Subtle Signs of Equine Gastric Ulcers

horse with pinned ears — Behavioral signs, such as pinning the ears, can indicate pain from gastric ulcers. | Shelley Paulson

Q: Are there early, subtle signs of gastric ulcers that owners often miss before the classic symptoms appear?

A: Historically, we have considered loss of appetite and unexplained weight loss as the most common signs of gastric ulcers, but our understanding of the diseases has changed a lot over the past few years. Loss of appetite can still be important, especially in individuals at high risk of squamous disease (ulcers in the upper part of the stomach), but now we recognize changes in behavior as the main clinical presentation of ulcers, with 85% of horses that present for gastroscopy having a history of undesirable behavior or behavioral change.

In considering undesirable behavior or behavioral change, it is important to recognize that such behaviors are not specific to ulcers; they are the horse’s language of pain. This change in awareness has caused a shift in our approach to these cases away from, “The horse must have ulcers,” to, “The horse has pain: Where does it come from?” The differentials for pain include not only ulcers but also a broader range of possible causes such as lameness, back pain, or dental disease. We also increasingly recognize pain as a potential driver of ulcers, reinforcing how important it is to look at the whole horse and not just focus on the stomach (a weird thing for the “ulcer guy” to say, right?) so, even when we diagnose ulcers, we’ll commonly look at other potential contributors such as concurrent lameness.

The Ridden Horse Pain Ethogram is a great resource for understanding the types of behavior associated with pain. These include overt behaviors such as bucking and rearing, along with a range of subtle behaviors including tail flicking, abnormal head carriage, and excessively pinning the ears. From there, no one knows your horse better than you, and the owner’s first perception of subtle changes in behavior is typically the tipoff for the potential presence of pain. This is a great point to engage with your veterinarian and discuss the best path forward for your horse and your circumstances.

Because there are many potential causes of pain, including common ones such as gastric ulcers, low-grade lameness, and poor saddle or bridle fit, it is important to assess the response to treatment before completely attributing the behavior to the gastric ulcer diagnosis. Most horses with behavioral abnormalities will improve with a correct diagnosis and treatment, although some will have residual learned behaviors that require specific intervention. This is especially true of ground-based anticipatory behaviors such as girthiness. If you do not see an improvement in abnormal behavior with treatment, then you might need to reassess the diagnosis and potential causes of pain beyond the stomach with your veterinarian.

Take-Home Message

Subtle behavior changes are a common early warning sign of ulcers, along with other potential causes of pain. When we know our own horses’ typical behaviors and the key signs to look for, we can recognize issues early and intervene for the benefit of our horses’ well-being. For further reading, the article “Can all behavioral problems be blamed on EGUS?” is an in-depth discussion on the topic of behavior and ulcers.

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