Omeprazole permanently?

[FromTheGalaxy]

I was going to say, I remember reading a post of someone who used long term omeprazole and it had disastrous effects on their horse’s gut health! I agree, the stomach needs some acid to help digest food, and long term acid reduction would be sure to cause issues.

Try looking up the Facebook group Equine Ulcer Research https://www.facebook.com/equineulcerresearch. Dr. Sykes is a long term researcher on equine ulcers, and I remember one of his lectures stated that each horse responds to omeprazole differently, and some have about the same reaction to the 1/4 dose of “Ulcergard” as they do the full dose of “Gastrogard.” (which are the same product, just labeled for different dosing). So basically, some horses only receiving a 1/4 tube effects their proton pumps the same way a full dose would. I would not consider a long term 1/4 tube dose safe for long term overall gut health personally.

I would be more inclined to try a supplement that will help coat the stomach lining. My highly ulcer prone mare is on GutX likely for the rest of her life, but I believe it coats the stomach enough to make her comfortable and help reduce the recurrence of ulcers after full omeprazole treatment.

You may find with time that your horse settles and becomes less ulcer prone. You said you got him in January? It would make sense to me that a TB that likely recently moved barns would be at a high level of stress, and more likely to rebound with ulcers right after treatment if not immediately placed on a preventative. Try re-treating and then starting on a proven supplement. It has taken both of my OTTBs about a year to settle into their new situations.

[Simkie]

@candyappy

ETA: is there a difference in Esomeprazole which is Nexium and Omeprazole that others here are using on their horses??

Yes, they’re related but different drugs. Esomeprazole is more potent, requires a lower dose.

[avjudge]

Since I just came across it, I’ll link @starsandsun’s thread here:

Repeat colic for 10 months, every test you could imagine, finally SOLVED

[floppyammy]

For what it’s worth, to all those recommending the Nexium treatment, I had a horrible experience. I treated my 1140lb gelding with the 3 20mg pills and tapered off. We scoped and he had Grade III/Grade IV ulcers. I tried treating him at the higher dose of 14-16 20mg pills daily. We re-scoped after 3 days and no improvement. We ended up having to go the Gastroguard/Misoprostol/Sucrulfate route, which ended up clearing up the ulcers.
I know some people have reported success, but that was not my experience. It cost us a lot of time, money and our show season.

Edited to add: I used the Nexium clear minis.

[Simkie]

@floppyammy

We ended up having to go the Gastroguard/Misoprostol/Sucrulfate route, which ended up clearing up the ulcers.
I know some people have reported success, but that was not my experience. It cost us a lot of time, money and our show season.

Yes, some horse require more than a PPI to clear up their ulcers. That’s not a failing of the drug, just a more complex case.

Nexium can be an excellent inexpensive and available treatment. If it doesn’t work–and it won’t work for everything–scope the horse and reassess.

A full round of gastrogard doesn’t work for everything, either. That doesn’t mean it’s not effective for many, many horses.

[JB]

@floppyammy

We re-scoped after 3 days and no improvement.

what kind of ulcers were there?

[floppyammy]

@JB

@floppyammy

We re-scoped after 3 days and no improvement.

what kind of ulcers were there?

Squamous ulcers only.

[Simkie]

What’s kind of interesting is that mutations exist where certain types of drugs just don’t get used/metabolized well. I have one of these, and one type of drug that doesn’t work for me because of it is PPIs.

So I can take all the PPIs, all of the really strong ones, and they do dick all. But a couple Pepcid a day? Boom, I’m better.

I often wonder about this sort of thing with horses.

[floppyammy]

@Simkie

What’s kind of interesting is that mutations exist where certain types of drugs just don’t get used/metabolized well. I have one of these, and one type of drug that doesn’t work for me because of it is PPIs.

So I can take all the PPIs, all of the really strong ones, and they do dick all. But a couple Pepcid a day? Boom, I’m better.

I often wonder about this sort of thing with horses.

The experience was interesting to me. My gelding showed ulcer signs in March of last year. We did the 3 pill a day Nexium treatment, with a taper period. His ulcer symptoms returned about two weeks after we finished the taper period. We scoped him and the vet and I were both surprised at how very bad his squamous ulcers were. We then tried the higher dose protocol. The ulcer symptoms never really went away. When we re-scoped him 30 days later, there was 0 improvement, and may have even gotten worse.

I hear you when you say that not every drug works for every horse. But I was surprised just how poorly/not at all the Nexium worked for this particular horse.

[JB]

@Simkie

I often wonder about this sort of thing with horses.

I think it’s almost a given, based on what Dr Ben Sykes has learned in all his ulcer research, including his most recent one on whether we need to taper the PPIs to avoid rebound where he goes into some detail on how omeprazole works with horses.

Not all horses react the same way to a given dose of omeprazole. Some react in a way that is really only good enough for prevention when given a full treatment dose. Some react in a way that’s good enough for treatment when only given a preventive dose.

It’s definitely true that no amount of esomeprazole works for some horses, and we know from many situations here that some horses heal just fine with the 3 capsule protocol, while others require the higher 12-16 cap dose for healing.

AND, it’s also true that the proper use of omeprazole doesn’t work for some of them either

Even when dealing with drugs as closely related as eso and om are, they’re still different, so it makes sense that while most of a population will respond like the words on the paper say they should, some just won’t

[pompeiii]

My gelding does not respond well to ulcergard/nexium/omeprazole. He has chronic hindgut issues (currently managed, but they do flare) and PPIs seem to set these issues off. I’ve unfortunately learned (the hard way) that in stressful situations, ulcergard will make things worse. It causes him to go off his feed and I basically have to re-settle his hind gut with can take weeks. Thankfully, he can tolerate sucralfate and that definitely help his gut when needed.

He had ulcers when I got him and never felt like he improved. A scope showed he was clear and once he was off the ulcergard? He felt MUCH better. Any time he’s on ulcergard (he won’t be on it again after his last terrible flare), he’s fine for a few days, then off his feed, then jumping out of his skin. His history is sketchy and he has so many hind gut issues, but I’d really caution long term omeprazole usage unless you have no other choice. It can really do a number to their guts – especially if they already have issues!

[JB]

PPIs are definitely not for hind gut issues, as they either cause them, or worsen them.

[scislandsprite]

I had a question about this actually since I’ve seen a small amount of research saying esomeprazole can heal glandular ulcers? I know it’s very similar to omeprazole but has made me curious. Study linked here!

[JB]

That’s an interesting case study on that,

The unfortunate part is that " levels of [dietary management] compliance varied." For all we know, some diets changed from less, to more, ulcer-friendly

Obviously, as it says, some real research into this is needed, especially with more than 5 horses, but that’s pretty interesting.

At the very least the same scenario needs to be repeated, swapping which drug was used first. And there need to be control horses, etc, all the Best Practice research stuff.