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Hind gut ulcers/colitis/right dorsal displacement and all it entails....

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  • Hind gut ulcers/colitis/right dorsal displacement and all it entails....

    I've been searching and reading as much as I can get my eyes on, but it seems there are many contradictions (though maybe that sums up horses in total!). I've given the background below, but the real question has to do with my plan, so you can skip through to the "Questions" part if the background is somewhat irrelevant to the diagnosis.

    My TB colicked for the first time in his life in mid July. No obvious risk factors....he lives out 24/7 with free choice grass, free choice hay, drinks plenty of water, and in the 7 years I've had him has never so much as batted an eye at colic. He's been in the best physical condition of his life....shiny coat, normal poop, jumping around 1.50m Grand Prixes happily. Oh, and he's been on Omeprazole since April (first year I've ever kept him on Omeprazole consistently...last year I just added it at shows). But the July episode was clear....he got badly agitated, thrashing about, biting at his sides, enough that we had to heavily sedate him to get him in the trailer and keep him standing. Upon admittance the vet said 60/40 that he would need surgery and with the ultrasound they felt it was fairly likely (though they didn't get a *great* look) that his colon had flipped (right dorsal displacement).

    12 hours of banamine and fluids, though, and he was basically back to normal. He spent 4 days in the vet clinic and I brought him home with the diagnosis of "well, sometimes horses just colic for no reason." Color me not happy for not having some (any) answer for what happened (I know, I know, that's what having horses is sometimes about).

    Fast forward 8 weeks later. Horse has been to several shows since the last colic and is still in the best condition of his life and still has a super shiny coat, normal poop, and just feels "good" under saddle in general. This time the colic presentation was a horse who laid flat out on his side and just did not want to get up. Got him out to the vet clinic (one on my side of the water this time and where they're taking more care to investigate the potential causes, though it ups the anxiety factor since I have to be ready to hop in the truck to haul him back to the other side of the water to the surgical center if necessary).

    Anyhow, his protein was low (turns out it was the first time too, but the other clinic never commented on it) and they did the Succeed test which showed positive for hind gut ulcers. I know there's a high error rate with the test, but they're pretty confident with the colon issue (right dorsal displacement) and hind gut ulcers going hand in hand. One vet feels that the long-term omeprazole has suppressed stomach acid to the point of passing more food through to the hind gut thus leading to acidosis and ulcers. And that could be spurring on the gas colic episodes. Another feels that a recent change in hay is all it took to trigger the issues. I can say that the only major change (aside from hay changes from batch to batch, though always orchard grass) I've made for this horse in 7 years is putting him on Omeprazole for the whole summer (which was wonderful in regards to attitude and appetite).

    I haven't dealt with colic before (I had a lucky 30 year run!), let alone hind gut ulcers. So I could use any/all advice for the best treatment options and I feel like I have a better chance of more opinions here than among my vets....two of whom admit to having little experience with hind gut ulcers beyond what they've read. The other seems to be fairly up on the literature and I intend to rely heavily on her opinion, but I'd like to know what else to ask about and anything else to consider.

    The answers for hind gut ulcers all seem to point towards "no hay for 3-5 months." But I keep getting conflicting answers on grass (one vet says no grass, the other vet says that while he shouldn't be on free-choice grass, a little bit of grass might help his brain enough that it outweighs any colon drawbacks). And the same goes for supplements. One says Succeed, the other says nothing beyond the senior feed we put him on.....etc. etc., you get the idea.

    So here's my plan and what I could use some opinions on.

    The plan is to bring him home from the horse-pital tomorrow afternoon if he continues improving and makes it off of fluids.
    He'll go on a dry lot and the feed plan is as follows:
    Triple Crown Senior
    Timothy Pellets
    Equerry's Plus (Probiotic: http://equerrys.com/Horse_GenPlus.aspx)
    Succeed (I know I could just use Oat Bran, but I'm aok with using a prepackaged anything right now)

    And he'll be on Sulfalcrate.

