yes, thank you!! It didn’t occur to me to add the RDC treatment protocol(s) but you’re absolutely right - it’s not any PPI.