I can’t remember the poster and “ulcer” search is bring up too much for my foggy memory to trigger - what was the thread about the recurring ulcers and the owner wouldn’t give up, and found someone who finally figured out it was a bacterial infection (or something completely random, I could be wrong here) that was causing? That a treatment of a non-ulcer med finally solved it? tia!
Maybe this one?
They found the stomach pH was all wrong, and bad bacteria was growing
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yes, thanks!!
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hahaha that’s me! definitely PM me (and I’m always up for a call) if you want more information or to discuss your situation.
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My vet said they’re seeing many more of these that only respond to a combo including an antibiotic. Her thinking is that there is a disbiosis caused by over treating for ulcers that may contribute. One horse in my care was scoped and treated with ulcergard, misoprostol, and minocycline. Visually the stomach looked like many small normal ulcers in addition to these weird yellowish plaque looking ulcers, she said the ulcers that visually look that way typically need to be treated with antibiotics.
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So interesting.
I would only mention that without testing stomach fluid to determine which antibiotic to use, there is a chance a less-effective antibiotic could be recommended. We used enrofloxacin for more than 2 months to eradicate the bad bacteria. And yes, that required additional gastroscopy for pulling and testing fluid. Once that fluid was examined by the lab, there was a recommendation of which antibiotic would be most useful. In our case, the bacteria was massive overgrowth of pseudemonas - there were some lesser overgrowths but they also got knocked out by the enrofloxacin so that was useful.
The gist of our problem may be theorized as follows … years of treating for ulcers changed the pH in the stomach which allowed bad bacteria to flourish. Once that happened, incorrectly processed food stuff made its way into intestinal system, which responded with inflammation which got worse over time. Only by treating the stomach to kill bacteria and encourage proper pH, with steroids for inflammatory response, did we see improvement. But my boy was very very very sick, and it took months to really start to return to health.
Oh - and not to stir the pot - but my theory is that my boy had ulcers because HIS BACK HURT because he was/is very athletic and asked for so much more than he could give when he was BTV every damn stride. I look back on pictures of him doing half-pass, extended trot, piaffe and his nose is BTV in every single one. He tried to tell me he hurt and that he couldn’t correctly do what the trainer was asking for. I still feel so darn bad every single day.
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Thanks for the explanation. I’m actually a microbiologist. I have a few questions. Did they actually culture pseudomonas from the stomach? And what was the pH in the stomach? It doesn’t tend to survive under pH of 4.5, though some of the species are resistant to many different anti microbial modes of action. I’m curious how they decided the pseudomonas was pathogenic in this instance vs an ubiquitous organism in the environment of the horse?
The pH in his stomach was 5 - after fasting for 16 hours, should have been 1-ish. I am not a microbiologist (unfortunately), so I hope I’m accurate when I say they did culture for pseudomonas - the report I got back showed what bacteria was present and how much of it existed (low, mid and high growth) (I think that’s right - I can go back and look). I think it was determined by my internist it was pathogenic in light of overall gut health (poor) and lack of other, beneficial bacteria. Stomach lining was yellowish, puckered and he had some ulcers (both kinds). The bacteria was not what would be normally found and in anything like a normal distribution. I am relying on memory here … but that sounds right.
ETA - I just pulled up the report. Heavy growth of serratia marcenscens, heavy growth of acinetobacter baumannii, and moderate growth of pseudomonas aeruginosa with no beta hemolytic strep isolated. Lab report indicated sensitivities with amikacin, enrofloxacin and gentamicin. Not sure why my internist chose enrofloxacin - maybe ease of availability, dosing?
I remember freaking all the way out about the serratia … seems my vet was more focused on reducing pseudomonas. Follow up testing after 2 months-ish on enrofloxacin showed light growth of aeromonas caviae, and enterobacter cloacae, and light growth of pseudomonas.
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Just curious, did you retest pH after antibiotic treatment? That inability to acidify is pretty interesting!
WRT to the antibiotic choice, I think gent and amikacin both are injection only? Enro is a easy pick in that case.
Yes, we did gastroscopies each month for 3 or 4 months and did pH testing and bacterial testing each time. That informed how much longer we would do the antibiotics. Each time his pH would be closer to ‘normal’ for fasting.
Thanks for sharing! Those are interesting culture results! And interesting on the pH, there was a paper out last year I believe, a slight decrease in pH also actually causes decreased uptake of antibiotics in Pseudomonas aeruginosa, which might be why it took a longer course of the enro.
Was your guy on a PPI long term before this? Or any other idea why he developed the high pH?
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He was on and off Gastroguard for 2 years. He was grinding (I think that was in response to back pain) and/but like a lot of amateurs, I listened to my ‘pro’ who said he was just ‘a thinker’. Well, he didn’t stop so we we treated the grinding as indicating ‘suspected’ ulcers without testing and over time I think the GG supressed gut function and changed pH.
ETA - we had a wellness check and abdominal ultrasound about 2 months ago … the inflammation at his duodenum went down from 8 mm to almost zero (normal).
