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Non healing glandular ulcers :-( Any experiences or recommendations?

I am at my wits end. I bought a 4 y/o mare last spring who had required multiple rounds of bute and SMZs over a few months due to a puncture wound, a couple bouts of cellulitis due to cuts on lower leg, and lameness due to issues with front feet. Over the summer I started to notice ulcer symptoms, tried Abler with no success so went ahead and scoped. Scope showed glandular ulcers, inflammation around pylorus and margo plicatus area.

First round of treatment was a month of injectable omeprazole (1 shot per week for 4 weeks- studies have shown more success with injectable for glandular ulcers). Re-scoped at one month, 70% better but not totally healed.

Started another month of ompeprazole with sucralfate added. After the first injection horse seemed worse and had a mild colic, so we started to suspect hind gut upset as well and switched to misoprostol and sucralfate for the rest of the month. Re-scoped again, pylorus looked GREAT- totally healed, but had a LARGE, VERY angry bloody looking area in the squamous area… my horse had actually been acting better so vets thought it may have been there previously but missed on previous scopes due to being at an odd angle to capture. SO, we added BACK in the remaining 3 omeprazole injections, as well as continued misoprostol and sucralfate.

After being on ALL three medications for a month, FOURTH scope yesterday showed complete healing of the large lesion and around margo plicatus but NEW ulcers around the pylorus despite being on THREE medications. I am SO frustrated at this point.

I asked the vets if this could be due to bacteria… (like H pylori causes uclers in humans). In my internet research it seems that this is very rare and hasn’t really been proven. The two vets that were there to scope (one being an internist) did think that we should add in antibiotics at this point and try that, since none of the acid decreasing medications have totally worked. They weren’t even sure which antibiotic to use so were going to do some research and get back to me. We will also be leaving her on the misoprostol…

This mare is turned out with a buddy during the day. She is getting free choice hay, 2 qts timothy pellets, 2 qts beet pulp and 3 lbs of Triple Crown Senior per day. For supplements she’s getting VT Blend to balance minerals, Purina Outlast, flax, vitamin E, and just added KER Rite Trac. (Had previously been on Vitalize Alimend).

Thank god for insurance, but I really can’t keep going with all the medications and scopes at this point. Has anyone had an experience like this before? Anyone had to use antibiotics to treat ulcers, or heard of that? If so, which antibiotic was used? I’ve read like crazy on supplements but always love to hear about any that people highly recommend.

I would love to hear if anyone has gone through this, and any recommendations would be much appreciated!

I have not had this issue.

But my first thought is trying sucralfate alone after having been through omeprazole + sucralfate making my horse extremely unhappy and sucralfate alone fixing her right up. Ymmv, but I do wonder about unknown/undiscovered drug interactions after my little science experiment of one horse lol

My second thought is Kaolinpeclin is you can dose her many times a day for a week or so. I work with dairy cattle and although most carry ulcers, they don’t usually show overt signs until they are ready to die from complications of them. However, we recently had one that showed us with black feces and inappetance. Now, treatment for cows has to be cost effective since they are not pets so a few gallons of Kao/pec was her ration of healthcare $$ It worked! Of course it was over Christmas so it was a struggle to get the right product (not modern kaopectate as the active ingredient has changed) but we found enough by borrowing from neighbours to get her through while the vet office was closed :slight_smile: That shouldn’t be a problem at this point and I have to say, I’d absolutely try it if I were in your position. However, it should also be noted that unless you can dose your horse 5 or 6x daily, it will be wasted. Dose for cowy was 500ml per dose. Yes, half a liter 5-6x day. :open_mouth:

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There was a thread a few years ago on drug resistant ulcers - don’t know if it has any helpful suggestions: Drug-Resistant Ulcers?


My horse got worse on omeprazole but improved significantly on esomeprazole (Nexium). Sucralfate didn’t make much of a difference.

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I believe there is some information in the Nexium thread about grandular ulcers that didn’t respond to the normal treatment, did after also treating with an antibiotic.

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