Horse Gastric Ulcer Scoring: Endoscopy and Treatment Monitoring

Gastroscopic scoring of equine gastric ulcers provides objective disease severity assessment essential for appropriate treatment selection and welfare monitoring.

Key Facts

The EGUS grading scale (0-4) provides standardized severity scoring for equine gastric ulcer syndrome
Grade 0-1 lesions may not require pharmacological treatment — management change alone may be sufficient
Grade 3-4 lesions involving deep ulceration require immediate omeprazole treatment at therapeutic dose
Glandular disease requires different treatment to squamous disease — misidentification leads to treatment failure
Repeat gastroscopy at 28 days confirms treatment response and guides continuation decisions
Horses may appear clinically normal with grade 3-4 ulcers — endoscopy cannot be replaced by clinical assessment alone

Welfare Considerations

Gastroscopic scoring creates accountability in equine ulcer management — welfare decisions are based on objective evidence rather than clinical impression. Without endoscopy, treatment is empirical and continuation decisions are made without evidence of response. The 28-day re-scope protocol has transformed equine gastric welfare by creating a feedback loop: treatment is confirmed effective, doses adjusted if response is inadequate, and management changes evaluated objectively. The cost of gastroscopy is frequently cited as a barrier, but compared to months of ineffective empirical treatment and ongoing welfare harm, endoscopy represents excellent value.

What You Can Do

Request gastroscopy before starting any equine ulcer treatment — diagnosis should precede treatment
Schedule a 28-day re-scope to confirm treatment response and guide continuation decisions
Work with your veterinarian to identify and address management factors alongside pharmacological treatment
Support equine welfare research improving gastroscopy technique and welfare assessment protocols