    Is there anything else I should consider (misoprostol, equishure, etc.)? Any other thoughts on grass, ways to keep him happy since he's always been an eat-a-little-all-day type horse? How long is it before you can start reintroducing a horse to grass? I understand that hay is 3 months out if all goes well, but is it the same story with grass?

    If you've stuck with me this far, thank you. I've been beside myself with worry over this guy. He's a horse of a lifetime for me and I want to do right by him. My vets have all encouraged me to research as much as I can, so I'm hopeful that the COTH experts can help. The clinic will be sending him home with a standard write-up and recommendations, but from what the two primary vets have said, most of the advice will come from the head guy who admittedly knows less than the other vet, and I'm hoping for words of wisdom, what to expect, or any relevant links that might help me dig up some more information.
    Flying F Sport Horses
    Horses in the NW

  • #2
    I think Succeed is a great idea.
    Also how about calling Rood & Riddle in KY, the Univ. of FL., Palm Beach Equine, etc? Might help.
    so sorry you're having these issues. WIshing you 100% success.
    Producing horses with gentle minds & brilliant movement!


    • #3
      so sorry to hear about your troubles. I know what you are going through. My GP horses has the same issues. We here at MAERC have come up with a feed program that really seems to work for theses guys.
      Here is goes.
      For the first 30 days NO HAY VERY LIMITED GRASS. ( you could may be do 15 min 3xdaily)
      NO GRAIN
      feed a ration balancer 1 to 2 pounds per feeding. ( Usually 1.5 lb per)
      I mix my ration balancer with 2 lbs of Alfalfa pellets and 1 large scoop of psyllium ( my guy likes orange flavored) The psyllium will add bulk fiber and water to the hind gut. Make this ration into a mash.
      Feed 1 cup of this mixture every hour. It may take you from on e feeding to the next to get this done.
      You need to do this for 1 week.
      The following week you may add ground flax to the mash up to 1 lb per feeding.
      Dont forget psyllium. Feed is fed the same way week 2.
      Week 3 gets easier.
      Just mix his mash and feed him ( we feed 3 times per day)
      grass turnout may be extended to 1 hour twice daily.
      Week 4 same but I'd give him at least 4-5 hours of turn out.

      Once we get to week 4 we add soaked beet pulp to diet as well as a fat supplement.

      After the first month and if you feel you don't have enough pasture and need to supplement with hay. Feed a commercial bag hay something like Safe Starch from Southern States. Use an Alfalfa mix.

      We feed hay chops twice daily. 10lbs in a muck tub along with lg scoop psyllium and a good bit of water . It makes a kind of hay mash tea. Horses love it.

      I always keep my difficult guys on Succeed and it does make a difference.

      I have 3 guys in my program that I keep on this diet. As long as they are fed this way Ive had no issues.

      Hope this helps.


      • #4
        Originally posted by PNWjumper View Post
        Another feels that a recent change in hay is all it took to trigger the issues. I can say that the only major change (aside from hay changes from batch to batch, though always orchard grass)
        I agree. It might be very interesting to see the WSC content of the hay. Test here: http://www.equi-analytical.com/

        A really large difference between ESC and WSC indicates high fructan levels, which vary with growing conditions before cutting. Can differ vastly from one batch to another, even from the same field. I've seen 50% of the WSC in hay as fructan in orchard and other cool season grasses. It's rapidly fermentable, and causes a lot of gas and acidity. It's soluble in water, so soaking the hay for a couple hours in a lot of water could help current issues until you get the hay tested.
        Are you feeding your horse like a cow? www.safergrass.org


        • #5
          Wait, he still has right dorsal displacement? How is that possible? That is a medical emergency and must be replaced to restore blood flow or the horse dies. Other than that I agree that long term omeprazole is a likely culprit in the hind gut ulcers and Succeed is worth a try. Jingles.
          McDowell Racing Stables

          Home Away From Home


          • #6
            Agree that long term omeprazole is a likely culprit. Dr. Madalyn Ward, a holistic vet in Texas, mused about this years ago that daily use of acid blockers may set a horse up for hind gut ulcers. Acid Blockers also deplete magnesium. I'd add magnesium ASAP. Best one out there IMO for reversing a deficiency (which given his travel/showing schedule - stress depletes magnesium, and his daily acid blockers, he probably is deficient) is MagRestore from Performance Equine. www.performanceequineusa.com

