Ulcers—need wisdom

Hi all,

I’m hoping some of you can offer some words of wisdom. I purchased horse from previous trainer and previous trainer and vet always thought horse had ulcers of some sort. Hindgut was suspected as main issue. Horse was never scoped. For over two years, every time horse had behavioral issue (and some were legit like kicking the stall wall frequently, and some could just have been fresh horse), horse was treated aggressively for suspected ulcers. Cost a literal fortune and everything but the kitchen sink was prescribed and supplemented. Horse was living on multiple meds. Behavior was okay but we had no idea what we were treating, and whether it was actually effective in the long run. I also had no idea if meds actually treated the problem and were no longer actually necessary and he was still on them indefinitely just because.

Moved horse to new trainer/barn and her point about his stomach was a sound one: let’s wean him off everything once he settles, scope him, and see what we have. Then, we know what we’re treating definitively, have a baseline, and can manage without spending a fortune on meds that may not be needed. The vets new barn uses are excellent. Management is excellent too. New trainer thought current treatment regimen was rather unorthodox.

Fast forward and he did settle, and we had a few good rides. Now, he’s nearly off all the meds. The only thing he’s on is a stomach acid buffer. And he’s acting like he indeed has ulcers: reactive, doesn’t want your leg on him, sucking back, getting worried when asked for things under saddle, right lead canter is really rough to get and sustain, and he looks tucked up. His back is sore too, which has happened before. He had a stressful change to new barn just because he’s a sensitive soul so no doubt that contributed.

Vet is going to scope him. I have no doubt that vet knows the difference between stomach and hindgut issues and can figure it out. But I feel like I’ve broken my horse in the meantime. And guilty. But I couldn’t keep him on 1-2K worth of meds/month to treat something that I wasn’t even sure we were effectively treating in the first place. I’m also not sure how well behaved he’s going to be while we diagnose and treat this.

Tell me good vet care can fix him and that this was a decent plan?

have you ruled out PSSM 1 and 2? So much of what you describe also fits those, especially PSSM2


I think those could be PSSM symptoms but my horse has never been unsound, stiff, or shown signs of tying up or muscle tremors. Anything is possible I’m sure but I think ulcers might make more sense. He always got better on the ulcer meds, but again we had no idea how many to give and for how long.

Oh and I’ll add, he’s also kicking out when his lower belly is even lightly touched. So there’s that.

Scope him and see what you have. But be aware that ulcers usually have a pain component — meaning they are present because of body pain elsewhere.

Could be PSSM, could be saddle fit, could be kissing spine, could be feet. You really don’t know over text and so many symptoms overlap.

Do you have a video of the horse going?


My gelding had two colics two days apart. Local vet had no idea. We hauled him to the regional vet clinic. They scoped and found ulcers.

We were stationed in AZ at the time. Our last duty station had been PA. He had been used to being out either all day or all night (depending on season) on lush grass.

Of course in AZ, we didn’t have that. The horses were out all day with free choice hay in large tubs, but he was never a big hay face. I think the change in forage was definitely the factor that caused them.

There was no choice of going back to green pastures, so we treated with Gastrogard for 6 weeks and re-scoped. He was clear. However, ever after that, if there was any change at the barn (new horse in his herd, new foal in the stall next to him), he would get colicky. I would automatically put him back on full dose GG and usually by the 3rd or 4th day, he would be right as rain again.

We retired back home to CA, still no green pastures, same problem. What worked for him was to go on the maintenance dose of GG and only use a full dose if changes at the barn were occurring. It was still expensive, but not like being on full dose GG all the time.

My CA vet ended up prescribing an omeprazole/ranitidine medication from a compounding pharmacy. That only cost $127/month, worked well (was for both foregut and hindgut) and saved me lots of money.

If this does turn out to be a tendency for recurring ulcers, maybe a similar compounded med would help. Sending hugs and good thoughts. I know how extremely stressful your situation is. :kissing_heart:


I have a gelding that is prone to ulcers. He was scoped and small ulcers (that were healing) were found. Vet put him on Sucralfate which did the trick for him, we are keeping him on it as he tends to slide backward if he goes off it. I also keep him on U-Gard.


I just want to say that I do not think you should feel awful that you broke your horse.

I think it is reasonable to see how things work out without all the supplements/medications. Scoping is a great idea. Have some facts and move forward.


First of all, I agree with the approach of your current barn. The scatter shot approach of the first barn didn’t make sense. I can see trying a supplement or omeprazole to see if symptoms improve before scoping, but when you’re spending $1-2K a month on meds, it’s crazy not to scope and get good baseline information.

This is a really timely thread for me. I acquired a horse last winter with a really horrible ulcer history, grade 3 and 4 ulcers on the lesser curvature and pylorus. The previous owner had him scoped multiple times, bless her, and spent a ton of money treating him, but the situation in her boarding board just wasn’t conducive to good ulcer management.

So he comes to my place, with lush pasture, 24/7 turnout and one non-dominant pasture buddy and he seems very happy. No ulcer symptoms, perfectly well-behaved.

So I made the decision to wean the horse off the meds.

Symptoms returned in 2 and 1/2 weeks. Girthiness, general grumpiness, freezing under saddle.

I felt awful and immediately restarted the meds. I told myself I was going to have to try to wean him off meds at some point, that it was a valid experiment, but my guilty conscience said I was torturing my poor horse to save $80 a month. So I understand where you’re coming from, I do.

