Equine gastric disease treatment grows more targeted
Treatment approaches for equine gastric disease are getting more nuanced, even if the core message hasn’t changed: diagnose first, then match the therapy to the lesion type and the horse’s management risks. A recent The Horse educational article, sponsored by Kelato, highlights that treatment works best when pharmacology is combined with management changes, reflecting a broader shift away from one-size-fits-all “ulcer treatment” toward more targeted plans for equine squamous gastric disease, or ESGD, and equine glandular gastric disease, or EGGD. (thehorse.com)
That distinction matters because the field has spent the past decade moving beyond the umbrella term equine gastric ulcer syndrome. The European College of Equine Internal Medicine consensus statement recommended separating squamous and glandular disease in both research and clinical communication, noting that the two conditions differ in prevalence, pathophysiology, and response to therapy. The same statement says gastroscopy is the only reliable antemortem diagnostic method and advises against relying on clinical signs alone, which are nonspecific and poorly associated with confirmed disease. (edu-veterinar.ro)
On treatment, omeprazole remains the anchor therapy. The ECEIM statement recommends omeprazole protocols for ESGD and omeprazole plus sucralfate for EGGD, with follow-up gastroscopy before stopping treatment for squamous disease and a control examination at about four weeks for glandular disease. Management changes are not optional add-ons: consensus guidance ties medical treatment to forage intake, lower starch load, meal spacing, and reduction of husbandry factors that increase gastric injury risk. (edu-veterinar.ro)
Recent literature adds both reassurance and caution. A UK Vet Equine review reported ESGD healing rates of roughly 67% to 92%, depending on formulation, population, and how the drug is administered, while also noting that glandular disease often responds less predictably. The same review points to promising data for long-acting injectable omeprazole in some countries, including better glandular outcomes with five-day rather than seven-day dosing intervals, but it also flags injection-site reactions as a concern. EquiManagement’s coverage of 2024 AAEP research similarly described stronger healing rates for injectable omeprazole than daily oral omeprazole in some EGGD studies, suggesting the profession is actively reassessing whether acid suppression can be delivered more effectively. (ukvetequine.com)
Comparative data also continue to narrow the role of older or adjunctive therapies. University of Illinois researchers reported that, in an experimental model involving fasting and flunixin exposure, omeprazole outperformed sucralfate for glandular disease scores, and sucralfate alone was not effective for prevention of EGGD in that setting. H2-receptor antagonists remain part of the historical treatment discussion, but consensus guidance and later reviews describe them as less effective than omeprazole in adult horses. (vetmed.illinois.edu)
The nutraceutical story is even less settled. A 2025 blinded, randomized, placebo-controlled trial in Equine Veterinary Journal tested a compound containing lecithin, pectin, and meadowsweet after omeprazole treatment in 30 horses. The study did not find a significant effect on ulcer recurrence by gastroscopy, though it did detect changes in salivary biomarkers that the authors said could suggest effects on mucosal health. For clinicians, that’s a useful reminder that biomarker shifts and endoscopic outcomes are not the same thing, and that recurrence prevention still lacks robust evidence beyond risk-factor control and established pharmacology. (pubmed.ncbi.nlm.nih.gov)
Why it matters: For veterinary professionals, this is less about a brand-new treatment breakthrough and more about sharpening case selection and expectations. Horses with suspected gastric disease still need lesion-specific diagnosis, because ESGD and EGGD don’t behave the same way and shouldn’t be managed as if they do. Oral omeprazole remains foundational, but formulation, timing, compliance, and follow-up scoping can materially affect outcomes. Meanwhile, newer options such as esomeprazole and long-acting injectable omeprazole may expand the toolkit for difficult or recurrent cases, especially where oral administration is impractical, but the evidence base is still developing and local product availability varies. (edu-veterinar.ro)
What to watch: The next phase of this story will likely center on head-to-head treatment data for glandular disease, recurrence-prevention strategies after omeprazole, and whether emerging protocols can improve healing without creating new practical or adverse-event tradeoffs. (pubmed.ncbi.nlm.nih.gov)