Equine gastric disease care shifts toward lesion-specific treatment

Equine gastric disease treatment is increasingly being framed less as a one-drug protocol and more as a diagnosis-led, lesion-specific management problem. That’s the thrust of a March 9, 2026 educational article from The Horse, which says successful treatment starts with accurate diagnosis, then combines pharmacologic therapy with management changes, with repeat gastroscopy as needed to confirm healing. The article features Dr. Ben Sykes, a widely cited authority in equine gastric ulcer syndrome, and reinforces a point that’s become central in equine practice: horses with squamous and glandular disease may look similar clinically, but they often need different therapeutic strategies. (thehorse.com)

That distinction has been building for years. UC Davis’ 2025 equine health review notes that what was once grouped broadly as equine gastric ulcer syndrome is now understood as two separate, sometimes concurrent conditions: equine squamous gastric disease, driven largely by acid exposure, and equine glandular gastric disease, which is more closely linked to breakdown of mucosal defenses. The same review says gastroscopy remains the gold standard and the only definitive way to confirm ulcers, localize lesions, and guide treatment. It also highlights how common recurrence is when underlying feeding and management risks remain in place. (cehhorsereport.vetmed.ucdavis.edu)

On the pharmacology side, omeprazole remains the anchor drug. FDA-approved GastroGard is labeled for treatment and prevention of recurrence of gastric ulcers in horses, with the label describing a 28-day treatment course at 4 mg/kg followed by 2 mg/kg for prevention of recurrence. But the real-world nuance is in how clinicians deploy it. The Horse and other veterinary education sources note that oral omeprazole performs well for squamous disease, while glandular disease is less predictable and often requires combination therapy and more aggressive risk-factor control. UC Davis states plainly that omeprazole alone has a poor success rate for EGGD and may be used in combination with sucralfate and misoprostol. (drugs.com)

The evidence base around glandular disease helps explain why. A PubMed-indexed study found misoprostol was superior to combined omeprazole-sucralfate for treatment of equine glandular gastric disease, underscoring that EGGD may not respond to acid suppression alone. At the same time, research continues to probe what happens after treatment ends. In a 2025 Equine Veterinary Journal trial, investigators tested a commercially available nutraceutical containing lecithin, pectin, and meadowsweet in 30 horses after omeprazole treatment. The supplement did not significantly prevent recurrence of ESGD or EGGD on repeat gastroscopy, even though salivary biomarkers shifted in ways the authors said might suggest improved mucosal health. (pubmed.ncbi.nlm.nih.gov)

Industry and expert commentary are broadly aligned on the bigger message: medication alone usually isn’t enough. In The Horse, Sykes argues that long-term success depends on revisiting feeding practices, stress reduction, and overall horse care. Separate coverage from the same outlet reports that oral omeprazole has a high healing rate for squamous ulcers, but also stresses that treatment should be viewed as a short-term measure while preventive management changes are made in the background. Sykes has also cautioned against over-focusing on tapering omeprazole after treatment, instead emphasizing removal of risk factors during the post-treatment period, when recurrence remains a concern. (thehorse.com)

For veterinary professionals, this matters because equine gastric disease is becoming a more layered pharmacology conversation. The challenge is no longer just whether to prescribe omeprazole, but how to classify disease accurately, decide when adjunctive therapies are justified, and counsel pet parents on why housing, forage access, training intensity, meal timing, and stress load can determine whether a case truly resolves. It also matters from an evidence stewardship standpoint: pet parents are likely to ask about supplements and compounded alternatives, yet the strongest support still sits with FDA-approved omeprazole products and gastroscopy-guided care. FDA has previously warned about unapproved omeprazole products marketed for horses, and testing found potency discrepancies in some of them. (cehhorsereport.vetmed.ucdavis.edu)

The forward look is likely to center on recurrence prevention and better EGGD protocols. Expect more research on adjunctive drugs, biomarkers, and nutrition-based strategies, but also continued insistence that these tools need to prove they improve gastroscopic outcomes, not just surrogate markers. For now, the clearest near-term direction is practical rather than novel: scope the horse, separate ESGD from EGGD, use approved pharmacology appropriately, and build a management plan that gives treatment a chance to last. (pubmed.ncbi.nlm.nih.gov)