Equine gastric disease treatment gets more precise

Equine gastric disease treatment is getting more nuanced, even if the headline therapies look familiar. A new educational piece from The Horse, published March 9, 2026, underscores a message that many equine practitioners already know from the literature: successful treatment depends on accurate diagnosis, targeted pharmacology, and management changes working together. (thehorse.com)

That framing reflects how the field has evolved over the past decade. What used to be discussed broadly as equine gastric ulcer syndrome is now more precisely divided into equine squamous gastric disease and equine glandular gastric disease. A 2023 review in Animals notes that the distinction matters because these are separate disease entities with different lesion locations, risk factors, and evidence bases for treatment. ESGD is largely associated with acid exposure to the poorly protected squamous mucosa, while EGGD appears more tied to impaired mucosal defense and inflammation. (mdpi-res.com)

In practice, that means diagnosis still drives everything. UC Davis equine guidance published in 2025 states that gastroscopy is the only way to definitively diagnose the presence, type, and severity of gastric ulcers in horses, and warns that clinical signs such as poor performance or weight loss are not specific enough to replace scoping. The same guidance also stresses that FDA-approved omeprazole products are the only approved medications in the U.S. for treatment and prevention of gastric ulcers, respectively, and cautions that compounded products can vary in pH, bioavailability, and effectiveness. (cehhorsereport.vetmed.ucdavis.edu)

The pharmacology story remains centered on omeprazole, but with caveats. A meta-analysis published in Equine Veterinary Journal found that prophylactic omeprazole significantly reduced gastric ulceration in horses in active training, with an absolute effect of 566 fewer ulcers per 1,000 horses treated. At the same time, other reports suggest clinicians should be careful not to overgeneralize that benefit across all gastric disease. University of Illinois investigators reported that omeprazole outperformed sucralfate monotherapy in a fasting and NSAID model, including for glandular lesion scores, but that does not settle the broader question of optimal therapy for naturally occurring EGGD, where response remains more variable. (pubmed.ncbi.nlm.nih.gov)

Recent recurrence data add another layer. A 2025 Equine Veterinary Journal trial evaluated a commercially available nutraceutical containing lecithin, pectin, and meadowsweet after omeprazole treatment in 30 horses with recent ESGD and EGGD. The supplement did not significantly outperform placebo for preventing recurrence on repeated gastroscopy; regardless of group assignment, only five horses remained ulcer-free by the end of the trial. The authors did report biomarker differences, including lower salivary ADA and higher bicarbonate concentrations in the nutraceutical group, suggesting a possible effect on mucosal health that did not translate into clear endoscopic benefit in this study. (pubmed.ncbi.nlm.nih.gov)

Expert commentary has also focused on what happens after acid suppression stops. In The Horse, Pamela Wilkins, DVM, MS, PhD, Dipl. ACVIM, ACVECC, described EGUS as an umbrella term covering lesions in either the squamous or glandular stomach, while emphasizing that each is effectively its own disease. That article also highlighted evidence that squamous ulcers can recur to pretreatment levels within as little as three days after omeprazole discontinuation, reinforcing why post-treatment management matters as much as the drug course itself. (thehorse.com)

Why it matters: For veterinarians, the bigger message is that equine gastric disease is no longer a one-protocol problem. Scoping remains central, because treatment decisions should be based on whether the horse has ESGD, EGGD, or both. Omeprazole remains foundational, particularly for acid-driven squamous disease, but recurrence is common, glandular disease can be harder to resolve, and supplements marketed for prevention still need stronger evidence before they can be positioned as reliable substitutes for proven therapy and management change. For pet parents, trainers, and barns, that translates into a more realistic conversation: medications help, but forage access, exercise timing, stress reduction, and follow-up evaluation remain part of the treatment plan. (mdpi-res.com)

What to watch: The next phase of this story will likely center on better recurrence-prevention protocols, clearer evidence for adjunctive therapies in EGGD, and whether salivary or other noninvasive biomarkers can eventually complement, though not replace, gastroscopy in monitoring response. (pubmed.ncbi.nlm.nih.gov)