Equine gastric disease treatment still hinges on diagnosis, management

A sponsored educational video from The Horse published December 3, 2025, underscores a familiar but still important message for equine practice: treating equine gastric disease starts with getting the diagnosis right, then matching pharmacologic therapy with management changes. The broader evidence base behind that message remains consistent. Reviews of equine gastric ulcer syndrome, or EGUS, continue to distinguish equine squamous gastric disease from equine glandular gastric disease, with gastroscopy still considered the definitive diagnostic tool and omeprazole remaining the main acid-suppressive treatment, especially for squamous disease. But newer data also reinforce how often ulcers recur after treatment stops, and how limited the evidence is for many adjunctive supplements. (thehorse.com)

Why it matters: For veterinarians, the takeaway is less about a new drug than about treatment discipline. The literature suggests ESGD and EGGD don’t behave the same way, and glandular disease may respond less predictably to omeprazole alone, sometimes prompting add-on therapy such as sucralfate or consideration of alternatives like misoprostol. At the same time, recurrence is common once omeprazole is discontinued: in the 2025 Equine Veterinary Journal trial, only five of 30 horses remained ulcer-free after follow-up, and a lecithin-pectin-meadowsweet nutraceutical did not outperform placebo on gastroscopy, despite biomarker shifts. That puts the emphasis back on gastroscopy, case selection, feeding strategy, forage access, starch reduction, and stress mitigation, not just dispensing medication. (pubmed.ncbi.nlm.nih.gov)

What to watch: Expect continued scrutiny of recurrence prevention, especially whether any nutraceuticals, tapering strategies, or glandular-specific protocols can improve outcomes beyond omeprazole plus management. (pubmed.ncbi.nlm.nih.gov)