Horse Gastric Ulcer Scoring and Treatment Monitoring

Gastroscopy allows direct visualization and grading of equine gastric ulcers. Understanding scoring systems and treatment monitoring enables welfare-optimal management.

Key Facts

EGUS is classified into equine squamous gastric disease (ESGD) and equine glandular gastric disease (EGGD)
The ECEIM consensus grading system scores ulcers from 0 (normal) to 4 (extensive deep ulceration)
Omeprazole (GastroGard) is the gold standard treatment for ESGD, achieving healing in 77-92% of cases in 28 days
EGGD responds less reliably to omeprazole and may require sucralfate or misoprostol as adjuncts
Repeat gastroscopy after 28 days of treatment confirms healing and guides decision on treatment cessation
Failure to confirm healing before stopping treatment leads to early recurrence in a significant proportion of horses

Welfare Considerations

Treatment monitoring by repeat gastroscopy is a welfare investment, not an optional extra. Stopping treatment before ulcers have healed results in rapid recurrence and ongoing pain. The horse that appeared clinically improved after 28 days of omeprazole may still have visible ulceration requiring extended treatment. Objective confirmation of healing before treatment cessation ensures that the horse is genuinely pain-free rather than simply tolerating residual discomfort more stoically as treatment continues.

What You Can Do

Arrange gastroscopy for diagnosis when EGUS is suspected — clinical signs alone cannot reliably diagnose or grade disease
Begin omeprazole treatment promptly at the recommended dose for the full 28-day initial course
Implement management changes alongside medication — forage access, reduced stress, appropriate feeding
Repeat gastroscopy at 28 days to assess healing before making decisions about treatment cessation
Continue treatment for an additional 14-28 days if healing is incomplete at first recheck
Implement preventive management long-term — healed ulcers recur rapidly without management changes