Equine Gastric Ulcers: Why Understanding the Difference Matters
Equine gastric ulcers are a common problem affecting horses across all disciplines, from racehorses and competition horses to leisure horses. However, not all gastric ulcers are the same, and understanding the differences is essential for effective diagnosis, treatment and prevention.
The European College of Equine Internal Medicine (ECEIM) published a consensus statement in 2015 highlighting the importance of distinguishing between two forms of equine gastric disease.
Two Distinct Types of Gastric Disease
Equine Gastric Ulcer Syndrome (EGUS) is an umbrella term encompassing two distinct conditions:
Equine Squamous Gastric Disease (ESGD): Affects the upper, non-glandular region of the stomach, which has limited protection against gastric acid.
Equine Glandular Gastric Disease (EGGD): Affects the lower, glandular region, which normally has protective mechanisms to withstand acidic conditions.
This distinction matters because the underlying disease processes and responses to treatment differ considerably.
ESGD is primarily associated with excessive acid exposure, often influenced by feeding practices, exercise and management. EGGD is less well understood but is thought to involve disruption of the stomach's natural mucosal defence mechanisms.
How Common Are Gastric Ulcers?
Gastric disease is not restricted to elite performance horses. The consensus statement reports ESGD prevalence reaching 80–100% in Thoroughbred racehorses after two to three months of training. Studies of sport and leisure horses also demonstrate substantial levels of gastric disease. Importantly, glandular disease is common too, with one UK study identifying EGGD in 54% of leisure horses and 64% of sport horses examined. These findings reinforce the importance of considering gastric disease across different equine populations.
Recognising the Clinical Signs
Horses with gastric ulcers may demonstrate:
Reduced appetite or selective eating
Weight loss or poor body condition
Recurrent colic or abdominal discomfort
Changes in behaviour or temperament
Reduced athletic performance
However, these signs are not specific to gastric ulcers, and some affected horses display no obvious abnormalities. The ECEIM consensus emphasises that clinical signs alone cannot reliably diagnose EGUS. Gastroscopy remains the only reliable method of definitively identifying gastric ulceration in the living horse. A thorough examination should assess both squamous and glandular regions, including the pylorus.
Why Treatment Must Be Tailored
One of the most important findings concerns differences in treatment response. The consensus statement reports healing rates of approximately 70–80% for ESGD following conventional omeprazole treatment. In contrast, studies reported only around 25% healing of EGGD lesions following 28–35 days of omeprazole alone. These differences demonstrate why identifying the affected region before treatment is so important.
Management and Prevention
Practical management recommendations include providing adequate forage, avoiding prolonged periods without feed, limiting excessive starch intake and ensuring continuous access to water. Exercise intensity and management practices should also be considered when assessing individual risk.
The Take-Home Message
Equine gastric disease is not a single condition, and successful management requires an individualised approach. Accurate diagnosis, appropriate treatment selection and follow-up gastroscopy are fundamental to achieving the best outcomes.
At DV Consultants, we recognise the importance of evidence-based veterinary medicine and a thorough understanding of the factors influencing equine gastrointestinal health. If you are concerned about gastric ulcers in your horse - speak to your vet who will be best placed to advise you on the appropriate diagnostics and treatment options.
Reference: Sykes BW, Hewetson M, Hepburn RJ, Luthersson N, Tamzali Y. European College of Equine Internal Medicine Consensus Statement—Equine Gastric Ulcer Syndrome in Adult Horses. Journal of Veterinary Internal Medicine. 2015;29:1288–1299. DOI: 10.1111/jvim.13578.
