Equine gastric disease treatment keeps shifting toward targeted care

A new sponsored educational piece from The Horse underscores a familiar but still clinically important message for equine practice: successful treatment of gastric disease depends on first identifying what kind of lesion is present. In the March 9, 2026, article and video, Dr. Ben Sykes said treatment should pair pharmacologic therapy with management changes, and that follow-up gastroscopy is often needed to verify resolution rather than assuming clinical signs alone reflect healing. (thehorse.com)

That framing aligns with the long-running shift away from using equine gastric ulcer syndrome as a one-size-fits-all diagnosis. The ECEIM consensus statement emphasized that disease of the squamous mucosa and disease of the glandular mucosa differ in pathophysiology, risk factors, and treatment response. That distinction matters because horses with squamous lesions often improve with acid suppression alone, while glandular lesions are less predictable and may require longer, multimodal treatment. (edu-veterinar.ro)

For squamous disease, consensus guidance supports oral omeprazole once daily, with evidence showing a documented response across doses from 1 to 4 mg/kg and most healing, when it occurs, by about day 21. Even so, the panel noted that only roughly 70% to 80% of squamous lesions heal within a standard 28-day course, which is why repeat gastroscopy is recommended before discontinuing treatment. In the U.S. market, Boehringer Ingelheim says GastroGard is the only FDA-approved equine gastric ulcer treatment, labeled at 4 mg/kg for treatment and 2 mg/kg for prevention of recurrence. (edu-veterinar.ro)

For glandular disease, the evidence base is less tidy. The ECEIM statement recommends omeprazole plus sucralfate at 12 mg/kg twice daily, with control examination at four weeks and a minimum of eight weeks of combination therapy before adding other adjunctives. The rationale is that glandular disease appears to involve impaired mucosal defenses, making a protectant such as sucralfate biologically plausible as part of therapy. More recent secondary sources, including the Merck Veterinary Manual and UC Davis’ 2025 Horse Report, also note use of misoprostol in equine glandular gastric disease, especially in difficult cases, though treatment selection still varies by clinician and case mix. (edu-veterinar.ro)

Research continues to complicate the picture. A 2025 blinded, randomized, placebo-controlled trial of a lecithin-pectin-meadowsweet nutraceutical found no significant prevention of ulcer recurrence on gastroscopy after omeprazole treatment, although salivary biomarkers suggested possible effects on mucosal health. Separately, prior work has raised concern about recurrence after stopping omeprazole, and a 2023 study documented hypergastrinemia developing within seven days of treatment, with gastrin returning to baseline within two to four days after discontinuation. That doesn’t prove clinically meaningful rebound acid hypersecretion in every horse, but it helps explain why many practitioners remain cautious about recurrence and tapering strategies. (pubmed.ncbi.nlm.nih.gov)

Industry and expert commentary broadly point in the same direction: formulation, lesion location, and management all matter. The Horse article centers Sykes’ view that feeding practices, stress reduction, and overall horse care need to be revisited alongside drug therapy. That’s consistent with broader reviews showing that prolonged intervals without forage, higher starch intake, stabling, and training intensity are associated with greater ulcer risk, especially for squamous disease. (thehorse.com)

Why it matters: For veterinary professionals, this is a reminder to resist empiric, symptom-based ulcer treatment when gastroscopy is available. The current evidence supports a more segmented approach: scope first, distinguish squamous from glandular disease, use labeled omeprazole appropriately, build in management changes from day one, and plan a recheck rather than relying on perceived improvement from trainers or pet parents. It also reinforces a practical client-communication point: some lower-cost compounded omeprazole products have shown major potency variability, which can affect both efficacy and trust in treatment response. (animalhealth.boehringer-ingelheim.com)

What to watch: The next area to watch is whether newer comparative studies sharpen first-line choices for glandular disease, particularly around misoprostol, esomeprazole, long-acting omeprazole formulations, and adjunctive nutraceuticals, or whether the field remains centered on omeprazole-plus-management with case-by-case escalation. (merckvetmanual.com)