Ulcers, how to treat? (tried nexium)

[scruffy_the_cat]

@CPL713

I don’t think anyone is attacking your choices or asking you to defend them, just sharing our experience after having gone through what you’re going through in an attempt to be helpful. Sorry if I came off that way. I read the latter part of your post as, “I’ve tried Nexium, should I give up on that and do you all have any other ideas if I do?” and that is the portion I have experience with and was responding to. It sounded like you’d been through all of this before with this horse, so I assumed you had already dropped some money into this over time.

I can tell you that all vets I’ve consulted who I trust on the matter say that for ulcers, the only treatment that they felt truly works for the type of ulcer I’m assuming your horse has is actual Gastrogard. I’ve used generic omeprazole/ranitidine in the past, but got it through my former vet so I don’t have a good suggestion on where else to get that, other than your vet. Or just stick with the Nexium at a higher dose for now, then taper off, and see if it appears to help, which is what it sounds like you are doing.

Italics, mine.
The vets around here who haven’t read the medical articles about esomeprazole and who only listened to what Merial says about their own product also only recommend Gastrogard, which is a little silly if you think about it. All horses are not alike. All ulcers aren’t caused by the same things and are not of the same type- thus the repeated recommendations to scope. Why would the same treatment apply to every case?

There are other respected vets here who have actually read the studies and are happy to recommend what works best for the horse or the owner, which in some cases is esomeprazole.

[CPL713]

@scruffy the cat

All horses are not alike. All ulcers aren’t caused by the same things and are not of the same type- thus the repeated recommendations to scope. Why would the same treatment apply to every case?

That was pretty much my (poorly made) point – if omeprazole worked before, and Nexium isn’t now, at least in the current dosage, talk to a vet and figure out what you’re dealing with then treat accordingly.
Someone can ask for The Internet’s thoughts all day long, but nobody here is really going to know what they’re dealing with and what worked for me might not work for them.

[Fharoah]

@joiedevie99

Scope the horse and get a vet involved. Gastroguard alone works great on ulcers on the non-glandular region of the stomach. It works poorly on glandular stomach ulcers - which often need much longer terms of treatment, and other drugs to help (like sucralfate and misoprostol). It does nothing for hind gut ulcers, and may actually make them worse (since raising the ph of the stomach allows more undigested food to pass into the intestines).

when my horse with scope at Washington State University he was found to have moderate glandular ulcers.The internal medicine specialist there recommended 30 days of Gastrogard, 2 weeks of half tube, 1/4 tube daily for prevention.I did a follow up scope and he was perfect no sign of ulcer anywhere, he never had any clinical signs of hind gut issues.although I don’t feel good about having them on daily Gastrogard it seems to work OK so I’m just going with it. Can get a pretty good price on Amazon.com. The internal medicine specialist also considers relyne GI a safe long term option.

[reithme2]

Thanks everyone, I do appreciate the feedback and will follow up on how the horse is doing on the nexium treatment.

[Thoro]

You could also go the injectable omeprazole route. It’s a bit cheaper than GG and healing occurs in a shorter time frame (one study showed in just 2 weeks). It is also much more effective on ulcers in the glandular portion than GG, even more than GG and sucralfate combined. I’ll try to find the studies I had and link them.

[tulachard]

My horse needs a full bottle of Nexium for when we show or if he’s having a flare (weather change is what makes him flare up for some strange reason). I then taper down - the 3 pill dose doesn’t do much for him other than using it for tapering. So, we use a full or half bottle depending on the event. Outlast supplement daily as well before I ride.

[kaya842]

I just treated my horse for the second time in 2018. I used 4 pills for the “therapeutic” doses for a full month, 3 pills for 2 weeks, 2 pills for 2 weeks, 1 pill for 2 weeks and then a pill when I went to the barn (3-4 days a week) for 2 weeks for a total of 3 months worth of “treatment”. It has made a difference for her both times, as well as a big difference for a horse I had earlier last year. I did not feed the pills with their soak grain as I thought I had read on the other big thread that getting them wet would weaken their effect somehow. I think that giving the Nexium another go is a good idea and just make sure you taper!

[greysfordays]

I would encourage scoping. It’s a pain and expensive but knowing what kind of ulcers matters. I spent months using gastroguard to treat my horses squamous and pyloric ulcers. Then added sucralfate. That killed the squamous but not the pyloric ulcers, which we wouldn’t have known without scoping. We had to use misoprostol for that and it worked really well. This allowed us also to be thoughtful about how to manage his stress load.

[reithme2]

UPDATE: Day three of a full bottle (14 capsules) generic nexium given with grain and no change. Previously I’d have seen an improvement by now when I’ve treated with omperazole. Going to wait through the weekend but at this point I don’t have much hope the nexium is working.

Just left a VM with my vet but thinking I may try to scope next week if no drastic improvements soon.

[NaturalSelection]

Posting here as well as the other Nexium thread. 10 yo TB gelding was rescoped today after 33 days of Nexium at 14 capsules per day and all visible stomach ulcers were resolved. Unfortunately, horse is still exhibiting some signs of discomfort (sensitive to touch on sides) so we’re going to begin tapering Nexium and start a course of Sucralfate to go after potential hindgut ulcers.

