Standard of care when ulcers suspected?

[gertie06]

I’m increasingly convinced that my jumper is ulcer-y. He was leased out to someone showing in Ocala and came back…different. He’s very irritable and reactive, when his M.O. is to be very quiet and relaxed. His appetite, coat, and weight are all fine, but his attitude is so sour. Given all the travel and showing he’s done, I can’t say I’m surprised. Poor dude.

I’m 90% convinced he’s got stomach/ulcer issues. There’s a number of things we could try. First, he’s already on UlcerAid (though it’s a minimal dose). We could increase the dosage. We could try him on “pop rocks” (the generic omeprazole). We could do a fecal to test for hindgut ulcers. Scoping is so expensive…I’d rather not do that first. But if that’s the standard of care, then I’ll do it.

Would love your input.

[Palm_Beach]

That poor horse. Get a definitive diagnosis and treat accordingly.

[Madison]

Scope. Otherwise you are throwing money at treatments without having any idea what you are trying to treat, and if he does have ulcers you need to know which type he has.

I’m surprised at the variation in cost on scoping, my vet has a relatively new scope in the clinic, and although we have to ship my horse over there, it has only been around $200 for the scope and sedation. Which is good, because his ulcers are glandular and stubborn to resolve, so we’ve had to re-scope to check progress. But that’s why I’m so glad we scoped, I bought him less than a year ago and we did it on a hunch after some fussy behavior, and were shocked with what we found. So, thanks to the scope he’s on his way to feeling much better.

[Simkie]

I do nexium. For fifty bucks (or less) you can treat and taper. If that doesn’t work, scope.

[beau159]

@gertie06

I’m 90% convinced he’s got stomach/ulcer issues. There’s a number of things we could try. First, he’s already on UlcerAid (though it’s a minimal dose). We could increase the dosage. We could try him on “pop rocks” (the generic omeprazole). We could do a fecal to test for hindgut ulcers. Scoping is so expensive…I’d rather not do that first. But if that’s the standard of care, then I’ll do it.

I know plenty of people that treat first and then scope later if they are not better. Because you are right, scoping won’t see hindgut ulcers and that’s why some people opt to treat for them first and then dig deeper afterward if the horse is not better.

But it is your horse and your call.

I opted to treat my horse (before scoping) last fall. He didn’t really have anything serious going on but he characteristically gets a little cinchy toward the end of the season, and his stools tend to get loose whenever he is tied to the trailer. I did a full month of treatment and I’m not sure that it really helped much. I’ve got a few changes we are going to make this year to see if it helps him at the end of the season.

@Simkie

I do nexium. For fifty bucks (or less) you can treat and taper.

I just asked my vet this week. She said giving human medication to horses does not work because our stomach acid is different than the horse, and the human meds are not buffered the same and therefore will not have the same effect.

[Simkie]

@beau159

I just asked my vet this week. She said giving human medication to horses does not work because our stomach acid is different than the horse, and the human meds are not buffered the same and therefore will not have the same effect.

Well, that’s not true. If you’d like more info, there’s a paper linked in the first post of the long nexium thread

[Lusoluv]

I did the Nexium treatment with my horse and it worked great! A couple other riders at my barn also tried it with success and $ savings vs the Ulcergard they used in the past. Also had a vet who said the medicine in Nexium and Ulcergard weren’t the same medication and wouldn’t work. Gee…all you have to do is read the label! Ulcergard contains two isomers of the drug omeprazole, while Nexium (esomeprazole) contains one isomer. Isomer is a term for a molecule that includes the same chemicals, but is arranged in a different way. So, omeprazole and esomeprazole are made of the same building blocks, but put together differently. Same effectiveness.

[Simkie]

It’s even simpler than that, @Lusoluv

Omeprazole contains both enantiomers–s and r. It’s like left and right handed molecules. They’re both in there. Esomeprazole just contacts the s version. So when you give a horse omeprazole, you’re using esomeprazole. Anyone who’s ever used omeprazole has used esomeprazole :yes:

Esomeprazole alone has the advantage of being a more potent version of the molecule, so we can give less.

Cool, huh?

​​​​​​

[mmeqcenter]

I assume these vets^^ are told this by companies like whoever owns Ulcerguard in order to push their expensive horse-specific treatments. Vets (and human doctors) don’t receive a lot of pharmaceutical training and most don’t bother doing any additional research on their own.

For the horse in OPs question I’d just start a treatment and see if the horse improves. Ranitidine is my preferred, especially if on a budget, and Omeprazole next.

[Sansena]

And Ranitidine Q8hrs, one hour away from grain meals (before or after is fine). Best to use a 60cc catheter tip syringe, melt them in warm water, and dose orally.

[beau159]

@Simkie

Well, that’s not true. If you’d like more info, there’s a paper linked in the first post of the long nexium thread

For some reason, I cannot find this Nexium thread you speak of. Can’t seem to figure out the right search function on COTH. Can you post a link? I’d like to read it for myself.

I highly trust my vet and she’s never steered me wrong before.

@mmeqcenter

I assume these vets^^ are told this by companies like whoever owns Ulcerguard in order to push their expensive horse-specific treatments.

