Equine gastric disease treatment sharpens around diagnosis and subtype

Treating equine gastric disease is increasingly being framed as a two-part job: confirm the lesion type with gastroscopy, then match medication and management to whether the horse has equine squamous gastric disease, equine glandular gastric disease, or both. A recent sponsored clinical explainer from The Horse underscores that accurate diagnosis should come first, reflecting long-standing consensus guidance that gastroscopy remains the only reliable antemortem way to definitively identify gastric ulceration. For squamous disease, omeprazole remains the mainstay, and in the U.S. GASTROGARD is the FDA-approved omeprazole product labeled for treatment and prevention of recurrence of gastric ulcers in horses and foals 4 weeks and older. But the broader literature shows glandular disease can be more refractory, often requiring combination therapy or alternative protocols, alongside feed, turnout, and training changes. (thehorse.com)

Why it matters: For equine veterinarians, the key message is that “ulcers” can’t be treated as a single entity. Consensus and review literature distinguish ESGD from EGGD because response rates, pathophysiology, and management needs differ, and clinical signs alone are often nonspecific. Newer research also adds caution around adjunct products: a 2025 randomized, placebo-controlled Equine Veterinary Journal study found a lecithin-pectin-meadowsweet nutraceutical did not significantly prevent recurrence after omeprazole when assessed by gastroscopy, even though some salivary biomarkers shifted. That keeps gastroscopy, evidence-based pharmacology, and management correction at the center of care. (pmc.ncbi.nlm.nih.gov)

What to watch: Expect continued attention on better options for glandular disease, recurrence prevention after omeprazole, and whether newer acid-suppressing approaches can outperform current protocols in real-world equine practice. (pmc.ncbi.nlm.nih.gov)