[J-Lu]

@reithme2

I’m not sure why I’m defending my choices here. I try to do right by my horse as much as I can, but here goes.

My horse has access to hay 24/7, as in ‘at all times’. Yes, most boarding places don’t do this, but knowing my horse I looked high and low and pay a premium for 24/7 access to quality hay. I dont think we could maintain his weight without some grain, but have cut back and replaced calories with beetpulp and oil. Other than that, yes I am limited, 24/7 turnout isn’t an option but the care he receives is excellent and hes turned out daily for 10-16 hours.

I appreciate the many opinions to scope and have noted multiple times I am open to scoping but do plan to wait until after the nexium treatment to make that call.

While he has presented with ulcer symptoms previously it was 2-3 years ago and was treated quickly (he improved within a few days, but did continue treatment for 30 days) and effectively (obvious improvement no issues after) with generic gastroguard/ulcerguard (omeprazole).

So far I’ve spent $20 and plan to spend another $120 on generic nexium for the 30 day nexium treatment so don’t feel i’ve quite gotten to the point of throwing money away and this hasnt turned into a persistent issue.

In making decisions for my horse I have to consider I’m on a budget, I have a healthy savings but try to only touch it for emergencies. If i dipped into savings at every possible sign of something being wrong with my horse I likely wouldn’t have a nice savings account to fall back on. So yes, I often take the wait and see approach or try a cheaper method first.

In conclusion, I may scope, I may not, that wasn’t the question.

You are defending your choices because you posted your problem on an internet board. I suspect you did this because you want the opinions. Being defensive won’t help you.

Access to hay or pasture 24/7 doesn’t rule out ulcers. Feeding grain doesn’t exacerbate them. Determining the root cause goes a long way.

I also recommend endoscopy. I paid around $300 for an internist with an endoscope to come to me and evaluate my horse. $300 for a + or - diagnosis (not hindgut) is easily weighted against the pills and other meds you are feeding your horse “just in case”, and the time lost for behavioral issues, and the saddle fitter, and other things you spent money on.

Your approach to “your savings” is interesting. You’ve already spent the cost of endoscopy. It’s interesting that you categorize suspected ulcers with “every possible sign of something being wrong with my horse”. Properly dose your horse with the meds you decide to give. If that doesn’t work, you’ll have to dip into your healthy savings to diagnose him if you want to make him comfortable.

[Foxtrot_s]

The reason the OP may sound defensive is because every time someone comes on for advice, there are those who reply with a slightly snarky (or not so snarky) comment…even if it is often supported by common sense. It is just the way of this board.

[Fharoah]

One of my friends had an off the truck throw bread it was very sweet would jump in anything. He was never scoped One of my friends had an off the truck throw bread it was very sweet would jump in anything. He was never scoped heard. This lovely 4 year old ended up colicking from a very bad case of ulcers which hadn’t been treated properly. It was very sad. Ulcergard isn’t that expensive and it’s clinically proven.

[Regardless]

Update?

[reithme2]

UPDATE:

Stopped treating with nexium after four days as horses symptoms seemed worse. Started a full 28 day course of ulcerguard (full tube once daily). Major symptoms (laying down, getting up, picking at grain, etc.) stopped almost immediately but after 28 days horse still would pin ears when brushed on sides/belly (not normal for this gelding).

Had different vet out to scope ($500, normal vet doesnt own scoping equipment) found a few few low grade ulcers remained and did a blood in stool test which came up positive so hind gut ulcers suspected. Hes almost done with his second 28 round of omperzole treatment and will start 60 day course of succeed for hind gut as recommended by vet.

Horse seems happy/more playful but still seems a tad underweight. Added 2 lbs of alfalfa pellets twice daily to regular feed for weight gain and have heard alfalfa is good for ulcers (calcium).

Not sure we are out of the woods yet and horse doesn’t seem excited about the alfalfa pellets so not sure if that will stick or not. He seems to eat alfalfa pellets, grain and beet pulp at night but in the morning will eat his grain and avoid alfalfa pellets regardless of if they are soaked. Cut AM alfalfa pellets.

Previously horse had pinned ears when brushed around stomach and when tacked up/girthed. Now doesn’t seem to pin ears when brushed but does occasionally pin ears when tacked up. Had saddle rep out to check saddle fit and reflock, was told saddle fits great no need to reflock. Now considering having chiro out/vet back to consider alternative issues for ear pinning when being tacked/saddled. Horse goes well under saddle.

[Lusoluv]

Honest question: On the original long Nexium thread it was discussed to treat horses with 3 capsules (60mg)/day for a month and then taper down over a few weeks. What did I miss that 14 capsules are now recommended?? That’s a huge difference! It’s hard enough getting my mare to eat 3 capsules with hand feeding them in her favorite treats - she is VERY suspicious. When left in her grain bucket, she picks around them. I can’t imagine trying to feed her 14 per day!

