Ulcers. Again.

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HopOnTrot

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If you remember, I had my mare scoped a year ago as I suspected ulcers, what we found was a nodule near the pylorus that was stopping the stomach from emptying. Medical intervention didn't work so we ended up having the nodule removed via laser.

We rescoped in June and again this month. Nodule is no longer an issue but ulcers still are. Grade 3 squamous ulcers on today's scope. Vet is going to prescribe Gastro Guard (again). We have been on a mix of gastroguard, misoprostal and sulfracate on and off for a year. Last scope the ulcers weren't as bad so she was just give a course of misoprostol.

What on earth is causing them?
Horse is semi retired, hacks out for half an hour twice a week, mostly walking and maybe the odd trot if she wishes to.
Horse lives out 24/7 in a stable herd with access to forage
Horse rarely travels and never travels for more than 20 mins.
Horse is fed a diet that contains certain gut friendly things (pectin and lecithin, as per vet) but also probiotic live yeast alongside prebiotic MOS & FOS

Said horse is now 22, but what do I do? Realistically I have to carry on scoping and treating ulcers every three months, not scoping and treating could leave her in pain so I can't do that, I don't think stomach ulcers warrant PTS yet either, horse maintains weight well, looks good and honestly until you shove a camera down her throat you wouldn't even guess there was an issue. On paper she should not be having these issues.

Any bright ideas?
 
Is she on any pain relief? Horses that age are likely to have niggles. Bozmerix seems to work for one of mine that has gut issues and I've noticed a difference if she comes off it. With her there are some issues in her body which could be causing some discomfort (wonky legs) and the low level pain relief does seem to help.
 
Does she look bothered?

To expand on that - I would treat the horse not the scope. If she looks miserable, in pain, tense, mouth clenched, compensating, lame, grumpy….you need to find what’s hurting her.

If she’s happy, then why throw money at it? I think that in years to come ulcers will be given ‘incidental finding’ status.
 
Thanks guys, a few questions for the vet added to the list! I will have a look at boswellia, as she could have something going on due to her age.

@Patterdale I would say that's a good measure of most horses but not this one, she's really stoic, queen of the quiet protest, when her stomach wasn't emptying and full of ulcers and rotting food the only sign was that she wouldn't trot out hacking and her poo smelt, she's never ever in over 13 years raised a leg of even flicked an ear in protest, I can tack her up loose in the field.

I wonder if the lack of grass this summer might be behind it, they were getting haylage in the field but the grass was incredibly poor.
 
I'm with @SEL here, ulcers can be caused by pain, taking into account her age I'd try her on some pain relief as well as treating ulcers and that hopefully will stop them from coming back. What pain relief you could try is a discussion for the vet. Equioxx is one that is supposed to be kinder on the stomach than bute/danilon but I'm not sure about giving it whilst there's active ulcers. Or perhaps a course of catrophen which is injectable and not traditional pain relief but would help if there's arthritis somewhere niggling her.
 
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Just spoken to vet, these ulcers aren’t related to the other issue so no scoping again until next year.

We suspect the ulcers may have been triggered by the poor grass this summer, either way we’re doing a tapering course of gastroguard. We think the ulcers were behind her looking uncomfortable chewing on the odd occasion (I suspected teeth but nothing too bad found on her teeth).

I’m going to ask about broad pain relief options that won’t affect her gut.
 
Could you possibly look at injectable omeprazole? Rather than the oral ?
Can have a better effect with some horses and doesn't need to be given on an empty stomach
 
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