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Pyloric / Glandular Ulcer Maintenance

I recently had a horse diagnosed via scope with glandular ulcers, specifically pyloric ulcers. The rest of the stomach looked healthy. There aren’t many threads here about this type of ulcers, and the management recommendations for squamous ulcers don’t directly apply, so I’m starting a new thread.

The clue that something was wrong was that the horse would became reactive under saddle (big spooks) and it would happen like a switch was flipped. The horse would seem quiet then the behavior would come out of nowhere. The horse tested negative for lyme and epm and is sound, but has “moderate” pyloric ulcers, which the vet says can definitely cause a horse to show erratic behavior, because they are painful.

The horse has started on Misoprostol (for 6 wks) and Sucrulfate (2 wks). The vet did not recommend Gastrogard at this point, but the vet did mention that Esomeprazole (Nexium) can sometimes be more helpful for pyloric ulcers than Gastrogard.

Have anyone else dealt with pyloric or glandular ulcers? Did they recur? Was anything recommended for maintenance? It seems that stomach coating products rather than buffers are indicated. There has been some research that a pectin/ lechtin supplement might be helpful. Has anyone tried it?

If you haven’t read it already, here’s an interesting article on risk factors for glandular vs squamous ulcers: https://www.yourhorse.co.uk/horse-care/gastric-ulcers/

“A similar study looking at racehorses found that horses working five or more days had a 10-fold increase in the risk of glandular disease when compared with horses exercising four or less days per week.”

“When a horse exercises acid is pushed up onto the squamous mucosa, so the longer the horse exercises the more damage is done.”

My takeaway is that exercise length/intensity affects squamous ulcers and exercise frequency affects glandular ulcers, so with glandular ulcers more days off or maybe hacking days (not sure if walking under tack counts as exercise) might be a management strategy to try.

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Glandular and pyloric ulcers are quite different though, which pyloric ulcers being the worst unfortunately. Are they glandular ulcers, but way down low? Or actually in the pyloric region?

What has made your vet feel esomeprazole more useful than omeprazole for this? I’ve never run into that thought, so am curious what she thinks

Mine with pyloric ulcers was cured from 4 weeks of misoprostol after failing to heal w 7 weeks of ulcerguard.

He ate predominantlyAlfalfa. The vet recommended Purina ultium since it is relative low sugar but still high fat content. I was told sugar was the devil that caused more acid prod. Grass is good. Alfalfa. Ulcerguard as a pretreatment for travel.
Another vet said to lay off supplements in powder form because they can irritate open ulcers.
Obviously keeping forage in front of the horse as much as possible so they chew constantly and make saliva and have a buffer. Mine was not an easy keeper so that was easy.

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Sugar doesn’t increase acid production. But, the more starch, the more volatile fatty acids are created in the stomach, VFAs which actively degrade the stomach lining, contributing to, or even actively causing, ulcers.

Not sure how that works, since it’s all mixed food and saliva and lots of food is chewed to “powder” before being swallowed.


I have an old thread on here you can search for called Drug-Resistant Ulcers. From the title, you’ll guess how my struggle with pyloric ulcers went.

Highly recommend asking for gastric pH testing if you go back for rescope. GG wasn’t initially recommended for my TB with grade 4 glandular ulcers and severe pyloric inflammation. 30 days of miso and Sucralfate yielded almost no improvement. The vet took several samples of gastric fluid and the pH was extremely low (not just down by the pyloris where it’s supposed to be). 30 days of GG + another 30 days of miso/Sucralfate and his ulcers went from Grade 4 to Grade 1. From there it was playing whack a mole with a few different physical issues and management changes to fully resolve.


Misoprostal is the best/typical treatment for pyloric ulcers. Try GoodRX for better pricing.

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