[Madison]

@Thoro

You could also go the injectable omeprazole route. It’s a bit cheaper than GG and healing occurs in a shorter time frame (one study showed in just 2 weeks). It is also much more effective on ulcers in the glandular portion than GG, even more than GG and sucralfate combined. I’ll try to find the studies I had and link them.

After 60 days of GG and misoprostol, my horse’s latest scope still shows glandular ulcers, so we are switching to the injectable, it arrives tomorrow. @Thoro I’d love to see the studies if you do have the links, my vet indicated the results are indeed very promising and I sure hope so for my poor guy’s sake!

To the OP, that is surprising that a scope was $500 - my horse was scoped yesterday for a total of $170 including the sedation! Amazing how much variation there is on pricing from place to place.

[IPEsq]

@Lusoluv

Honest question: On the original long Nexium thread it was discussed to treat horses with 3 capsules (60mg)/day for a month and then taper down over a few weeks. What did I miss that 14 capsules are now recommended?? That’s a huge difference! It’s hard enough getting my mare to eat 3 capsules with hand feeding them in her favorite treats - she is VERY suspicious. When left in her grain bucket, she picks around them. I can’t imagine trying to feed her 14 per day!

There were 2 studies done. Depends on what you / your vet chooses to follow. CSU told me to go with the .5mg/kg dose, and that seemed to work for me. Would less have worked? Maybe. Who knows.

[Simkie]

@Lusoluv

Honest question: On the original long Nexium thread it was discussed to treat horses with 3 capsules (60mg)/day for a month and then taper down over a few weeks. What did I miss that 14 capsules are now recommended?? That’s a huge difference! It’s hard enough getting my mare to eat 3 capsules with hand feeding them in her favorite treats - she is VERY suspicious. When left in her grain bucket, she picks around them. I can’t imagine trying to feed her 14 per day!

One study was looking for a lowest effective dose–that’s what we’re basing the three capsules a day on. The other wasn’t looking for a lowest effective dose.

The study in the nexium thread found 40 mg as effective as 80 mg at raising the pH of the stomach. We went with 60 mg (three capsules) in case one gets crunched going down.

It’s unclear if those advising a higher dose are even aware of the study linked in the nexium thread.

IMO, if three capsules of nexium doesn’t work, it’s worth scoping as there’s a decent likelihood that something else is up.

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[Badger]

This may sound out-of-the-box, but I’ve had some excellent success getting my ulcery horse happy and healthy and off Ulcerguard and gastrotek, etc. by getting the gut and gut microbes happy by pulling all grains and added sugars from his diet. The Ulcerguard and the Nexuim etc. are changing the colony of good bugs in the gut. Now that you have had the benefits of the Ulcerguard course, try to get the gut happy by feeding only grasses, legumes, and natural salt. There is a ton of reading here that explains the whys and how’s:

https://theequinepractice.com/why-horses-should-not-be-fed-grain/

link to all his nutrition blogs:
https://theequinepractice.com/travels-with-doc-t/horse-nutrition/

I pulled all grains and grain byproducts from my barn six months ago, starting with two weeks of only grass, grass hay, alfalfa flakes, and natural salt. After two weeks I started giving 1 pound of soybean meal (toasted/roasted, dehulled, oil extracted) per day ($0.38 per horse per day) to give the full range of amino acids needed to build muscle and top line and repair soft tissue, etc. I was already feeding free choice good quality hay, so cutting out supplements and ration balancers and top-of-the-line$$$$ grains and treats and ulcer treatments from my barn has saved me a boatload of money. And I have a group of happy horses as a result. The once ulcery guy has given no ulcery signs, has dramatically improved his once-explosive behavior, is schooling all the GP and competing I-2. Several friends have started the same protocol after seeing my horses’ results and none have gone back to their old way of feeding.

The great thing about this feed program is you can try it for a few weeks and if you don’t see improvement just go back to the old way you have been doing things.

There is is tons of reading in those links, read the comments/discussions at the end of the blog, too. Then if you are willing, give it a try. I’m six months in, and my local vet just came to do spring shots and was thrilled with the condition of my horses on this protocol: free-choice grass hay (Timothy in my case), 4-5 pounds alfalfa as a protein source (I feed it as hay but pellets or cubes is fine), 1 pound soybean meal as a protein source (after six months I’m about to cut this down to 1/2 pound per day), Himalayan salt (natural Redmond salt or white salt are also okay, don’t use red salt blocks that use molasses binders), and only alfalfa cubes or roasted peanuts as treats (alfalfa, soybean meal, and peanuts are all legumes). No cookies, peppermints, carrots, etc.

I havent used or needed one drop of Ulcerguard or other ulcer treatment since switching to this protocol. I was TERRIFIED the first time I trailered for an away weekend without Ulcerguard, took a tube with me just in case…didn’t need it. It’s hard to make the leap of faith to try this after all the marketing we’ve all been inundated with by feed, supplement, and drug companies, but I am SO grateful that, out of severe desperation, I took the plunge. The benefits have been many.

The Succeed course is probably fine to finish as you start this protocol but I’d pull everything else but hay and salt the first two weeks and then add in only SBM. Give it a couple more weeks and evaluate. Good luck!