Omeprazole worsening diarrhea - stop or stay the course?

[stb]

My 17 y/o has had waxing and waning diarrhea since last October. It ranges from soft but mounded poops to cow splats with juicy stuff on a bad day. He’s happy, has good energy, not losing weight, his coat looks fabulous. My regular vet has seen him and we have checked fecals and he is fine on that regard. He was wormed with Quest Plus in the Spring. Teeth were just done.

I recently removed him from his ration balancer and he improved pretty dramatically. I thought I had him figured out but the diarrhea returned after about 3 weeks of improvement. Ugh.

Sports medicine vet was out the other day and he suggested we treat for ulcers and for hind gut issues. He started him on Omeprazole and sucralfate. The sucralfate came a day earlier than the Omeprazole and I started him on that before he started the Omeprazole. Since the day he started the Omeprazole his diarrhea has been worse - not better. We are back to poopy tail status. It’s only been 3 days on the Omeprazole, but he has not had 3 days of this severity in quite a long time.

So, I’m not sure whether or not to continue with the Omeprazole. Is this something we just need to push through? The original protocol was 1 month of Omeprazole and 2 months of Sucralfate.

[SuckerForHorses]

Sounds like he definitely has hind gut issues since Omeprazole can exacerbate those.

I don’t have a lot of experience with hind gut problems but I would talk to your vet and see what they think.

If it’s possible to scope and see what’s going on in the stomach you might find that he does not have gastric ulcers at all but instead hindgut issues and can treat those with sucralfate and eliminate the omeprazole.

[dressager]

Is he on gastrogard/ulcergard or some kind of compounded or generic omeprazole?

[stb]

Compounded omeprazole.

[Fharoah]

I would start with a gastroscope and take it from there

[dressager]

@stb

Compounded omeprazole.

There have been a lot of studies to show that compounded omeprazole widely varies in terms of the dosage and consistency. As someone who has tried a generic drug (which is theoretically the same as the name brand- different than compounded) myself and suffered from severe unexplained stomach issues I would strongly suggest you try the GastroGard. Your horse could be getting too much omeprazole or not enough or having a sensitivity to an inactive ingredient.

[stb]

Thanks everybody for your help. I did not give omeprazole last night, this morning, or this evening and poops are improving. I guess I just wasted that money:(

[JB]

At this point I think I’d discontinue the omeprazole, and continue the sucralfate, and see what happens.

[pryme_thyme]

Agreed with JB.
I have a gelding with hind gut trouble, we have been dealing with this intermittently since December. It all began after being gelded and given long acting penicillin shots every other day. Vet also advised to continue pen despite really bad diarrhea.
I continued for a one dose after he advised this then stopped.

Since then it has been a battle. Though, it did improve, poops firmed up but it continued with dribbly gas. Ugh.

Long story short after trying several things we just stayed course, things would go away and then come back a couple weeks later. It seemed to follow suit with hay changes, round bale versus squares, different fields for these.

The issue went away completely for about month then came back with pasture introduction, went away then pasture changed to a different pasture…ugh, now a week into the new pasture, things have dried up again.

Vet suggested imbalance with gut bacteria (pro and prebiotics did not help btw), apparently it takes a LONG time to rebalance and rebuild the bacteria needed to digest.

Has the hay changed with your guy? Any other meds before?

[joiedevie99]

I wouldn’t treat for ulcers without scoping. It sounds like your horse likely has hind gut issues. Whether he also has stomach ulcers is an open question. He may have both - in which case you’ll need to carefully balance the meds to avoid causing more issues…

[stb]

So, an update for you who have been so helpful. I did stop the omeprazole and the awful, juicy poops went away shortly thereafter. I am continuing to give sucralfate at this point, as I agree that we are probably dealing with hind gut issues. At this point poops are semi-formed and horse has no poop stains on his rear.

Diarrhea issues started last fall when pastures were pretty much done and horse went back on hay. I initially thought it was the hay I was feeding, which was a timothy/alfalfa blend. I switched to a straight orchard and things got worse, not better. Tried a different orchard and things were a bit better but not great. Ended up going to Coastal Bermuda, which I don’t like to feed. I do think that was a bit better than the orchard as far as poops go. Diarrhea waxes and wanes - most of the time it is just soft poop but periodically it reverts to nasty, juicy cow splats.

After several months on the Coastal hay I went back to orchard. I just can’t get comfortable with Coastal - I worry about colic issues, and in fact, both of my horses had mild colic episodes while on the Coastal. So, Coastal is a big no-go for me.

I will say that last summer my horses were out on grass pretty much 24/7. I routinely fed a couple of flakes of hay in the morning just to keep them in the habit of having hay, but their forage was almost entirely grass. This year I am dyrlotting during the day and turning out at night. The horses are spending more time off the grass and are eating hay almost half of the day. I do think that my gelding does better with more grass and less hay, but my other gelding tends to be fat and IR, hence the dry lot. I’m back to orchard hay since that is what I can reasonably source. I could also get an orchard/tim blend if anyone thinks that would be a better idea.

I’m also feeding beet pulp as I think it helps a bit. My dry lot is sandy, so I worry about sand exposure and I feel like the beet pulp may help that as well. I do psyllium once a month. Smartdigest ultra has also been suggested to me and I may try that after finishing the sucralfate.

Any ideas on management are welcome. This is a frustrating thing to deal with. Since it waxes and wanes it is hard to know if things are working or not. When I took my guy off of soy products he had 3 weeks of almost normal manure and I thought I had it figured out - then he relapsed. Very frustrating.

