Post ulcer treatment/wean-off period

[rockyriver7]

Hi all,
Wanted opinions/experiences on weaning horses off of ulcer treatment.

My horse just came off of a 6 week treatment (gastrogard, misoprostal, sucralfate) for grade 2 glandular and non-glandular ulcers (confirmed with scope). He was rescoped 2/14 and shown to have completely healed and no longer was showing any symptoms. He is now on Purina Outlast for maintenance, in addition to free choice hay and ample turnout. He was on alfalfa hay during treatment but I stopped giving it to him when we stopped treatment b/c it makes him very hot/excitable, and the Purina Outlast has alfalfa in it already.

I followed my vets recommendation for weaning off of meds to the letter: full treatment day of and day after scope, 2 days ½ tube GG and half dose sucralfate and misoprostal, 4 days ¼ tube GG, ½ dose sucralfate/misoprostal, and 2 days with only ½ dose sucralfate. However, ever since my horse has come off of the gastrogard, I’ve noticed some of his symptoms come back. It’s now been 5 days since his last gastrogard dose, and 3 days with no meds.

I’ve been reading about acid rebound and am thinking that’s probably what is going on. I put a call into my vet but haven’t heard back yet. I am thinking he needs to go back on Gastrogard.

Do you guys have experience with this? What weaning period/doses did you do? How quickly can ulcers develop? Is it possible he has redeveloped ulcers in the last 3-5 days without meds? Does sucralfate also have an acid rebound effect?

[DinkyDonk]

I treated for a month, then tapered for a month while also moving on to a permanent maintenance protocol of 4 oz aloe vera juice with 2 level tsp of slippery elm bark mixed in and top dressed on evening bucket. So far has worked better than anything else (commercial products) I’ve tried–also very economical.

[Simkie]

Glandular ulcers are just such a different beast

Are you giving the Outlast per the label directions of 3-4 times a day? It buffers for (IIRC from the product literature) only four hours, so if not given frequently, does leave you open for some pretty significant coverage gaps.

I wonder if an H2 antagonist would be helpful, since they create less rebound when coming off…?

[rockyriver7]

I tried Aloe Vera juice with him previously and didn’t see any benefit from it. Haven’t tried the slippery elm though!
Outlast is being given at recommended dose for his size with his AM grain, before I ride him (time varies but usually late afternoon), and with his PM grain. For the H2 antagonist, perhaps-- that would be ranitidine right?

[greysfordays]

If the horse is being ridden, maybe consider giving a half a flake of alfalfa before riding. I found that buffering really helpful before being groomed and ridden. Maybe a scoop of pellets in his stall while you curry?

For my horse with the squamous ulcers, we weaned off the misoprostol and gastro guard a bit more slowly than your directions and sucralfate stayed for a good month or so after that.

We did the aloe vera juice and Enviro Equine Gastro plus. Other than free choice timothy and the smidge of alfalfa, he got nutrena empower topline ration balancer.

[rockyriver7]

I was giving him alfalfa pre-ride during his treatment, but swapped it for Purina Outlast b/c the alfalfa was making him act wild under saddle. Not unsafe or unmanageable, so I could put him back on it but I am really hoping to find an alternative that doesn’t have that affect. What was your weaning schedule for the meds?

[crthunder]

When I wean off GG I go a lot slower than vet recommended. Once down to 1/4 tube a day (I did this for full two weeks), then 1/4 tube every other day, then every two days. All tracked on calendar so if any symptoms returned I could just go back up a little. I did a full thirty days in Succeed paSte per my vet’s recommendation. I now have my horse on Ramard Total Gut Health which I find he eats better than the powdered Succeed and has made the most difference in keeping his tummy happy. BUT my horse is allergic to alfalfa so that put a limit on supplements.
good luck!

[Simkie]

@rockyriver7

Outlast is being given at recommended dose for his size with his AM grain, before I ride him (time varies but usually late afternoon), and with his PM grain. For the H2 antagonist, perhaps-- that would be ranitidine right?

Yeah–ranitidine or cimetidine? Ranitidine will be hard to find right now, but you might be able to get it from a compounder like wedgewood. It might be worth talking to your vet about at least.

Could he have one more serving of Outlast as late as possible, like at late check? That might aid in carrying him over until breakfast.

Good luck!

[DinkyDonk]

@Simkie

Yeah–ranitidine or cimetidine? Ranitidine will be hard to find right now, but you might be able to get it from a compounder like wedgewood. It might be worth talking to your vet about at least.

Could he have one more serving of Outlast as late as possible, like at late check? That might aid in carrying him over until breakfast.

Good luck!

Human 150 mg OTC tablets (generic) were still readily available at Sam’s Club and Walmart when I was in town last week

[Simkie]

@DinkyDonk

Human 150 mg OTC tablets (generic) were still readily available at Sam’s Club and Walmart when I was in town last week

Good to know, thank you!

[Glorybee]

I followed a similar protocol with my gelding, and I am having similar issues. Actually, many of the treated horses in our barn are. It’s quite upsetting. we all had about three good weeks, and now symptoms are starting again regardless of the Outlast. One vet said horses who rebound like this need to stay on the Misoprostal permanently. Which bothers me. Not sure what to try.

