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Pyloric Ulcers?

Any new treatment, cures (haha) or management out there for them?

It’s been a while since I dealt with pyloric in specific, but I remember ranitadine & sucralfates really made a difference. I remember keenly that this one was awful to resolve - every scope recheck showed marginal improvement but not enough. The horse was already on several months of GastroGard at full dose with no improvement before the vet prescribed R & S. The timing of the R&S was crucial, but the vet also wanted it before meals but the whole reason the horse developed ulcers in the first place was because he didn’t always have food in front of him.

The horse ended up being put on WellGel (the dehydrated alfalfa powder) and UlserShield as well.

Management wise, there is no point in treatment if management does not drastically change, because otherwise the ulcers come back. The ulcers are a symptom rather than direct cause. Horses tend to develop them because of the long hours kept in a stall with no food in front of them. I’ve only seen these cases improve to the point of no reoccurence if the horse is put outside 24/7 with grass and/or constant hay. It’s not an easy thing to change and I really feel for boarders who are struggling with ulcers in their horses.

Prevention wise – having quality forage in front of them 24/7, having as much turnout or as close to 24/7 as possible, and reducing high NSC grain intake or transferring to quality concentrate is paramount… and… don’t work a lame horse. Several horses I’ve treated with ulcers were also ridden while not quite right, but not obvious enough to be three legged unsound.

This is a chronic condition unfortunately. Horse always has good quality grass hay. Not overworked or lame. Outlast 3x a day and sucralfate & Outlast before riding. Horse is the anxious hot type.

What is his turnout schedule like?

Do you know if that hay is offered in front of him 24/7? Or is it more like industry standard - 2 flakes AM, 2 flakes for lunch, 2 flakes PM, that kind of thing?

No new treatments I’ve heard of, and pyloric ulcers can be a total beech to heal well, unfortunately.

There is some promising research into using HA for gastric issues, so I don’t know if something like Gut-X might be useful.

What is/has been his total diet? Is he the “anxious hot type” due to breeding? Have you done any elimination type dies to see if you can rule out a sensitivity to a particular ingredient? The common ones are oats, alfalfa, corn, soy. Have you tried any B1 supplementation? If they get deficient for some reason, they may never be able to make enough on their own to get back to normal, and need help for a short while.

I have a horse with a perfectly awful ulcer history. Initial scope found grade 3 - 4 ulceration on lesser curvature and several pyloric ulcers. Ended up being treated with the 28 days of Gastro Gard plus Sucraflate 3 separate times; scoped 4 separate times.

Horse was in a boarding barn situation where they just couldn’t provide good ulcer management, which is how he came to me.

After 6 months of a happy horse with 24/7 turnout, free choice forage or hay at all times, pleasant turn out buddy and daily Omeprazole, I thought the problem was resolved and started to reduce the Omeprazole. Symptoms starting returing after 21 days, so he’ll be on the Omeprazole forever.

ETA: And I added the OutLast supplement to his regimen because I felt so bad about reducing the Omeprazole and having him suffer. Anecdotally, I think the OutLast helps. But I added it after returning to the full dose of Omeprazole, so there’s no way to be sure.

Pyloric ulcers are no joke.

Have you tried misoprostol?

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The horse lives with me. I manage everything including inspection and purchase of hay, feed selection et cetera. I’ve spent thousands on this horse including 8 months of misoprostol without healing them. She’s been scoped probably 6 times and I’ve been told I just need to manage them.

This! My horse lives with me and I’ve been trying to manage this for years. I’ve been told that I’m just going to have to live with it. Where do you get your omeprazole? I cannot afford gastrogard or ulcergard. I’ve literally spent over $15,000 over several years on this horse for her ulcers. Well, I should say me and the insurance company.

Did the wellgel and ulcershield help? Haven’t heard of either

It’s tough to say. Towards the end his owners were throwing anything at him to see what stuck.

Taking care of him, I think it made a big difference in his overall condition. For some context, he was a boarded horse at the barn I managed. He was an ex-UL eventer that stepped down to be a prelim packer for my clients. They tried everything to get those ulcers to go away but every rescope showed minor/barely any improvement to the pyloric, and sometimes more squamous ulcers. I remember he had, quite literally, round the clock medication - I was always stopping a chore I was doing, setting a timer, to give him his pills. He had about seven buckets and most of the meds couldn’t be mixed or set up ahead of time, had to be done then and there. I wouldn’t wish pyloric ulcers on anyone.

The WellGel is basically dehydrated complete feed. Their vet, as a last ditch effort, thought the pyloric could be sparked by hind gut ulcers (which couldn’t be scoped). They had him on a litany of HG supplements to help, too.

In the end he was retired down south and put to pasture 24/7. Last I heard he was doing really well, but was no longer rideable. While we were juggling with his ulcers, we were also trying to get some NQR pain behind resolved that ultimately led to his retirement. Personally, I think that some of the ulcers we saw were because of his pain. I still text his owner from time to time, he was a really special horse and they tried everything to get him comfortable.

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By ordering through Abler I have been able to lower my cost to about $35 - $40 a month, which is totally doable.

https://abler.com/omeprazole

Previously, it was costing me about $85./month, which is why I tried phasing it out.

ETA: Probably the best thing I did for this horse’s management is find him a compatible turn out buddy. Previously he was a medium sized herd and was being bullied and chased by the dominant horse, which made everything worse. Finding another Gamma/bottom of the pecking order horse for him to pal around with has made him very happy.

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Do you use the sachets, tablets or paste?

The Abler comes in tiny pellets, sort of like pop rocks.

They have an enteric coating, so they have to be feed with dry food.

I feed wet alfalfa pellets, then a scoop of ration balancer, then a scoop of OutLast with the Abler pop rocks on top.

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Yes I’ve fed the granules, but I see they now have paste and enteric coated tablets.

do you remember what the thought process behind that was? I’m not following how the hind gut could affect something upstream.

it also comes in tablets and paste :slight_smile:

You can put them on top of a soaked/wet meal, at feeding time. Just don’t mix them in and let them soak with the rest. The coating doesn’t immediately disintegrate if put on top of a wet meal.

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The thought process was that there was significant discomfort from the hind gut ulcers, causing stress, which lead to more ulcers and decreased healing rate in the ones present. Think very ugly ulcer oroboros.

There have been some very interesting webinars by Dr Bill Vandergrift who is saying that one of the new theories is that hind gut issues are causing the stomach ulcers rather than the other way around. The bottom line is pyloric ulcers are a bitch.

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My vet is an internal med specialist and a hind gut/gastric guru. Sounds like you have tried the usual suspects–the misoprostol has been a god send for my guy. She sometimes uses a compounded omeprazole/fenbendazole paste which has been really amazing for some horses who just don’t respond to gastrogard for whatever reason. It’s also a few hundred dollars a month cheaper than plain Gastrogard.

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My horse was part of a clinical trial for a compounded drug to treat pyloric ulcers. She qualified based on the amount and severity of the ulcers, and the fact that Gastrogard did very by little to help. The medicine was a fenbendazole/Omeprazole compound, in syringes. I gave 1/3 of the syringe daily. It healed her ulcers totally in the month’s time. I was told this product would eventually be on the market but that was almost 3 years ago and I haven’t heard much more. I was also told it would be around $10/ tube when it was finally out.

I do recall some other users talking about this compound at some point, so maybe someone will chime in.

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