Equine gastric disease treatment shifts toward subtype-specific care

A new sponsored educational update from The Horse underscores a familiar but still important message for equine practice: treating gastric disease in horses starts with an accurate diagnosis, then combines pharmacologic therapy with management changes tailored to the individual horse. In the March 9, 2026 piece, equine gastric ulcer expert Dr. Ben Sykes says veterinarians should distinguish lesion type, use gastroscopy to guide care, and revisit feeding, stress, and husbandry alongside drug treatment. That message aligns with recent literature showing that recurrence after stopping omeprazole is common, and that newer evidence is sharpening the conversation around which therapies work best for squamous versus glandular disease. (thehorse.com)

Why it matters: For veterinary professionals, the practical takeaway is that “equine gastric disease” can’t be treated as a single entity. Omeprazole remains the FDA-approved mainstay for equine gastric ulcer treatment, with labeled treatment dosing at 4 mg/kg and recurrence-prevention dosing at 2 mg/kg, but outcomes differ by disease subtype. Recent expert summaries suggest oral omeprazole performs well for equine squamous gastric disease, while equine glandular gastric disease often needs a broader plan that may include sucralfate, misoprostol, or other approaches, plus management changes such as more continuous forage access and lower-starch feeding. A 2025 randomized, placebo-controlled trial also found a lecithin-pectin-meadowsweet nutraceutical did not significantly prevent recurrence by gastroscopy after omeprazole treatment, despite some biomarker changes. (drugs.com)

What to watch: Expect more attention on subtype-specific protocols, especially for glandular disease, and on whether injectable omeprazole, esomeprazole, misoprostol, or adjunctive strategies can improve outcomes in horses that relapse or respond poorly to oral omeprazole alone. (equimanagement.com)