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Ulcers (or something else)?

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    Ulcers (or something else)?

    Looking for help (have a call into my vet but it's the weekend). New horse came and had what we believed to be bad ulcers. I treated for a few weeks with ulcergard (full tubes) and saw no improvement. Added in Nexium for a month and still not much improvement. Vet then put him on Sucralfate which made a huge difference (night and day). Horse happily went to work. Prior to the Sucralfate, he would bolt about 10 minutes into a ride, presumably when the acid starting hitting his stomach. Was on the Sucralfate (in addition to Nexium) for a month and I weaned him off of it. Took him to a horse show last weekend and then this past week it's back to bolting again. I haven't taken him off the Nexium but it seemed to do nothing to prevent the Ulcers from coming back. Does anyone have any advice? I don't know what to do from here. Obviously frustrated and want my poor boy feeling better.

    If sucralfate improves him, that is suggestive of hind gut ulcers. The PPIs don't do jack for that, and may make ulcers in that area worse.

    Sure sounds like it's time to scope to see what exactly is going on in the stomach and then really evaluate him from a hind gut perspective. Equishure and Succeed are two things that address hind gut ulceration.


      Original Poster

      Thanks! How are they evaluating hind gut these days? Was there a blood test?


        There's a fecal test, but it's not terribly reliable. I think you can also ultrasound the colon? It's really a "treat it and see" sort of deal, I think...


          Might be worth putting the horse on Succeed, which is supposed to help with hind gut ulcers. I kept my guy on it for a year or so before moving him to SmartDigest Ultra which is very similar, but much less expensive. On that note, I won't treat a horse for stomach ulcers without also adding in a hind gut supplement because of a horse I have who colicked badly (gas colic) as a result of being on long term omeprazole which definitely helped his stomach ulcers, but my vets and I believe led to bad hind gut ulcers and ultimately the two colics.

          But also, it could be stomach AND hind gut ulcers.

          Are you doing anything diet wise to help the horse? Beyond free choice orchard grass, grain, and Platinum Performance, like everyone else, my two ulcer prone horses get: a flake of alfalfa in the AM and Smart Digest Ultra along with 1-2 oz of Apple Cider Vinegar, and then in the PM more Apple Cider Vinegar. My vet has also suggested Aloe Vera juice, but I tried the Apple Cider Vinegar first and the horses seem to love it and didn't ever move on (or add or try) the Aloe Vera juice.
          Flying F Sport Horses
          Horses in the NW


            Agreed with Simkie that improvement on sucralfate suggests hind gut. I have my ulcer prone guy on KER RiteTrac (it contains EquiShure) which is for whole digestive system health and he seems to be responding well to it. It's a bit pricey but worth it with the other supplements I was able to drop and not having to treat with UG or sucralfate as often. I also feed alfalfa pellets with each meal and soaked alfalfa cubes at night check. My guy also does well if I give him a handful of mint Tums while in tacking up. It seems to settle his belly from anticipation of ulcer-related discomfort. Good luck!
            "Last time I picked your feet, you broke my toe!"


              Personally I wouldn't guess. I would start with a gastroscope often something will show.


                Time for some diagnostics. Scope the stomach, and make sure they run it all the way to the exit (the pylorus) because ulcers there can be much different/harder to treat. Then ultrasound the colon to check for thickening (indicative of hind gut ulcers). Finally, a fecal occult blood test can help you figure out if there are bleeding ulcers in the digestive tract, and if so, roughly where.

                Those three things, along with behavior and response to meds, should get you moving in the right direction.


                  I agree with the formal diagnostics suggestion, but also want to say I seem to be having a good response to Purina Outlast supplementation. I only feed it as a snack before rides, and before trailering, but it can be fed as a regular supplement. I think you can feed a max of 5 servings a day - I'd have to look up the feeding guide.

                  I have suspected that my horse gets mild ulcer flare ups that come and go. What makes me think this is he will have bouts of sensitivity in the chest, and his flank and girth areas on the right side, when I groom him (this was one of his symotoms, along with more severe ones, back when I had to treat a full blown case of ulcers years ago).

                  Since starting the Outlast he hasn't had any of this sensitivity and also just seems more chilled. Plus he loooooves it, so even if it isn't doing anything magical, it is his favorite treat these days.


                    You weaned him off the Sucralfate, then took him to a show, correct? Was he back on the Sucralfate before, during and after the show for a few days? If not, I'd assume the ulcers flared back up from stress. I'd do another round of Sucralfate and taper. Then the next time he's in a stressful situation, like traveling, I'd start the Sucralfate and Nexium 2-3 days before and keep him on it 2-3 days after he gets home.