Treating and Managing Horses With Glandular Gastric Disease

Glandular ulcers involve different risk factors and treatments than squamous ulcers. To help, address an affected horse’s exercise frequency, stress, and environment.
Please login

No account yet? Register

EGGD might cause abnormal behaviors in horses. | iStock

Not all gastric ulcers in horses have the same signs, risk factors, and treatment approaches. Specifically, equine glandular gastric disease (EGGD) involves ulcers in the lower portion of the stomach, and often manifests during tacking or riding in response to pain or expected pain during these activities. Owners suspecting their horses might have EGGD need to work closely with their veterinarians to arrive at a diagnosis and treatment plan—which is different than that for squamous ulcers—to avoid long-term welfare concerns.

A horse’s stomach is a single chamber with two distinct regions—upper and lower. The upper is lined with squamous mucosa, while the lower is lined with glandular mucosa. “It is really important that we differentiate ulcer type because the factors that drive disease in the squamous mucosa are very different from the factors that drive disease in the glandular mucosa,” says Ben Sykes, BSc, BVMS, MS, MBA, Dipl. ACVIM, PhD, FHEA, associate professor in equine medicine at Massey University, in New Zealand. Determining what factors initiate each horse’s disease can help veterinarians create an effective treatment and management plan.

Risk Factors for Equine Glandular Gastric Disease

When considering your horse’s gastric issue, his time spent grazing and consuming hay, the nonstructural carbohydrate (NSC) content of the diet, and timing of exercise are important factors. However, they play a much larger role in squamous gastric disease than glandular.

“Glandular gastric disease is very different from squamous,” says Sykes. “We have no epidemiological evidence to say that diet is a major contributor to disease. It might be something we use as a therapeutic target during the long-term management phase but, really, diet is not the main driver of disease.” Instead, EGGD is more of a behavioral and stress-based disease.

“Stress plays a role in the development of both squamous and glandular gastric disease, although the scientific evidence is stronger in the case of glandular disease,” says Robin van den Boom, DVM, PhD, Dipl. ECEIM, head of the equine medicine team at Utrecht University, in the Netherlands. “Some of this stress may be related to interaction with humans as trainers, the number of caretakers, and the time interacting with humans (which) all increase the prevalence of gastric disease.”

The relationship between exercise and glandular ulcers differs from the relationship between that and squamous ulcers. “For squamous disease it is a cumulative effect. It is the number of minutes of exercise we do during a given period, say a week,” says Sykes. “For glandular disease, it’s the number of times we exercise, and the absence of rest days.” Horses that exercise five or more times per week are at a significantly higher risk of developing glandular gastric disease. “It is advised to give horses two or three rest days per week to assist in preventing glandular gastric disease,” says van den Boom.

Clinical Signs of Equine Glandular Gastric Disease

Horses that have EGGD do not typically show a change in appetite or unexplained weight loss. “Most horses with glandular disease have an excellent appetite and a normal body condition,” says Sykes. “The symptoms that we see tend to be behavioral and are often associated with aversive behavior during riding or tacking up.” These clinical signs indicate glandular disease is primarily a pain-based disease. If it seems like your horse is dealing with pain, work closely with your veterinarian to determine the best course of action.

Diagnosing and Treating Equine Glandular Gastric Disease

If veterinarians suspect a horse has EGGD, they perform a gastroscopy to confirm it. “Scoping is valuable for several reasons,” says Sykes. “First, it assists us in getting an accurate diagnosis. With it recognized that it is a pain-based behavioral condition, in the welfare interests of the horse, we want to get an accurate diagnosis as soon as possible. So, gastroscopy is a critical element in doing that.” A definitive diagnosis equips your veterinarian with the information needed to design the best treatment plan.

“Glandular lesions usually take longer to heal (than squamous), and the first line of treatment is omeprazole and sucralfate, whereas squamous disease is treated with omeprazole only,” says van den Boom—omeprazole alone is relatively ineffective for treating glandular disease. “Treatment with misoprostol may also be considered for glandular lesions. With the treatment duration and healing being longer for glandular disease, this means that repeat gastroscopy may be better performed after six to eight weeks as opposed to three to four weeks which is seen when treating squamous disease.”

Your veterinarian will recommend treatment approaches based on your individual horse’s needs.

Preventing Equine Glandular Gastric Disease

To prevent the recurrence of glandular disease, become familiar with the established risk-factors. To review:

  • Exercise: Again, the cumulative amount of exercise is not as important as the frequency. Your horse needs a minimum of two rest days per week—ideally, three—to reduce his risk of EGGD.
  • Stress and Environment: Minimizing your horse’s stress is a critical aspect of long-term management. “Optimizing the horse’s environment should be a central focus of glandular disease prevention,” says Sykes. “This means factors like companionship, the ability to cohabitate with other horses, and the ability to engage in natural behavior (e.g., mutual grooming).”

    “Although we don’t think we know well enough what the most common stressors are, it is advised to provide a regular daily routine and keep an eye on how horses interact,” adds van den Boom.
  • Human Handling: When reducing stress in a horse’s life, consistency is key. Horses prefer consistency in their handlers, riders, and routine, says Sykes. But horses live in a variety of situations and respond differently to change. Some horses have a multitude of riders and do not exhibit any health issues, while other horses are more sensitive to inconsistency. “It is very easy to understand, particularly, horses like dressage horses, where they are trained to respond to an aid and release from the aid,” says Sykes. “If you change the rider and they’re pressing slightly different buttons, the horse is trying to do the right thing but not getting its release, this can become behaviorally frustrating for the horse, and contribute to behavioral stress.”

Long-Term Management of Equine Glandular Gastric Disease

When horses have glandular disease for months or years, other related issues might surface. “Many of these horses with glandular disease may have a learned behavior so, even when the ulcers have been treated, we may see an anticipatory pain-based response,” says Sykes. “Sue Dyson completed research on orthopedic lameness where the horses that were lame during exercise showed aversion behavior to tacking up. This tells us that it’s not the tacking up that is painful, but they’ve made an association to the pain that will occur during exercise.”

To address these responses, owners can work to reduce their horses’ stress. “Modalities such as massage, music to change the environment, and pre-exercise feeding to change the event from a negative experience to a positive experience are valuable go-to strategies,” says Sykes.

Supplements can also play an important role in the long-term management and presentation of glandular disease. “Critically, when selecting supplements, it is essential that we choose ones with peer-reviewed scientific evidence to support their use,” says Sykes. “This gives us our best chance of a positive outcome, which in turn benefits the owner financially and the horse from a welfare perspective.”

Take-Home Message

Understanding the common clinical signs, established risk factors, and prevention strategies for glandular gastric disease helps optimize welfare of affected horses. Prioritize reducing stress, maintaining a consistent handling schedule, giving the horse rest time, and improving the environment. If you suspect your horse might be struggling with pain or any other health issue, be sure to contact your veterinarian immediately.


Written by:

Madeline Boast, MSc completed her master’s in Equine Nutrition at the University of Guelph and started an independent nutrition company known as Balanced Bay. She has worked with a variety of equids—from Miniature Ponies to competing Thoroughbreds. Boast designs customized balanced nutrition plans that prioritize equine well-being, both for optimal performance and solving complex nutritional issues and everything between. 

Related Articles

Stay on top of the most recent Horse Health news with

FREE weekly newsletters from

Sponsored Content

Weekly Poll

sponsored by:

What signs does your horse show when he has gastric ulcers? Please check all that apply.
86 votes · 215 answers

Readers’ Most Popular

Sign In

Don’t have an account? Register for a FREE account here.

Need to update your account?

You need to be logged in to fill out this form

Create a free account with!