Equine gastric treatment is getting more lesion-specific

Treatment of equine gastric disease still starts with diagnosis, then splits by lesion type. A recent sponsored educational piece in The Horse underscores a familiar but important point for practitioners: horses with gastric disease need gastroscopy when possible, because equine squamous gastric disease and equine glandular gastric disease don’t behave the same way, and they don’t respond the same way to treatment. Across reviews and label information, omeprazole remains the pharmacologic mainstay, with FDA-approved GastroGard labeled in the U.S. for treatment and prevention of recurrence of gastric ulcers in horses and foals 4 weeks of age and older. But the evidence base also shows glandular disease can be harder to resolve, often requiring adjunctive therapy and management changes rather than acid suppression alone. (thehorse.com)

Why it matters: For equine veterinarians, the practical message is that “ulcer treatment” can’t be treated as one-size-fits-all. Label data support a 28-day omeprazole course for ulcer treatment, followed by a lower-dose recurrence-prevention phase, and published work has shown strong healing rates for squamous disease. Glandular disease is less predictable: one PubMed-indexed study found misoprostol outperformed combined omeprazole-sucralfate for equine glandular gastric disease, while a new randomized, placebo-controlled Equine Veterinary Journal study found a lecithin-pectin-meadowsweet nutraceutical did not significantly prevent recurrence on gastroscopy after omeprazole, despite shifts in salivary biomarkers. That leaves veterinarians balancing evidence, client expectations, cost, and management change, especially for performance horses at high risk of recurrence. (drugs.com)

What to watch: Expect more attention on lesion-specific protocols, recurrence prevention, and whether adjuncts or nutraceuticals can show clinically meaningful benefits beyond biomarkers. (pubmed.ncbi.nlm.nih.gov)