Equine gastric disease treatment gets more lesion-specific

Treatment approaches for equine gastric disease are evolving less through a single breakthrough than through a sharper understanding of what clinicians are actually treating. Recent coverage in The Horse highlights that successful care depends on accurate diagnosis, pharmacologic therapy, and management changes together. That reflects where the evidence base now stands: equine gastric disease is not one condition, and treatment decisions increasingly hinge on whether the horse has equine squamous gastric disease, equine glandular gastric disease, or both. (pmc.ncbi.nlm.nih.gov)

That distinction has been building for years. The European College of Equine Internal Medicine consensus statement framed equine gastric ulcer syndrome as two separate syndromes with different pathophysiology, and later reviews have reinforced that split. Squamous disease is primarily associated with acid injury, especially in horses in training or under feeding and management stress. Glandular disease, by contrast, appears more related to breakdown of mucosal defense mechanisms, which helps explain why it can be more frustrating to manage and why some horses worsen despite standard acid suppression. (pmc.ncbi.nlm.nih.gov)

The clinical picture may also differ more than many practitioners once assumed. A retrospective study of 52 horses with gastroscopically confirmed ulcers found a significant association between ulcer location and the type of clinical signs reported: physical signs were seen more often with equine squamous gastric disease, while behavioral or mixed physical-behavioral signs were more common in horses with equine glandular gastric disease or mixed lesions. The same study found associations between both sign type and ulcer location and the horse’s sport activity, but no association between clinical signs and ulcer severity. That does not make clinical diagnosis reliable without scoping, but it does support the idea that lesion location can shape presentation in ways that matter during workup and client conversations. (mdpi.com)

The treatment picture is clearest for squamous disease. Reviews and consensus guidance continue to support omeprazole as first-line therapy, alongside management measures such as increasing forage access, reducing fasting, and adjusting exercise and concentrate feeding. In the U.S., GastroGard remains the only FDA-approved equine gastric ulcer treatment, and the product labeling promoted by Boehringer Ingelheim still positions it as the only FDA-approved treatment with an established efficacy history. Older FDA-linked references also continue to distinguish GastroGard for treatment and UlcerGard for prevention. (animalhealth.boehringer-ingelheim.com)

For glandular disease, the evidence is less straightforward. Retrospective and clinical studies have reported poor healing rates for equine glandular gastric disease with oral omeprazole alone, and one widely cited trial found misoprostol superior to combined omeprazole-sucralfate for healing glandular lesions and improving clinical signs. Other reviews still describe omeprazole plus sucralfate as a common protocol, but the literature increasingly suggests veterinarians should be cautious about expecting the same response they see with squamous ulcers. (pubmed.ncbi.nlm.nih.gov)

Newer research is also focusing on what happens after apparent improvement. A 2025 blinded, randomized, placebo-controlled trial published in Equine Veterinary Journal tested a nutraceutical containing lecithin, pectin, and meadowsweet after omeprazole treatment in 30 horses. The supplement did not significantly prevent recurrence of squamous or glandular disease on gastroscopy, although investigators did observe changes in salivary biomarkers that may suggest effects on mucosal health. In other words, adjunct products may be biologically interesting, but they haven’t yet solved the recurrence problem that clinicians and pet parents regularly face. (pubmed.ncbi.nlm.nih.gov)

Industry and expert commentary broadly match that reading of the evidence. Educational materials from academic and professional sources continue to emphasize gastroscopy as the diagnostic standard, management change as a necessary part of therapy, and caution around extrapolating from squamous disease to glandular disease. Commentary from the University of Illinois and other equine-focused outlets has also highlighted that sucralfate alone is unlikely to be enough, and that glandular disease may call for different or more aggressive protocols than many barns historically used. (vetmed.illinois.edu)

Why it matters: For veterinary professionals, this is really a story about precision in everyday equine practice. Horses with vague performance decline, behavioral change, poor appetite, or intermittent colic signs may still get labeled generically as “ulcer horses,” but the literature increasingly argues for lesion-specific diagnosis and treatment planning. The newer clinical-sign data sharpen that point: behavioral complaints may be especially common in glandular or mixed disease, while more overt physical signs may cluster with squamous lesions, yet severity on gastroscopy does not necessarily predict how the horse presents. That has implications for drug selection, duration of therapy, re-scoping decisions, and client communication. It also matters commercially and regulatorily: in the U.S., veterinarians still have one FDA-approved omeprazole product for treatment, while several adjunctive or alternative approaches sit in a thinner evidence base or outside labeled equine indications. (pmc.ncbi.nlm.nih.gov)

What to watch: The next phase is likely to center on recurrence prevention, better protocols for glandular disease, and more rigorous evaluation of adjuncts such as nutraceuticals and long-acting formulations; clinicians will also be watching whether emerging work on behavioral versus physical sign patterns can improve suspicion and triage before gastroscopy. For now, the strongest evidence still supports diagnosing the lesion type first, then combining targeted pharmacology with management change and follow-up assessment. (pubmed.ncbi.nlm.nih.gov)