Equine gastric disease treatment moves toward lesion-specific care

Treatment guidance for equine gastric disease is getting more nuanced, and the clearest message from recent coverage and research is that one-size-fits-all ulcer therapy doesn’t hold up. A March 9, 2026, sponsored educational article from The Horse emphasized that treatment should start with an accurate diagnosis, then combine pharmacologic therapy with management changes. Broader veterinary sources reinforce why: equine gastric ulcer syndrome is now understood as two distinct conditions, equine squamous gastric disease (ESGD) and equine glandular gastric disease (EGGD), with different risk factors and different treatment responses. Gastroscopy remains the diagnostic gold standard, and in the U.S., omeprazole is still the only FDA-approved treatment, with best results in ESGD rather than EGGD. (thehorse.com)

Why it matters: For equine practitioners, the practical takeaway is that location matters. Recent expert commentary cited by The Horse and UC Davis notes that many horses with squamous disease improve with omeprazole alone, while glandular disease often needs a more tailored plan, commonly adding sucralfate and sometimes misoprostol, alongside changes in forage access, exercise scheduling, stress reduction, and rest. Timing also matters: experts cited by The Horse say feeding can reduce omeprazole absorption, which may affect treatment success, especially in harder-to-manage glandular cases. Meanwhile, a 2025 randomized trial of a lecithin-pectin-meadowsweet nutraceutical found no significant reduction in ulcer recurrence on gastroscopy after omeprazole treatment, despite shifts in salivary biomarkers, underscoring that adjunct products shouldn’t replace evidence-based therapy. (cehhorsereport.vetmed.ucdavis.edu)

What to watch: Expect continued attention on better EGGD protocols, recurrence prevention, and whether biomarkers or behavior-based tools can help practitioners monitor disease beyond repeat gastroscopy. (pubmed.ncbi.nlm.nih.gov)