Equine gastric disease treatment still hinges on diagnosis first
A new sponsored educational piece from The Horse is putting the spotlight back on a core challenge in equine medicine: gastric disease treatment is rarely just about prescribing omeprazole. In the March 9, 2026, item, Dr. Ben Sykes emphasizes that successful treatment begins with accurate diagnosis by gastroscopy, then combines pharmacologic therapy with feeding, stress, and management changes, plus repeat scoping when needed to confirm healing. (thehorse.com)
That framing reflects how the field has shifted over the past decade. What many clients still call “ulcers” is now more precisely divided into equine squamous gastric disease, or ESGD, and equine glandular gastric disease, or EGGD. The distinction matters because the two syndromes have different risk factors, pathophysiology, and treatment responses. The 2015 European College of Equine Internal Medicine consensus statement helped formalize that split, and a 2023 review by Vokes, Lovett, and Sykes said understanding of ESGD is relatively mature, while major gaps remain around EGGD pathogenesis, diagnosis, treatment, and prevention. (pmc.ncbi.nlm.nih.gov)
On the pharmacology side, omeprazole remains the anchor drug. FDA-approved GastroGard is labeled for treatment and prevention of recurrence of gastric ulcers in horses, with treatment dosing at 4 mg/kg and prevention dosing at 2 mg/kg. But the literature also shows why clinicians keep looking for better protocols, especially in glandular disease. A retrospective study cited in current reviews reported poor healing rates for EGGD with oral omeprazole alone, and some horses worsened despite treatment. Secondary options discussed in reviews and clinical summaries include sucralfate combinations, misoprostol, and, in some markets, long-acting intramuscular omeprazole, though evidence quality and regulatory status vary by jurisdiction. (animalhealth.boehringer-ingelheim.com)
The management piece is just as important, and that's where the new The Horse content aligns with current expert messaging. EquiManagement’s coverage of the 2024 Purina Equine Veterinary Conference summarized practical recommendations from equine nutritionist Kelly Vineyard: diagnose first by endoscopy, dose omeprazole with attention to feeding timing, maintain free-choice forage, avoid exercising on an empty stomach, reduce barn stress, increase turnout where possible, and keep routines predictable. Those changes are intended not just to support healing, but to reduce the high rate of relapse once acid suppression stops. (equimanagement.com)
Newer adjunctive products are attracting interest, but the evidence is mixed. The 2025 Equine Veterinary Journal trial on a nutraceutical containing lecithin, pectin, and meadowsweet tested whether the product could prevent recurrence after omeprazole treatment. It didn't significantly beat placebo on repeat gastroscopy. The biomarker findings were more encouraging, with lower salivary ADA and higher bicarbonate in the treatment group, but the authors themselves noted that those biomarkers still need validation. For clinicians, that's a useful reminder that surrogate signals and endoscopic outcomes are not the same thing. (pubmed.ncbi.nlm.nih.gov)
Industry and expert perspective around this topic remains cautious rather than celebratory. Sykes is a recognized authority in the field, but the 2023 review also discloses his consulting and funding relationships with multiple companies in the equine gastric ulcer space, including Kelato, the sponsor of The Horse video. That doesn't invalidate the educational message, which is broadly consistent with the literature, but it does matter contextually when veterinarians assess sponsored content and product-adjacent recommendations. (thehorse.com)
Why it matters: For equine veterinarians, the real story isn't a new drug launch or guideline change. It's the continued consolidation of a treatment model that is more precise, and more demanding, than many pet parents and trainers expect. ESGD and EGGD shouldn't be managed as interchangeable problems. Gastroscopy remains the diagnostic standard, omeprazole remains the labeled cornerstone, and management changes remain essential to reduce recurrence. At the same time, the field still lacks consistently effective, well-validated options for refractory glandular disease, which keeps pressure on clinicians to balance evidence, practicality, cost, compliance, and jurisdiction-specific drug access. (pmc.ncbi.nlm.nih.gov)
What to watch: The next phase of this story will likely center on recurrence prevention, better evidence for adjuncts, and more rigorous comparisons among omeprazole-based, misoprostol-based, and long-acting protocols, particularly for EGGD, where unmet clinical need is still highest. (pubmed.ncbi.nlm.nih.gov)