But the situation you were in at the first barn was untenable. Starting over to get a base line with a scope and targeting the treatment makes way more sense than just throwing gobs of cash and meds at it with fingers crossed.

We can have a support group called “I am not a terrible horse owner.”

PS - I now get the meds through Abler Equine at a much, much lower price.


OP, have you visited the Esomeprazole for Equine Ulcers thread here?
FWIW, I had a horse this year that I know had ulcers on and off. We fixed the ulcers intermittedly, but there was something else going on IMO. I don’t think I would have “cured” the ulcers until I found out what the other thing was.

Strongly agree with chronic/treatment resistant ulcers having a pain component. Worth also spending some time thinking about that part. Solving the discomfort often includes solving the ulcer situation. Not always, but a statistically significant amount of the time.


As part of your back to basics program I’d also suggest looking at feed. I would cut out grain, give free choice hay 24/7, much of it in a slow feeder net, and maximise turnout with forage. Keeping thindhe stomach full buffers acid. Feed a flake of alfalfa before you ride. Grain can affect hind gut.

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Good vet care alone will not fix him. You need management changes too. Consider turnout or a larger paddock. If that’s not an option don’t waste all your money fixing a problem that’s just going to come right back.

Lucerne (Alfalfa) is a buffer. Feed half a biscuit before riding or travelling.

Feed your horse on the ground.

Feed plenty of hay. Cut out grain. Introduce slowly. Eating grain hurts with ulcers some will take to dunking hay in water.

Turn out 24/7.

Canter causes acid to splash on the ulcers. You don’t have to canter.

So here’s the thing: this horse never had 30-days of ulcerguard at full dose (plus whatever). He’s lived on nexium for years, injectable omeprazole “as needed” (ie given somewhat randomly), very long periods of misoprostol as a stand alone treatment, sucralfate here and there, succeed as a stand alone treatment, equishure, neighlox, and platinum performance. All while having no baseline or metric for biological improvement. He’d act ulcery and vet and trainer would throw something at him. Most of the time, trainer would just tell vet what she wanted. Me not knowing much thought they knew what they were doing. He also—and I think this is interesting—had a wheat allergy show up as a positive on allergy testing. And there is wheat in his grain. But plan for moving him was to initially keep grain the same, keep hay the same. New barn was fully on board with: we don’t know what’s up with his tummy but we have to figure this out. Now, we can investigate all of this.

New barn has the management to support whatever he needs. He has hay nearly 24/7 (I’ve never seen him without it, or if he doesn’t have it, it’s for very short periods of time).

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All I can tell you is that horses come here with ulcers.

I turn them out, take off grain and don’t do anything else.

It is the management that causes ulcers, not the horse.

They don’t have ulcers anymore. They are thoroughbreds.

Also John Kohnke, veterinary surgeon says that places with radios have 100% ulcers.


You still haven’t said anything about this horses living arrangement which leads me to believe you think that you can fix this without having to change his turnout routine but you really can’t. I think you might as well burn your money if you’re going to scope and treat this horse but continue stalling him. Some horses do fine stalled, some do not. This one does not.

You’re looking at this too simply. Your suggestion could work great if you have green pasture to put them on. If you’re out West in the US, that is rarely possible.

An owner has to work with what is possible and, hopefully, like with my guy, find a solution that works for that particular horse. As in all things horse, each horse is an individual, and the right program needs to be found.

There are many aspects to managing the problem, unfortunately it does take some trial and error to reach the best solution for the individual. Sending best wishes to the OP as she finds the best way to help her horse.


Clearly this does not work 100% of the time. See @McGurk’s post above.


When is the scope scheduled? I think your approach is very reasonable. Scope and see what’s there, and then come up with an actual treatment protocol if there are ulcers, whether that’s GG, GG + something else + supplements, whatever, follow that and then rescope before deeming the treatment a success (some cases take way longer than 30 days). If no ulcers are found, then it’s on to removing wheat and investigating other differential diagnoses. You are at least taking a scientific approach to this at this point.

Until he can be scoped (which I hope is soon), figure out what he can tolerate reasonably well. Maybe that is just groundwork, maybe it’s some time off. I’ve seen horses with severe ulcers (Grade 3 or worse) whose behavior wasn’t that bad or was atypical, and I owned one with extreme behavior where we found barely perceptible ulceration, but just enough for my vet to lean towards grading it Grade 1.

If it’s going to be a while till he’s scoped, I wonder if removing wheat might not be that bad to do first, although even if there is some improvement in behavior, I’d still scope. Even switch him to some alfalfa pellets and a v/m supp and some fat source as needed for the time being before formulating an entirely new diet since a lot of commercial feeds will have wheat middlings.


Definitely rule out pssm. The chronic pain from pssm is what CAUSED my horse to have every type of ulcer for months. She had glandular and non-glandular any pyloric and was treated with injectable omep., sucralfate and misoprostol for months…scoped 4 times, some would heal but new ones would form.

Once another vet ruled out type 1 and suggested diet for pssm2 she was a different horse, back to her old self within a WEEK, after more than 6 months of treatment.

With so much ulcer treatment there is likely a hind gut issue too. Our/their stomachs are meant to have acid to start digestion…when it is suppressed so much more food passes to the hind gut where it ferments and causes acidosis. (At least that’s what I think I remember reading😂)

Good luck!