Equine gastric disease treatment remains a diagnosis-first challenge

A new sponsored educational update from The Horse, published March 9, 2026, revisits a persistent challenge in equine practice: how to treat gastric disease in a way that actually lasts. In the video feature, Ben Sykes emphasizes that effective care starts with accurate diagnosis and usually requires both pharmacologic therapy and management changes, with repeat gastroscopy used as needed to confirm healing. (thehorse.com)

That framing aligns with the broader shift in equine medicine away from talking about “ulcers” as a single entity. Current literature distinguishes equine squamous gastric disease, which is largely driven by acid exposure, from equine glandular gastric disease, which appears more closely tied to impaired mucosal defense, inflammation, exercise, and other horse-specific risk factors. Reviews of the field have also stressed that acid suppression alone doesn’t heal tissue by itself; it creates conditions that allow healing, which is why feeding practices, forage access, starch load, turnout, water availability, and stress reduction remain central to case management. (pmc.ncbi.nlm.nih.gov)

On the pharmacology side, omeprazole remains the anchor therapy. FDA records and product information identify GastroGard as an approved omeprazole paste for treatment and prevention of recurrence of gastric ulcers in horses and foals four weeks of age and older, and the labeled treatment dose is 4 mg/kg. Evidence summarized in peer-reviewed reviews shows omeprazole outperforms H2-receptor antagonists such as ranitidine or cimetidine for squamous disease, while lower-dose maintenance strategies may help reduce recurrence in some horses after treatment. (animaldrugsatfda.fda.gov)

The harder clinical problem is glandular disease. Evidence is more mixed, and outcomes are often less predictable. A 2019 study found misoprostol was superior to combined omeprazole-sucralfate for treatment of equine glandular gastric disease, while a later retrospective study suggested lesion type and severity may influence response. Separate work from the University of Illinois also found omeprazole performed better than sucralfate alone in a fasting/NSAID model, including lower glandular disease scores, reinforcing that sucralfate monotherapy is unlikely to be enough in many cases. (pubmed.ncbi.nlm.nih.gov)

Newer adjunctive approaches are drawing interest, but the latest controlled data are cautious. In a 2025 Equine Veterinary Journal trial, 30 horses recently treated with omeprazole for both ESGD and EGGD were randomized to a placebo or a nutraceutical containing lecithin, pectin, and meadowsweet. Only five horses remained ulcer-free by the end of follow-up, and the nutraceutical was not superior to placebo on gastroscopic recurrence outcomes, although biomarker changes suggested a possible effect on mucosal health. In practical terms, that means supplements may be worth studying further, but they haven’t yet shown they can replace established treatment and management protocols. (pubmed.ncbi.nlm.nih.gov)

Expert commentary around the field points in the same direction. Sykes has repeatedly argued that glandular disease is especially “horse-centric,” meaning treatment failure is more likely when clinicians focus only on the stomach and not on the broader husbandry picture. That perspective is echoed in review literature showing recurrence after omeprazole discontinuation is common, and that horses maintained on high-fiber, low-starch feeding programs fare better after treatment withdrawal than those returned to ulcer-promoting management. (thehorse.com)

Why it matters: For veterinarians, this is less a story about a brand-new drug than a reminder that equine gastric disease management is becoming more stratified and more evidence-driven. Cases need to be scoped, phenotyped, treated with the right pharmacology, and then followed with realistic prevention plans for the horse’s workload and environment. It also highlights a compliance and stewardship issue: when recurrence is common and treatment is expensive, pet parents may look for compounded or supplement-based workarounds, but the strongest evidence and regulatory backing still sit with approved omeprazole products and gastroscopy-guided care. (thehorse.com)

What to watch: The next phase of this story will likely focus on recurrence prevention, better protocols for glandular disease, and whether biomarkers, lesion typing, or selected adjunctive therapies can help veterinarians personalize treatment and reduce repeat cases. (pubmed.ncbi.nlm.nih.gov)