Equine gastric disease treatment shifts toward lesion-specific care
Treatment approaches for equine gastric disease are evolving toward a more differentiated, diagnosis-first model, with fresh attention on how poorly a one-size-fits-all ulcer strategy serves horses with different lesion types. That’s the central takeaway from a March 9, 2026, educational piece from The Horse, sponsored by Kelato, which says successful treatment starts with accurate diagnosis, then combines pharmacologic therapy with management changes and, when appropriate, repeat gastroscopy to document resolution. (thehorse.com)
That framing reflects a broader shift in equine practice over the past several years. Review literature now separates equine squamous gastric disease, or ESGD, from equine glandular gastric disease, or EGGD, because they have different underlying drivers and different treatment responses. In adult horses, omeprazole remains the mainstay for acid suppression and is generally effective for ESGD, but outcomes are less predictable for EGGD, where longer treatment courses, combination therapy, or alternative drugs may be needed. (sciencedirect.com)
The practical details matter. UC Davis’ 2025 equine health report says omeprazole is the only FDA-approved treatment for equine gastric ulcers and is highly effective for ESGD, but that omeprazole alone has a poor success rate for EGGD. The same report says EGGD may be treated with omeprazole in combination with sucralfate and misoprostol, while also stressing that ulcers commonly recur if feeding patterns, forage access, exercise timing, transport stress, and stall confinement aren’t addressed. The Horse article echoes that point, citing the need to revisit feeding practices, stress reduction, and overall horse care alongside medication. (cehhorsereport.vetmed.ucdavis.edu)
Recent research also adds nuance around adjunctive products. A 2025 randomized, placebo-controlled trial published in Equine Veterinary Journal evaluated a nutraceutical containing lecithin, pectin, and meadowsweet after omeprazole treatment in 30 horses. According to the PubMed summary, the product did not significantly prevent recurrence of either ESGD or EGGD on follow-up gastroscopy, although salivary biomarkers suggested possible effects on mucosal health. That’s a useful reminder that biomarker movement and endoscopic healing aren’t the same endpoint, especially in a condition where recurrence is common. (pubmed.ncbi.nlm.nih.gov)
On the pharmacology side, the strongest signal for refractory glandular disease still appears to favor misoprostol in selected cases. A research report presented through the Journal of Veterinary Internal Medicine’s 2016 ACVIM Forum program found healing in 73% of horses treated with misoprostol, compared with 22% in horses treated with omeprazole plus sucralfate, with no reported worsening in either group. Separately, a recent review in Veterinary Clinics of North America: Equine Practice states that treatment is usually successful in ESGD, but less so for EGGD, where sucralfate may be added or alternatives such as misoprostol may be necessary. While the ACVIM report is not the same as a full contemporary consensus guideline, it continues to shape how clinicians think about difficult glandular cases. (academic.oup.com)
Expert commentary in the educational coverage points in the same direction. In The Horse article, equine gastric disease researcher Dr. Ben Sykes emphasizes that long-term success depends not just on drugs, but on management changes and follow-up scoping when needed. That perspective is consistent with university and review sources that describe gastric disease as both a pharmacologic and husbandry problem, not simply a medication problem. (thehorse.com)
Why it matters: For veterinarians, the key takeaway is that treatment selection should follow lesion location, case history, and likely recurrence risk. ESGD may respond well to standard omeprazole-based protocols, but EGGD often warrants a more guarded prognosis, closer follow-up, and earlier discussion of combination therapy, alternative agents, and management redesign. It also means pet parents may need clearer counseling that a horse can improve clinically without full lesion resolution, and that supplements marketed for ulcer support haven’t consistently shown prevention of recurrence on gastroscopy. (sciencedirect.com)
What to watch: The next phase to watch is whether newer controlled studies can clarify when nutraceuticals have a meaningful adjunctive role, and whether stronger comparative data will further define when clinicians should move from omeprazole-based regimens to alternatives such as misoprostol in recurrent or refractory glandular disease. (pubmed.ncbi.nlm.nih.gov)