Equine gastric disease treatment focus shifts to tailored care
A new sponsored educational item from The Horse is putting a familiar but still clinically important message back in front of equine practitioners: treatment of equine gastric disease works best when it starts with an accurate diagnosis and continues with both medication and management change. In the March 9, 2026, video tip, Dr. Ben Sykes says long-term success depends on tailoring therapy to the horse’s specific disease pattern, reducing risk factors, and repeating gastroscopy when needed to document resolution. (thehorse.com)
That framing reflects how the field has evolved over the past decade. More recent literature has moved away from treating equine gastric ulcer syndrome as a single entity and instead separates equine squamous gastric disease, or ESGD, from equine glandular gastric disease, or EGGD. A 2023 review notes that the distinction became formalized in the European College of Equine Internal Medicine consensus process, and subsequent research has focused especially on the gaps in knowledge around glandular disease. (mdpi-res.com)
The clinical reason that distinction matters is straightforward: the diseases do not behave the same way. UC Davis’ 2025 equine health report says ESGD is largely linked to acid exposure, with risk factors including high-starch feeding, long periods without forage, and more intense exercise. EGGD, by contrast, is more closely tied to breakdown of mucosal defenses and has been associated with management stressors such as single housing, multiple handlers, and more days in work. The same report says gastroscopy remains the only way to confirm whether a horse has squamous lesions, glandular lesions, or both. (cehhorsereport.vetmed.ucdavis.edu)
On treatment, the evidence base still favors omeprazole for squamous disease, but not as a one-size-fits-all answer. The Horse summary points to pharmacologic therapy plus management changes, and outside sources align with that message. UC Davis says omeprazole is the only FDA-approved treatment and is highly effective for ESGD, but has a poor success rate as monotherapy for EGGD. A randomized clinical trial indexed in PubMed found glandular ulcers improved less completely than squamous ulcers under oral omeprazole treatment. Another study found misoprostol outperformed combined omeprazole-sucralfate for treatment of EGGD, highlighting how glandular cases may need a different therapeutic strategy. (thehorse.com)
There’s also growing interest in what happens after apparent healing. A blinded, randomized, placebo-controlled trial in Equine Veterinary Journal evaluated a nutraceutical containing lecithin, pectin, and meadowsweet after omeprazole treatment. The supplement did not significantly prevent ulcer recurrence on gastroscopy, but investigators reported changes in salivary biomarkers that could suggest effects on gastric mucosal health. Separately, a 2025 Kentucky Equine Research report highlighted work on wireless gastric pH monitoring, arguing that better continuous measurement could help explain why some horses appear to relapse quickly after omeprazole withdrawal. (ker.com)
Industry and expert commentary broadly reinforce the same point: management is not optional. Kelato materials tied to Dr. Sykes’ educational work emphasize that omeprazole remains the treatment of choice for squamous disease, while efficacy for glandular disease is less certain, and that prevention depends on addressing feeding practices, stress, and routine. Because the newest The Horse item is sponsored, that commercial context matters, but the core clinical message is consistent with the independent review literature and university-based educational materials. (kelato.com.au)
Why it matters: For equine veterinarians, this is a reminder to resist empirical “ulcer treatment” as a blanket approach, especially in performance horses with vague signs. The literature continues to show that lesion location changes the diagnostic and therapeutic plan, and that recurrence is likely if forage access, meal timing, exercise intensity, travel, confinement, or other stressors are left unaddressed. That has implications for client communication with pet parents, follow-up scoping, medication selection, and expectations around duration of care. (cehhorsereport.vetmed.ucdavis.edu)
What to watch: The next wave of change will likely center on better recurrence-prevention protocols, more data on adjunctive or alternative therapies for EGGD, and improved monitoring tools that help clinicians decide when treatment has truly worked and when a horse’s management plan still needs adjustment. (ker.com)