            My pony had hind gut ulcers for close to 7 YEARS! From the time I bought him in 2002 until 2009. No one could figure out what was wrong with him. Several vets, many, many different supplements, no answers and no better. I ended up figuring it out myself after reading about hind gut ulcers in Horse Journal back in February of 2009. (see if you can find that article) In my pony's case, soy was a HUGE trigger. His stomach was always bloated, he would gas colic frequently and his manure was always wet and heavy along with watery, gassy squirts. 24 hours after removing soy, his stomach went down about 50%. After 3 days, for the first time in 7 years, his manure started to become normal horse poop. The gas and watery squirts also subsided.

            Back in 2009 - no one knew ANYTHING about right dorsal colitis. So, my pony stayed on hay and pasture because nobody knew any better. Just the simple removal of soy changed him. He has done really well ever since. He gets NO PROCESSED FEED because they all contain soy. Even Ration Balancers - although I think MacCauley just came out with a soy-free one. He gets soaked hay cubes and beet pulp mixed with a vit/min supplement and his other supps. (flax, salt, etc). He gets an orchard/alfalfa mix and also peanut hay and pasture. Personally, given his history of daily acid blockers, I would remove all grain based feed. His foregut is likely not digesting it due to not enough stomach acids and sending it back to the hind gut where it is fermenting. This very well could be your issue.

            One of the keys to managing this is keep the diet VERY simple, HIGHLY digestible and VERY consistant. You have got hind gut inflammation going on and he needs a bland diet right now. Hay cubes are great because they are very consistant from bag to bag - unlike loads of hay which can vary from shipment to shipment. If and when you go back to hay, do not feed stemmy hay. Stemmy hay is one thing that will set my guy off. Worming used to cause a set back, but it has been so long now, that I feel his hind guy is healed and he tolerates worming fine now. So, if you don't have to worm anytime soon, don't. NSAIDs also are very irritating. Use very sparingly or not at all.

            My guy responded very well to aloe vera. I either fed him the juice or I put him on another product from Performance Equine called MSM and Aloe. MSM is one anti-inflammatory that did not bother him and I think helped speed up getting rid of the inflamaation back there. I used these before worming and right after so as not to set him back.


            • Original Poster

              Originally posted by Laurierace View Post
              Wait, he still has right dorsal displacement? How is that possible? That is a medical emergency and must be replaced to restore blood flow or the horse dies. Other than that I agree that long term omeprazole is a likely culprit in the hind gut ulcers and Succeed is worth a try. Jingles.
              No, his colon rectified after somewhere in the 36 hour range of displacement. During his first colic it was back in a normal position within 12 hours of admittance to the hospital. This time it took a lot longer. I don't know if that's relevant or means anything, or is just part of the "every colic is different" sentiment. The vets did feel that it was relevant that both colics were right dorsal displacements.

              Thank you for the advice, ERC. My regular vet (not associated with the vet clinic who's caring for him) is going double time trying to research the issue as well. In the meantime I've got one vet saying to let him eat a little grass and the other saying absolutely zero grass and disagreeing with each other on food type.
              Flying F Sport Horses
              Horses in the NW


              • Original Poster

                Thank you, jm2 and Katy.

                His feed up to this point in addition to free choice grass, has been orchard grass hay (free choice), a complete feed for his grain (LMF TACO complete), a bit of rolled oats on top, a custom Glanzen (added Magnesium @ 15mg/serving and Se/Vit E), and omeprazole. Since the first colic he's also been on a YeaSac probiotic.

                The vet I trust the most said to eliminate the rolled oats and the omeprazole and after we get through the 3 month period he should be able to go back on his current diet (through a slow transition, of course). I will be testing my load of hay, so thank you for the link, Katy. The stuff I recently picked up is from the western side of the region, and I'm not thrilled with the quality compared to what I've always feed before.