[rockyriver7]

Hmm. I asked my vet and put him back on a 1/2 tube GG/ day, plus 10 pills sucralfate twice/day. We will see how long it takes for that to make a difference. Started back on this Wednesday, no change so far but horse has been historically slow to show improvement. I asked about the ranitidine but vet recommended to go back to what worked before, plus I still have some leftover meds. I am thinking maybe I need to change something else about his management, but maybe he is just not happy at our current barn. Whatever it is, I am struggling to figure it out and what he will need long term.

[Escapetotjestars]

Do some research on lecithin/apple pectin. There are supplements with these ingredients that are proven by many independent studies to prevent reoccurrence of ulcers. My vet had me use the supplement from smart pak Smart Gut Ultra during the weaning period of Gastrogard. There are many supplements like Starting Gate, Egusin, smart Gut ultra that are basically lecithin and apple pectin. I have had great luck using the two when I have to use a NSAID as well. I feed 1/2 cup lecithin with 2 tablespoons apple pectin. Also collagen is great. Forefront collagen is a good option.

[bathsheba8542]

My horse rebounded after very, very slow weaning following 30 days of full tube of ulcergard and misoprostol. (He was diagnosed with glandular and non-glandular ulcers on scoping.) (ETA: he actually started demonstrating symptoms of ulcers when I reduced him to 1/4 tube.)

We did recheck gastroscopy at 30 days, glandular ulcers had healed, but needed another 30 days on misoprostol. Went back after another 30 days and rescoped, and glandular ulcers were back but nonglandular ulcers had healed. Did another round of treatment for 60 days, then weaned off over 6 weeks. That finally did the trick. My vet is reporting that more and more often 30 days is not getting it done for glandular ulcers. Also, I have had to turn over every rock to figure out why my horse developed ulcers. Based on everything I know now, he was in some degree of muscle pain probably likely to Vitamin E deficiency, and that has been addressed also.

[doublesstable]

When I read your post I had to look to see if it was something I wrote about my horse.

In July my horse was diagnosed via scope with ulcers (pyloric) and they were bad! Vet had me treat my horse as you - Gastrogard, Misoprostal and Sulcralfate.

My horse also has an issue with Alfalfa… he gets WILD… Vet had me put him on the Purina Oulast as well. It seemed to take a long time for healing. We did a second scope and he was much improved but still had pyloric ulcers. We continued treatment with the medications. I am not a fan of Gastrogard for too long. I have had another horse have issues. It creates issues with the hindgut.

We gradually weaned him off all the medications. But after that he would have what seemed like relapses. I found when he started acting painful to give him a 6 am dose of Sulcralfate. Then breakfast an hour later. I did that for four days and taper down to nothing… then add it again when he seemed painful. Did that until he was stable.

For about two months he has been very comfortable. YAY

For the ulcer maintenance I have been giving him Outlast, Relyne GI and Immubiome G-Tract…

This is what is working well for him feeding:

Timothy hay

Mash made with:
Timothy pellets
Stabilized ground flax seed
Purina Outlast
Relyne GI
G - Tract
Silver Lining Keep Cool

I also started Triple Crown Naturals Timothy/Alfalfa cubes. I found the timothy/alfalfa cubes don’t make him hot at all. This was a big deal since I have not been able to give him any alfalfa because he gets so hot. The Outlast doesn’t make him wild.

It’s kind of a hit and miss thing and I suspect it will be something I will manage for the rest of his life.

I hope you figure out a recipe that will help your horse.

[rockyriver7]

thanks everyone for your kind responses! He had a full week back on 1/2 tube gastroguard, and 10 pills sucralfate, and showed improvement after 5 days of that. We cut it down to 1/4 tube GG and 10 pills sucralfate daily and he has had that for 5 days and symptoms are back. I really do not want to continue this long term but we will see what he needs.

At this point I am nervous that his ulcers have come back and maybe he needs full treatment again. However he has only had about 3 days total with no treatment at all, every other day he has gotten at least a low dose of sucralfate. Can horses redevelop ulcers while still being on a low dose of treatment? I do not want to scope him again.

I am thinking of starting him on SmartGut Ultra in addition to the Outlast for now. He has been on Vit E for a few months now. The timothy alfalfa cubes are a good idea! I bet the blend would cut down his crazy behavior. Maybe I will reduce his grain and give him some timothy/alfalfa cubes.

[Fharoah]

@rockyriver7

thanks everyone for your kind responses! He had a full week back on 1/2 tube gastroguard, and 10 pills sucralfate, and showed improvement after 5 days of that. We cut it down to 1/4 tube GG and 10 pills sucralfate daily and he has had that for 5 days and symptoms are back. I really do not want to continue this long term but we will see what he needs.

At this point I am nervous that his ulcers have come back and maybe he needs full treatment again. However he has only had about 3 days total with no treatment at all, every other day he has gotten at least a low dose of sucralfate. Can horses redevelop ulcers while still being on a low dose of treatment? I do not want to scope him again.

I am thinking of starting him on SmartGut Ultra in addition to the Outlast for now. He has been on Vit E for a few months now. The timothy alfalfa cubes are a good idea! I bet the blend would cut down his crazy behavior. Maybe I will reduce his grain and give him some timothy/alfalfa cubes.

The ulcers Can recur within five days According to research. Work with your vet to find a reasonable management. A lot of supplements control the symptoms but that doesn’t always mean. I have personal experience with my horse had no symptoms but had ulcers upon scope. You may want to repeat the scope.You might want to try the outlast four times a day.

best wishes!