Horse Gastric Ulcer Syndrome: Advanced Management

Evidence-based management of equine gastric ulcer syndrome (EGUS) addressing both squamous and glandular forms of the disease.

Key Facts

EGUS encompasses both equine squamous gastric disease (ESGD) and equine glandular gastric disease (EGGD), which have different causes and treatment responses
ESGD affects the upper (squamous) stomach lining through acid splash during exercise and management with long periods without forage
EGGD affects the lower (glandular) stomach and is associated with stress, NSAIDs, and possibly Helicobacter-like bacteria
Omeprazole is highly effective for ESGD but shows more variable treatment response for EGGD, which may require additional agents
Dietary management — increasing forage, reducing concentrate meals, and providing hay before exercise — addresses ESGD risk factors
Sucralfate provides mucosal protection for EGGD that omeprazole alone does not achieve through acid suppression

Welfare Considerations

Gastric ulcer syndrome in horses is a welfare crisis that affects a very large proportion of horses in training and performance disciplines — with prevalence rates in racehorses of up to 90%, many affected horses live with chronic abdominal pain that is either unrecognized or managed only partially. The behavioral signs — poor performance, girthiness, reluctance to work, and behavioral changes — are often misattributed to training problems or poor temperament rather than pain. The distinction between ESGD and EGGD is clinically important because they require different management approaches: purely dietary solutions address ESGD risk but less effectively address EGGD. Comprehensive management requires endoscopic diagnosis to determine which form is present before committing to a treatment protocol.

What You Can Do

Have horses with suspected ulcer signs scoped endoscopically to confirm diagnosis and determine whether ESGD, EGGD, or both are present
Implement dietary management including ad libitum hay access, hay before exercise, and reduced concentrate meals regardless of which form is diagnosed
Follow the full prescribed treatment course with appropriate medication before rescoping to confirm healing
Work with your veterinarian to identify and reduce stress factors in your horse management and training environment
Maintain forage-based feeding practices after treatment to reduce ESGD recurrence risk