Equine gastric disease treatment grows more targeted

Accurate diagnosis remains the starting point for treating equine gastric disease, with current guidance emphasizing gastroscopy to distinguish equine squamous gastric disease from equine glandular gastric disease before choosing therapy. A recent The Horse educational piece, sponsored by Kelato, reinforces the now-familiar framework: pharmacologic treatment, usually centered on acid suppression, should be paired with management changes such as forage access, meal timing, and reduction of known risk factors. That message aligns with the European College of Equine Internal Medicine consensus statement, which says gastroscopy is the only reliable antemortem method for definitive diagnosis and recommends omeprazole-based protocols, with sucralfate commonly added for glandular disease. More recent reporting and conference coverage also suggest the treatment conversation is evolving, with growing interest in long-acting injectable omeprazole and esomeprazole for cases that respond poorly to standard oral therapy. (thehorse.com)

Why it matters: For equine veterinarians, the practical takeaway is that “gastric ulcer” is still too broad a label to guide treatment well. Squamous and glandular disease differ in pathophysiology and treatment response, and glandular lesions can be more refractory. Evidence continues to support omeprazole as the backbone of therapy, while H2-receptor antagonists appear less effective, and sucralfate alone has shown weaker performance than omeprazole in comparative work. A 2025 randomized, placebo-controlled Equine Veterinary Journal study also underscores how limited the evidence remains for adjunct nutraceuticals: the tested product did not significantly prevent ulcer recurrence on gastroscopy after omeprazole treatment, despite changes in salivary biomarkers. (ukvetequine.com)

What to watch: Expect more scrutiny of formulation choice, repeat-scoping protocols, and whether newer options such as long-acting injectable omeprazole can improve outcomes, especially in glandular disease and recurrence prevention. (ukvetequine.com)