Equine gastric disease care shifts toward lesion-specific treatment

Treatment of equine gastric disease is still centered on a familiar message, but one that’s getting sharper in practice: scope first, then match therapy to lesion type, while changing management at the same time. A new sponsored educational piece from The Horse, featuring equine internal medicine specialist Dr. Ben Sykes, emphasizes that gastroscopy remains the only way to confirm disease and distinguish equine squamous gastric disease from equine glandular gastric disease, which respond differently to treatment. Current background sources continue to support omeprazole as the main pharmacologic option, with FDA-approved GastroGard labeled for treatment and prevention of recurrence of gastric ulcers in horses, while glandular disease often needs a broader plan that can include sucralfate or misoprostol alongside management changes. (thehorse.com)

Why it matters: For equine veterinarians, the practical takeaway is that “gastric ulcers” shouldn’t be treated as a single disease category. The distinction between ESGD and EGGD matters for case workups, client communication, treatment selection, and expectations for response and recurrence. That’s especially relevant as recurrence after stopping omeprazole remains common, and a 2025 randomized, placebo-controlled Equine Veterinary Journal study found that a lecithin-pectin-meadowsweet nutraceutical did not significantly prevent recurrence on gastroscopy after omeprazole treatment, despite changes in salivary biomarkers. In other words, supplements may generate interest from pet parents and trainers, but the evidence still favors diagnosis-led pharmacology plus feeding, housing, exercise, and stress-management changes. (pubmed.ncbi.nlm.nih.gov)

What to watch: Expect continued scrutiny of recurrence prevention, especially for glandular disease, and more discussion around when adjunctive therapies or nutraceuticals truly add value beyond omeprazole and management reform. (pubmed.ncbi.nlm.nih.gov)