Equine gastric disease treatment remains a diagnosis-first challenge

Treatment of equine gastric disease still centers on getting the diagnosis right, then matching medication with management changes, according to a March 9, 2026, sponsored educational update from The Horse featuring equine internist Ben Sykes. The piece reinforces a now-familiar but still clinically important message: equine squamous gastric disease and equine glandular gastric disease shouldn’t be treated as interchangeable problems, and long-term success depends on gastroscopy-guided diagnosis, pharmacologic therapy, and changes to feeding, stress, and daily care. The broader evidence base continues to support omeprazole as the core acid-suppressive therapy for many cases, while adjuncts and alternatives such as sucralfate or misoprostol may have a role in selected horses, especially when glandular disease is involved. (thehorse.com)

Why it matters: For veterinary professionals, the practical takeaway is that recurrence remains common, especially once drug therapy stops, so treatment plans need to extend beyond a prescription pad. A 2025 randomized, placebo-controlled trial in Equine Veterinary Journal found a lecithin-pectin-meadowsweet nutraceutical did not significantly prevent recurrence of squamous or glandular disease after omeprazole treatment by gastroscopy, even though some salivary biomarkers shifted in a potentially favorable direction. That adds to the case for prioritizing repeat scoping, risk-factor reduction, and evidence-based drug selection over relying on supplements alone. It also underscores the regulatory reality in the U.S. that FDA-approved omeprazole products remain the benchmark, with GastroGard approved for treatment and prevention of recurrence of gastric ulcers in horses and foals four weeks of age and older. (pubmed.ncbi.nlm.nih.gov)

What to watch: Expect continued attention on recurrence prevention, better strategies for glandular disease, and whether biomarkers or nutraceuticals can eventually help monitor or support, but not replace, proven treatment protocols. (pubmed.ncbi.nlm.nih.gov)