[DunByMistake]

Oh the joys of hindgut issues. I bought a gelding last summer that I suspected had something going on with his guts. Then in the fall, he had full blown ulcers which I treated for (on compounded omeprazole from my vet and it was a lifesaver). However, the omeprazole made the hind gut issues worse (aren’t horses fun?!?!).

Moved horse home over the winter and dumped food into him. And I mean, dumped. He’s a big horse but easily ate 40+ lbs of hay a day plus a high fat feed supplement. He put on a marginal amount of weight but still wasn’t happy. This spring, he lost some of that precious weight and his stomach was so sore you could not touch his flank. He would kick if you even looked at his last rib. He was girthy and anxious being tacked up. He would actually flinch when I first put girth on.

I actually had to consult an equine nutritionist because I was over my head and my vet will admit she is not the most knowledgeable person about equine nutrition. This nutritionist has a feed store a few hours away from me. With some phone calls and emails, she put together a feed plan. Cost me a small fortune to buy several months up front.

BUT her feed plan did more in week than the stuff I had been trying for about 8 months. In about 2 weeks, his belly sensitivity went away and he started putting on weight. He’s been steadily improving ever since. I toss him a couple flakes of hay a day but he gets the majority of his forage from grass. He has the odd day of being a little grumpy but nutritionist warned me it takes at least 3 months to get their hind guts back to healthy and functioning well.

It is extremely frustrating and I have wished my horse could talk almost everyday. But advice from nutritionist honestly changed things around. If you can find an expert to consult and develop a feed plan, I highly recommend it. I didn’t actually pay her for her services - I just bought the feed she sells. But it has been money very well spent.

[stb]

So Dun, what feed company did you consult with? Do you mind telling me what feed regimen she recommended? I’ve certainly also considered more grass and less hay for my boy.

[pryme_thyme]

Any update op?

[buck22]

OP, try being aggressive about treating for sand. I live in a sandy area and my gelding has done fine on daily flax for many years, but in the past 18 months, as he’s getting older and older (he’s in his mid 30’s) his body is becoming less and less tolerant of sand and he gets very watery manure. Which, at his age, is tough on him.

Grazing is best, but during dry spells when the grass dies down his manure gets worse.

The more aggressive I am about treating for sand, the better he is. Once a month sand clear and daily flax is just not enough any more.

[stb]

Another update: I think we are making some progress, but it is glacially slow. For the most part poops are loose but not diarrhea. Every now and then he has a bad day where he gets liquid on his back end, but those days are thankfully not coming around more than every 10 days to 2 weeks. We are still on sucralfate. I’ve also added SmartDigest Ultra. Appetite continues to be good and horse looks good overall. Currently I also have him on psyllium - I usually do that for one week per month.

Buck22, you might be right about the sand intolerance. Currently, my dry lot has some weeds, and the horses want to graze them while they are in there - even though they have plenty of hay. I do think that the more my problem gelding is out on decent grass the better his stomach is. Whether that is from ingesting sand while eating weeds or because the grass digests easier than hay I don’t know.

I think I am on the right track, but I sure would like to know that for sure. We started sucralfate 3 weeks ago, so I guess it hasn’t really been that long. SmartDigest Ultra was added a week ago. I guess I just need to give this stuff time, but it is frustrating. Thanks for everyone’s help and advice.

[bigolebay]

OP, I’ve dealt with the loose stool issue for 4 years. Early on I was told by one vet after ruling out with the usual bloodwork and other tests that were negative that was just how he was and to just deal with it. My horse does have a dx of inflammatory bowel disease now but is still somewhat idiopathic. 1/4 doses of Gastroguard while on dex did make it worse–more watery and projectile. I do know that my gelding cannot tolerate legume hays or clover in pasture. As a rule out, did a glove test for sand early when his troubles started but inconclusive. As of late when his problem started to cause weight and protein loss I did find trace amounts of grit. The grit can definitley cause irritation to the gut lining and he may have been eating dirt to replace the nutrient imbalance he was experiencing. I can tell you in his case smart digest did not work nor any pro or prebiotics or anything with sulfer in it like MSM as these things him very gassy and watery. My horse needs a trip to a hospital to get an xray to check for large amount of sand or other blockage to be sure, however I am waiting for him to gain a little more weight to try a good dose of psyllium or sand clear as suggested by the vet, which unfortunately will cause more loose stools and gas while being treated. We have had some success keeping him on a low NSC diet and electrolyte supplementation with stress-dex in one of his buckets of water (no mag sulfate). I think the sucralfate may help your problem at least to help protect the mucosal lining in your horses gut while you figure it out. I do feel for you and your horse as it has been a nightmare for us.

[stb]

bigolebay - I have found the psyllium to help my horse’s symptoms - does it make your horse worse? I am also doing a low NSC diet of timothy pellets, a bit of Coolstance, and High Point Grass Balancer. Fortunately, my horse is holding condition very well. His weight, coat, and energy are all good. He looks hale and hearty.

I sure wish I would get a clear sign that I’m on the right track. I do think my boy is better but not a whole lot.

[bigolebay]

stb, the psyllium makes mine worse while on the 5 day treatment since it is a laxative. I haven’t done a treatment in a while though. Yours may not have a large accumulation of sand so it may have helped clear any sand or dirt.

[pryme_thyme]

Glad to hear of progress!!!

For us - I have removed all supplements except grain (purina ultra f and equalizer) as well as his brewers yeast.
Manure has been continuing firm, still has liquid discharge with manure passing which dribbles down his bum. Ugh!