Expedited management of ulcer, colic and diarrhea in 209 horses: An open-labeled observational study of a potency-enhanced sucralfate-like elm phyto-saccharide

A potency-enhanced polyanionic phyto-saccharide of elm mucilage (PEPPS) was prescribed in 209 horses in an open-labeled field trial. Clients provided informed consent to 32 equine veterinarians to prescribe PEPPS for low grade colic and diarrhea unresponsive to deworming. Most of the horses (n = 175/209) were presumed to have ulcers clinically, while 23/209 were confirmed by gastroscopy to have ulcers and 11/209 horses had colic related to diarrhea. A 4-day/7-dose response rate, determined by veterinarians’ consensus, provided the threshold for a significant clinical outcome, and data was collected through phone interviews over period of 3.5 years. 166/198 horses with ulcer associated colic and 10/11 horses with diarrhea-associated colic responded to PEPPS within 4 days or 7 doses. Using PEPPS alone was associated with positive outcomes in 81% (29/36) of horses. PEPPS added to failed regimens of omeprazole, ranitidine and antacids was associated with positive outcomes in 85% (137/162) of horses. Accelerated healing of ulcers occurred in 8 horses within 14 to 20 days using PEPPS alone and in 15 horses using PEPPS added to failed treatment regimens of omeprazole, ranitidine and antacid. PEPPS appears useful for managing equine ulcer, diarrhea and colic. As an electronegative polyanionic saccharide with substantial muco-adherence, PEPPS was compared to sucralfate. However, a randomized blinded placebo controlled trial is needed to quantify true clinical efficacy.