My vet sells both the Ulcerguard as well as a cheaper compounded alternative (which is what I get for my horse) because she’s price conscious and knows Ulcergaurd is terribly expensive. And she very much is up-to-date on research. Again, I’d love to read and see the Nexium research myself.

@mmeqcenter

Vets (and human doctors) don’t receive a lot of pharmaceutical training and most don’t bother doing any additional research on their own.

Being a human doctor myself, I strongly disagree with your statement.

[Simkie]

@beau159

For some reason, I cannot find this Nexium thread you speak of. Can’t seem to figure out the right search function on COTH. Can you post a link? I’d like to read it for myself.

I highly trust my vet and she’s never steered me wrong before.

https://www.chronofhorse.com/forum/forum/discussion-forums/horse-care/9650940-esomeprazole-nexium-for-equine-ulcers

Given that you’re a physician “esomeprazole doesn’t work in equines” shouldn’t pass the stiff test Omeprazole is both ​enantiomers​​​​​​, esomeprazole is just s-omeprazole. If you’ve given omeprazole, you’ve used s-omeprazole. Last I dug around, we don’t know why s is more effective than r.

[beau159]

@Simkie

https://www.chronofhorse.com/forum/forum/discussion-forums/horse-care/9650940-esomeprazole-nexium-for-equine-ulcers

Thanks. I did finally find the thread after I posted but I’m still waiting to get a full text copy of the article, as the link posted only gives me the summary. I emailed requested one but it hasn’t shown up yet.

@Simkie

Given that you’re a physician “esomeprazole doesn’t work in equines” shouldn’t pass the stiff test Omeprazole is both ​enantiomers​​​​​​, esomeprazole is just s-omeprazole. If you’ve given omeprazole, you’ve used s-omeprazole. Last I dug around, we don’t know why s is more effective than r.

She didn’t say “omeprazole doesn’t work in equines”. She said the way the human drug is prepared for human intake/digestion is not effective for equine intake/digestion, compared to something that IS formulated for equine bodies (such as the compounded omeprazole I get from her, essentially a “knock off” of the UlcerGuard). While there are similarities between the digestive systems of humans and equines, there are also big differences. There’s a few other full text articles available I’m going to take a peek at while I wait for a copy of the main one quoted from 2009.

[Simkie]

@beau159

Thanks. I did finally find the thread after I posted but I’m still waiting to get a full text copy of the article, as the link posted only gives me the summary. I emailed requested one but it hasn’t shown up yet.

Good for you! Yeah, the thread is popular enough that it’s never very far off of page one in this forum. Bummer that they pulled the full text from that link–it certainly used to be there.

She didn’t say “omeprazole doesn’t work in equines”.

I said esomeprazole, not omeprazole

She said the way the human drug is prepared for human intake/digestion is not effective for equine intake/digestion, compared to something that IS formulated for equine bodies (such as the compounded omeprazole I get from her, essentially a “knock off” of the UlcerGuard). While there are similarities between the digestive systems of humans and equines, there are also big differences. There’s a few other full text articles available I’m going to take a peek at while I wait for a copy of the main one quoted from 2009.

Oh? Certainly the first that idea has come up. Where are the papers describing the difference in buffer/coating that you think is required between equines and humans?

There’s at least one other paper describing the use of Nexium in equines. Other vets have prescribed it. At least one veterinary teaching hospital has prescribed it. All of this is covered in that nexium thread–I really encourage you to read through it. There are also a plethora of reports that it’s worked. Anecdotal, I know. But it seems exceedingly unlikely that you’re correct about the coating/buffer given the papers, the support of other vets and the increasingly large amount of anecdotal data. :encouragement:

[beau159]

@Simkie

Good for you! Yeah, the thread is popular enough that it’s never very far off of page one in this forum. Bummer that they pulled the full text from that link–it certainly used to be there.

It is a bummer … and I STILL have not gotten it emailed to me!!! I just requested it again. (No one has it saved on their computer somewhere, do they?)

@Simkie

Oh? Certainly the first that idea has come up. Where are the papers describing the difference in buffer/coating that you think is required between equines and humans?

I did not ask her specifically (but I can). The only relevant article I have found thus far is this one discussing the bioequivalence between two different coatings on esomaprazole (in humans) but the full text is not available.

It does make sense to me that our digestive systems have differences that may affect the effectiveness of oral medications based on how they are prepared/coated for digestion.

@Simkie

There’s at least one other paper describing the use of Nexium in equines. Other vets have prescribed it. At least one veterinary teaching hospital has prescribed it. All of this is covered in that nexium thread–I really encourage you to read through it. There are also a plethora of reports that it’s worked. Anecdotal, I know. But it seems exceedingly unlikely that you’re correct about the coating/buffer given the papers, the support of other vets and the increasingly large amount of anecdotal data. :encouragement:

Yes, anecdotal is one thing but I would really, really like to read that original study for myself. The abstract just does not give the same details. I would love to see if the authors talked about this at all in the paper.

I too have seen two papers discussing the use of Nexium in equines (of course, with one being unable to read the full text!!!) but everything else I have read says that more studies are needed to understand how equines respond to esomeprazole and more studies are needed to understand omeprazole vs esomeprazole in equine (although I came across this one, which is a nice comparison of the two in paste form and concluded they were equal in effectiveness).