Gastric Information

Equine Gastric Disease: An In-Depth Guide for Horse Owners

Introduction

Equine Gastric Disease (EGD), commonly referred to as gastric ulcers, is one of the most frequently diagnosed medical conditions in modern horses. Research consistently shows that a majority of performance horses—and many pleasure horses—will develop some degree of gastric disease during their lifetime. Because the signs are often subtle and easily mistaken for training or behavioral issues, gastric disease is frequently underdiagnosed and undertreated.

Understanding how the horse’s stomach works, what causes disease, and how it is diagnosed and treated empowers owners to partner more effectively with their veterinarian and advocate for their horse’s long-term health.


The Horse’s Stomach: Why Ulcers Develop

The equine stomach is relatively small and produces hydrochloric acid continuously, whether the horse is eating or not. In a natural grazing situation, near-constant forage intake helps buffer this acid. Modern management—meals, stall confinement, training schedules, and travel—often disrupts this protective balance.

The stomach is divided into two distinct regions, each with different protective mechanisms and disease processes:


Types of Equine Gastric Disease

1. Equine Squamous Gastric Disease (ESGD)

Location:

  • Upper (non-glandular or squamous) portion of the stomach

  • This region has no natural acid protection

Cause:

  • Primarily due to acid exposure and acid splash, especially during exercise

  • Increased pressure in the abdomen forces acid upward onto vulnerable tissue

Common Risk Factors:

  • Intense or frequent exercise

  • Limited access to forage

  • High-concentrate or high-starch diets

  • Fasting or long gaps between meals

  • Transport and competition schedules

Typical Clinical Signs:

  • Poor or inconsistent performance

  • Resistance under saddle

  • Girthiness or sensitivity to brushing

  • Weight loss or difficulty maintaining condition

  • Mild, recurrent colic

  • Behavioral changes such as irritability or anxiety

Treatment Overview:

  • Acid suppression (most commonly omeprazole)

  • Improved forage availability

  • Feeding strategies that reduce acid exposure

  • Often responds well when management changes are made alongside medication


2. Equine Glandular Gastric Disease (EGGD)

Location:

  • Lower (glandular) portion of the stomach

  • This region normally produces acid but also has protective mechanisms

Cause:

  • More complex than acid alone

  • Involves breakdown of the stomach’s protective lining, blood flow, and inflammatory responses

Common Risk Factors:

  • Chronic stress

  • Intensive or prolonged training

  • Frequent travel

  • NSAID (non-steroidal anti-inflammatory drug) use

  • Concurrent illness or pain

Typical Clinical Signs:

  • Subtle behavioral changes

  • Decreased willingness to work

  • Poor performance without obvious lameness

  • Intermittent discomfort

  • Sometimes no outward signs at all

Important Note:
EGGD often does not fully respond to acid suppression alone, which is why some horses appear improved clinically while ulcers persist on gastroscopy.

Treatment Overview:

  • Acid suppression combined with mucosal protectants (such as sucralfate)

  • Stress reduction strategies

  • Careful review of NSAID use

  • Longer treatment courses and follow-up gastroscopy are often needed


Why Gastric Disease Is Commonly Missed

Unlike acute colic or lameness, gastric disease tends to cause gradual, non-specific changes. Many horses continue to eat well and maintain a normal appetite, leading owners to assume the stomach is not involved. Performance decline, attitude changes, or resistance are often attributed to training, tack fit, or temperament.

Because ESGD and EGGD behave differently, treating without confirming the ulcer type can lead to incomplete resolution and recurrence.


Diagnosis: Getting Clear Answers

Gastroscopy is the gold standard and only definitive way to diagnose gastric disease.

It allows the veterinarian to:

  • Visualize the stomach lining directly

  • Distinguish between ESGD and EGGD

  • Grade ulcer severity

  • Monitor healing and guide treatment duration

While treatment trials are sometimes used, current veterinary consensus emphasizes the value of accurate diagnosis whenever possible.


Treatment and Ongoing Care

Medical Treatment

  • Proton pump inhibitors (PPIs) such as omeprazole reduce acid production

  • Mucosal protectants help support healing, particularly for glandular disease

  • Treatment length varies depending on ulcer type and severity

Nutritional Management

  • Provide near-constant access to forage

  • Reduce high-starch concentrates when possible

  • Incorporate forage before exercise to help buffer acid

  • Ensure clean water is always available

Management and Lifestyle Adjustments

  • Minimize prolonged fasting

  • Reduce unnecessary stressors

  • Review training intensity and recovery time

  • Use NSAIDs judiciously and under veterinary guidance


Long-Term Management and Prevention

Gastric disease can recur if underlying risk factors remain unaddressed. Long-term success often depends on management changes, not just medication.

Owners should work closely with their veterinarian to:

  • Identify individual risk factors

  • Develop realistic feeding and training plans

  • Monitor behavior and performance over time


When to Call Your Veterinarian

  • Ongoing performance decline without clear cause

  • Behavioral changes or resistance

  • Recurrent mild colic

  • Weight loss or poor condition

  • Lack of response to empirical ulcer treatment

Early evaluation can prevent chronic disease and improve outcomes.