Treatment strategies sharpen for equine gastric disease

Treatment approaches for equine gastric disease are becoming more nuanced as clinicians move away from treating “ulcers” as a single entity and toward lesion-specific plans for equine squamous gastric disease (ESGD) and equine glandular gastric disease (EGGD). Recent educational coverage from The Horse emphasizes that accurate diagnosis by gastroscopy, pharmacologic therapy, and management changes all need to work together, rather than relying on empiric medication alone. Across the broader literature, omeprazole remains the mainstay for ESGD, while EGGD continues to be harder to treat and may require combination therapy or alternative approaches such as misoprostol in selected cases. (thehorse.com)

Why it matters: For equine veterinarians, the key shift is practical: treatment success depends on distinguishing squamous from glandular disease, setting expectations for different healing rates, and pairing drug therapy with feed, housing, exercise, and stress-management changes to reduce recurrence. Omeprazole is still the only FDA-approved treatment for equine gastric ulcers in the U.S., but published reviews and clinical reports suggest glandular lesions often respond less predictably than squamous lesions, and recurrence after stopping therapy remains a persistent challenge. A 2025 randomized, placebo-controlled trial of a lecithin-pectin-meadowsweet nutraceutical found no significant reduction in ulcer recurrence on gastroscopy after omeprazole treatment, despite biomarker changes that may suggest mucosal effects. (animalhealth.boehringer-ingelheim.com)

What to watch: Expect continued attention on recurrence prevention, better EGGD protocols, and whether adjunctive nutraceuticals or newer delivery strategies can improve outcomes beyond standard omeprazole-based care. (pubmed.ncbi.nlm.nih.gov)