Equine gastric disease treatment still hinges on diagnosis

A new sponsored educational article from The Horse is putting equine gastric disease treatment back in focus, with a familiar but important message: horses with gastric disease need an accurate diagnosis, pharmacologic treatment, and meaningful management changes, not a one-size-fits-all ulcer plan. Published March 9, 2026, the piece highlights the practical reality facing equine veterinarians, especially when differentiating squamous from glandular disease. (thehorse.com)

That distinction has become increasingly important as the field has moved away from treating all equine gastric lesions as the same syndrome. Equine squamous gastric disease is generally more responsive to acid suppression, while equine glandular gastric disease has proved harder to heal consistently and may reflect a more complex pathophysiology. Earlier coverage from The Horse and peer-reviewed literature has emphasized that management changes, including forage access and reducing stressors, should run in parallel with medication rather than after the fact. (thehorse.com)

On the pharmacology side, omeprazole remains the anchor therapy in U.S. practice. Boehringer Ingelheim says GASTROGARD is the only FDA-approved treatment for equine gastric ulcers in horses and foals 4 weeks of age and older, with labeled treatment and recurrence-prevention dosing. The company also stresses formulation stability, an issue that has long mattered in discussions around compounded omeprazole products. FDA-linked materials and prior veterinary reporting have also noted concerns about potency variation in unapproved omeprazole formulations marketed for horses. (animalhealth.boehringer-ingelheim.com)

But the tougher clinical question is often glandular disease. A 2019 Equine Veterinary Journal study found misoprostol outperformed combined omeprazole-sucralfate for equine gastric glandular disease, with higher healing and improvement rates in the study population. That doesn’t settle the protocol for every case, but it does reinforce that glandular lesions may need a different therapeutic mindset than straightforward squamous disease. Separate experimental work has also suggested omeprazole can outperform sucralfate alone in a fasting and NSAID injury model, underscoring that drug choice should follow lesion type and clinical context. (pubmed.ncbi.nlm.nih.gov)

Newer research is also sharpening the conversation around relapse prevention. In a blinded, randomized, placebo-controlled clinical trial published online ahead of print in Equine Veterinary Journal on December 30, 2025, investigators evaluated a nutraceutical containing lecithin, pectin, and meadowsweet after omeprazole treatment in 30 horses. The product did not significantly prevent recurrence of either squamous or glandular disease by gastroscopy, although the authors reported changes in salivary biomarkers that could suggest effects on mucosal health. In other words, the biomarker signal was interesting, but the clinical endpoint veterinarians care most about, recurrence seen on scope, did not improve. (pubmed.ncbi.nlm.nih.gov)

Industry and educational commentary remains broadly aligned on a multimodal approach. The Horse has repeatedly emphasized that management changes are the hallmark of both treatment and prevention, and that oral omeprazole performs well for squamous ulcers but not nearly as reliably for glandular lesions. That framing is consistent with the wider evidence base and with what many equine practitioners already see in the field: some horses improve quickly, while others cycle through recurrence, especially when training, diet, confinement, transport, or NSAID exposure continue to drive risk. (thehorse.com)

Why it matters: For veterinary professionals, this is less about a single new product or study than about treatment discipline. Equine gastric disease is common, but the pharmacology is not interchangeable across lesion types, and recurrence remains a practical problem after treatment ends. That means gastroscopy, lesion-specific planning, realistic conversations with pet parents, and attention to management are still central to good care. It also means nutraceuticals should be approached cautiously unless they show meaningful clinical benefit, not just biomarker movement. (pubmed.ncbi.nlm.nih.gov)

What to watch: The next phase to watch is whether newer recurrence-prevention strategies, especially adjunctive products and glandular-disease protocols, can produce stronger gastroscopic outcomes in larger controlled trials, and whether U.S. practice patterns shift further toward more lesion-specific treatment pathways. (pubmed.ncbi.nlm.nih.gov)