                I did worm him 3 weeks ago and he didn't have any issue with it. He also hasn't ever had runny poop. Is that something that varies from horse to horse?
                Flying F Sport Horses
                Horses in the NW


                • #9
                  I have a very similar situation with my mare, put her on omeprazole three weeks ago and she's been gas colicky and bloated since putting her on it. She had symptoms of both gastric and hindgut ulcers. Took her off the omeprazole this week because it must have exacerbated the hindgut ulcers. Who knew? She's already been on Succeed for one month, but no where did I ever hear/read/been told omeprazole could make hindgut ulcers worse. I wish I had never started her on it.

                  So thank you ERC for the feeding regimen suggestion to get her back on track. I can't stand to see her in pain from the bloating and gas. I already have her on alfalfa pellets with corn oil and psyllium, she's still on orchard/alfalfa hay. So I guess take her off the hay completely? Just feed the pellets more frequently throughout the day? What about soaked alfalfa cubes? That has been mentioned to me as a replacement for the regular flakes I give her.

                  As with PNWjumper, I will do anything to help my girl. Buy a fancy new dressage horse and she arrives with painful ulcers - try treating the ulcers with GastroGard and she gets worse! Ugh!


                  • #10
                    Crap. SO in trying to help my young TB by giving him ranididine, have a screwed him up?
                    I have him on equishure now.


                    • #11
                      I do wish there were more scientific studies on cause and cure of hind gut ulcers vs speculation. Omeprazole has cured 75% of my gelding's symptoms, but I do suspect some hind gut ulcers. FWIW, hate to write it down.... But my guy has never been colicky. Just teeth grinding, girthy, pacey, sleep deprived, spooky, cranky, some cribbing type behavior - yet fat with a healthy appetite. The only things the omeprazole hasn't cured is the girthiness and crankiness about being groomed around the gut as well as a bit of a bloated appearance. He only gets runny poop as he first starts the omeprazole which is a known side effect, but I do wonder if the oil he gets, for EPSM, has a harder time being digested without the stomach acids...
                      Anyway, when you read the descriptions about what the various hind gut supplements do to solve these problems then look at the "miracle" ingredients - I just have a hard time believing they can be worth the money. Equishure is baking soda it seems... And Suceed is oat flour. Tried the super expensive Biostar cookies. The only trial I haven't tried is Sucrafate. SmartDigest Ultra seems to have more of the magic healing ingredients so am trying that next.

                      But my point is, I think omeprazole and ranitidine are more miracle drugs than the hind gut supplements, so to be careful to label them as "bad", but to figure out how to protect and heal the hind gut simultaneously as you heal the stomach ulcers since most horses seem to have both. Would be interesting to see a study on tackling hind gut ulcers first then stomach vs vice versa.


                      • Original Poster

                        Well, I don't have any more answers than I did when all of this started. But since this got resurrected I'll give an update 4 weeks in.

                        My guy came home after 4 1/2 days in the clinic. The vets put him on Triple Crown Senior Feed and Timothy Pellets. For the first couple of days he dove into the grain like a starving horse (which, of course, he was after 3 days of fasting), but he quit eating the timothy pellets pretty early on. And within about 24 hours of coming home his poop got wetter and wetter until he was at cow pie status. In addition, over the course of the next couple of days it started smelling worse and worse. This is a horse who has never had wet manure...not even when he has a "stress poop" (ie getting in the trailer).

                        In the meantime I found a couple of other folks who had been through strikingly similar situations with horses they'd had a while with no colic history colicking while on omeprazole. And my vet talked to several [relatively big name] vets in California and a couple of places back east. All signs pointed towards omeprazole being the culprit and pulling hay out of the diet = bad (in this case).

                        But I gave my guy a week and a half on the grain-only diet and his manure stayed pretty ugly. My vet (not associated with the clinic) finally called me and told me that after talking the whole scenario over many times, she disagreed entirely on the idea of having my guy on grain only, and asked me to put him back on hay. I also read everything I could get my hands on and kept coming across the comment that changing feed drastically is the worse thing you can do for a horse's system. So here I am with a horse who has been on a hay-only diet for 7 years and I put him on a soy-based grain at a time when his system is already stressed. I started adding hay back into his diet a little at a time with no real positive change. Then after a few days I moved him back to hay as his primary food. Within about 24 hours his poop got normal again. I have never been so obsessed over manure, nor have I ever been happier to see poop balls.

