Equine gastric disease treatment is getting more targeted

Treatment approaches for equine gastric disease are continuing to sharpen around one core message: horses with suspected gastric disease need a specific diagnosis, because equine squamous gastric disease and equine glandular gastric disease don’t behave the same way and shouldn’t be managed as if they do. Recent educational coverage from The Horse emphasized that pharmacologic treatment should be paired with management changes, while the broader literature continues to support gastroscopy as the diagnostic standard and omeprazole as a central therapy, especially for squamous disease. More recent commentary and reviews also highlight a practical shift in how clinicians think about treatment delivery, including the effect of feeding on omeprazole absorption and the growing recognition that glandular disease can be harder to resolve and may require a different multimodal plan. (thehorse.com)

Why it matters: For veterinarians, the takeaway is less about a new drug and more about better treatment matching. Consensus guidance and subsequent reviews argue against relying on empiric treatment alone when gastroscopy is available, because lesion location matters for prognosis, drug choice, and prevention planning. Omeprazole remains the mainstay for equine squamous gastric disease, but glandular disease often needs closer attention to stress, exercise load, rest, feeding strategy, and, in some cases, adjunctive drugs such as misoprostol or sucralfate under veterinary direction. Evidence also suggests that sucralfate alone may be less protective than omeprazole in horses exposed to fasting and NSAIDs. And while nutraceuticals continue to draw interest for recurrence prevention, a blinded randomized placebo-controlled trial found no significant gastroscopic benefit after omeprazole treatment: only five horses in the study remained ulcer-free by the end, regardless of whether they received the nutraceutical or placebo. (pmc.ncbi.nlm.nih.gov, pubmed.ncbi.nlm.nih.gov)

What to watch: Expect continued focus on lesion-specific protocols, post-treatment recurrence prevention, and whether nutraceuticals or other adjuncts can meaningfully improve outcomes beyond acid suppression alone. The recurrence question remains especially important because available trial data suggest ulcers commonly return after pharmacologic treatment stops, even when horses stay in their usual home and training environments. (pubmed.ncbi.nlm.nih.gov)