Equine gastric disease treatment gets more lesion-specific

Treatment approaches for equine gastric disease are getting more nuanced, with a clearer split between how veterinarians manage equine squamous gastric disease and equine glandular gastric disease. Recent educational coverage from The Horse underscores a now-familiar clinical message: treatment works best when it starts with gastroscopic diagnosis and pairs pharmacologic therapy with management changes, rather than relying on medication alone. That aligns with the broader literature, which consistently supports omeprazole as the mainstay for squamous disease, while glandular disease remains harder to treat and may require combination therapy or alternatives such as misoprostol. In the U.S., omeprazole paste remains the only FDA-approved treatment option for equine gastric ulcers, marketed as GastroGard. (animalhealth.boehringer-ingelheim.com)

Why it matters: For equine practitioners, the practical takeaway is that “gastric ulcers” can’t be treated as a single entity. Consensus guidance and subsequent studies have shown that squamous lesions, driven largely by acid exposure, respond well to acid suppression and feeding-management changes, while glandular lesions appear more tied to impaired mucosal defense and show lower, less predictable healing rates with omeprazole alone. Emerging clinical-sign data add another reason not to generalize: a retrospective study found physical signs were more often associated with squamous disease, while behavioral or mixed signs were more common in horses with glandular or mixed ulceration, reinforcing that presentation may differ by lesion location even though signs remain nonspecific overall. That makes case definition, follow-up gastroscopy, and expectation-setting with pet parents especially important, particularly in performance horses where recurrence after treatment withdrawal is common. (pmc.ncbi.nlm.nih.gov)

What to watch: Expect continued interest in recurrence prevention, including adjunct nutraceuticals, but so far evidence remains preliminary and not strong enough to replace evidence-based pharmacologic and management protocols. Clinicians will also be watching whether newer work on behavioral versus physical presentation helps refine when to suspect squamous versus glandular disease before scoping, especially in sport horses. (pubmed.ncbi.nlm.nih.gov)