                        So now I have him on Succeed, Sucralfate, and a probiotic, and back to his normal diet (free choice orchard grass, 24/7 pasture, and TACO complete feed, which is Timothy, Alfalfa, Corn, and Oats). He's gained back the weight he lost in the vet clinic (which was fairly significant considering it was only 4 days), and he's back to his normal shiny self and normal attitude.

                        I don't know if the omeprazole is really the culprit or just a convenient scapegoat, and I certainly don't mean to imply that I have all (or any of) the answers. But he looks (and presumably feels) great, and is nickering for the grain he's getting despite not being on omeprazole.

                        I would be curious to know if the gas colics are a side effect of omeprazole. And if so, what the actual mechanism that causes that might be (hind gut acidosis/ulcers, or something else). Regardless, I will not be putting my guy back on long term omeprazole again. I still think it can be a great thing for an ulcery horse, but I'm definitely a bit gun shy and would have to have a compelling reason to do it for more than a week or two at a time.
                        Flying F Sport Horses
                        Horses in the NW


                        • #13
                          Originally posted by candico View Post

                          But my point is, I think omeprazole and ranitidine are more miracle drugs than the hind gut supplements, so to be careful to label them as "bad", but to figure out how to protect and heal the hind gut simultaneously as you heal the stomach ulcers since most horses seem to have both. Would be interesting to see a study on tackling hind gut ulcers first then stomach vs vice versa.
                          I re-read all of PNWJumper's posts and she never says omeprazole is 'bad' just that through a process of elimination she has chosen to take away the only obvious change in her horse's life prior to the colic. As she has stated repeatedly, she has no conclusive evidence that the omeprazole is the culprit, but she is trying to remove that to see if she can help her boy.

                          FWIW I too had a horse with a very similar situation and I also eliminated omeprazole. I don't know that the omeprazole caused the colic episodes, but it was the only obvious change to my horse's diet and routine, so why not begin with the most obvious? We are all just trying to do what is best for our horses and there is no harm in discussion. Everyone should consult with his or her vet prior to any medical decisions for their horses, but there is great benefit in an open dialog sharing similar experiences and trying to find a solution. Kudos to PNWJumper for continuing the discussion and for her diligence in trying to find a solution for her horse.

                          I agree that a study tackling hind gut ulcers first then stomach vs. vice versa would be very interesting...and perhaps very needed?!?!?! I've been googling, but can't find anything like that.


                          • #14
                            I think it could just be very possible that some horses just can't handle omeprazole, it is a drug and not every drug is perfect for every horse. Last time I took doxy I broke out in hives oops, switched drugs and I was ok, I had had doxy as a kid and was fine so who knows. I am sure plenty of people can't handle omeprazole as well so it wouldn't surprise me to know of horses that it upsets their stomachs.


                            • #15
                              I'm reading this thread half nervously, hoping for any gems of information.

                              My mare had a colic with small intestine displacement.

                              Her stomach issues started maybe 6 weeks prior with intermittent, small amounts of very liquid diarrhea, especially after working. But most of the big poops were pretty normal. I de-wormed her. The hay had changed, but after a couple weeks I had the vet out. I didn't see sand myself in the test, but maybe it was a little gritty so the vet suggested Sand Clear for a week.

                              When starting the Sand Clear, I also removed Smart Bug Off from her supplements about that time as I've heard that can aggravate sensitive stomachs. Also removed electrolyte (she has a salt lick). And started giving probiotics.

                              The diarrhea got worse with Sand Clear and she was clearly cramping and unhappy. After the week, no more diarrhea.

                              About 1.5 weeks later, colic. With medication, fluids, and maybe 7-10 hours, everything was back where it should be.

                              Now I'm not sure what to do for her. I had ordered UGard before the colic - it has antacid and fiber. We know she's a worrier, so we suspected ulcers. But now I'm nervous to give her any antacids. I kept her on the probiotic.

                              Putting this out in case it helps this case or if anybody has any advice.

                              She's always been pretty easy, eating, pooping, drinking a lot. I did suspect she started drinking less with the Smart Bug Off, though.
                              Born under a rock and owned by beasts!


                              • #16
                                Just spoke to the vet. She recommended dropping the UGard and giving 2 weeks of Ranitidine.
                                Born under a rock and owned by beasts!


                                • #17
                                  OH, pnw your poor horse! How awful!

                                  I won't go on a tirade and villianize omeprazole because it does have benefits. However, I had an awful, awful experience with the stuff myself. I was put on it long-term to treat severe reflux secondary to a hiatal hernia. I ended up with delayed gastric emptying and irritable bowel syndrome which finally resolved once I got off the omeprazole. The only other thing I will say about that is to taper it, unless you've already stopped it cold turkey...the acid rebound can be bad when all those pumps start back up.

                                  There are plenty of studies that have shown that omeprazole (and ranitidine, and other gastric acid supressants) retard gastric motility. My granny always told me you have to keep things moving in the digestive tract, and darnit she was right!


                                  • Original Poster

                                    Originally posted by meaty ogre View Post
                                    OH, pnw your poor horse! How awful!

                                    The only other thing I will say about that is to taper it, unless you've already stopped it cold turkey...the acid rebound can be bad when all those pumps start back up.

                                    There are plenty of studies that have shown that omeprazole (and ranitidine, and other gastric acid supressants) retard gastric motility. My granny always told me you have to keep things moving in the digestive tract, and darnit she was right!
                                    Thanks MO I had actually been in the process of weaning him off of it for the year (since the goal was to only have him on it for the show season) when the second colic hit. The vet clinic promptly put him back on a full dose for his time at the clinic because they felt it was important to keep him from getting ulcers while getting no food (I disagreed, but I'm just the crazy horse owner, not a vet, so my opinion was disregarded). And then I did have him quit cold turkey after that, but he went on sucralfate at the same time, so if any ulcers were to start up they should be dealt with via sucralfate (in theory, I think). It's now been 4 weeks since his last omeprazole and I'm really pleased that he still has a great appetite and appears to be eating as well as he did on omeprazole.

                                    But good point about cutting omeprazole out cold turkey. It would seem that perhaps "cold turkey" is a phrase that should have no part of the horse world!

                                    I forgot to add that I also added apple cider vinegar into his diet. 1 oz twice a day in his grain. I didn't think he would be willing to eat it, but he gobbles it up without complaint.
                                    Flying F Sport Horses
                                    Horses in the NW


                                    • #19
                                      The more I read about all that goes wrong with horse digestion it not only hurts my head, but makes me wonder where we have gone wrong.
                                      Anyway, I have known at least two horses who had issues with right dorsal displacement, repeated gas colics, projectile diarrhea which made you flip a coin as to who did the butt bar, repeated surgeries, various protocols to try and "right" them and what finally worked was TCVM and the herbal formulas prescribed to them. The blue pop rocks are much cheaper in my case, but if costs were the same I would go with Dr. Xie's herbs and in the end I'd probably save money since the herbs are supposed to rebalance or what-have-you wind, wood, fire, excess so that your horse heals itself. Might be worth a look if the hospital vets can't come up with something that you are comfortable with. Have no idea how or why, but these horses were colicking up to three times per week, tried all the traditional protocol, and with the herbs - never had any GI issues again. FWIW


                                      • #20
                                        How is everyone dealing with these hind gut ulcers doing???

                                        I'm going through this with my gelding right now. He has been on the short fibre protocol since September 17th. He is doing much, much better although I still think he is slightly bloated some days, but hard to tell if he is just getting chubby with his slightly higher fat diet.

                                        For those of you with horses on Sucralfate - how long to you intend to keep them on it? I just weaned my guy off after almost 2 months. He is still getting Equishure, pysllium, l-glutamine, yea-sacc and canola oil and flax mixed into his mushy alfalfa pellets and rice bran three times a day.

                                        Just wondering how every one is doing, or if anyone has any new tips or tidbits to share.