Diagnosing and Treating Gastric Ulcers in Horses

What you need to know about squamous and glandular gastric diseases in horses

By: Stacey Oke, DVM, MSc

Ben Sykes, BSc, BVMS, MS, Dipl. ACVIM, MBA, PhD,

is a world leading expert on equine gastric ulcer syndrome (EGUS) who is actively changing the way we think, talk about, treat, prevent, and manage EGUS in our horses. Sykes is a veterinarian with over 28 years clinical experience who is boarded with the American College of Veterinary Internal Medicine. He graduated from Murdoch University in 1997 before completing an internship at Randwick Equine Centre followed by a residency in Equine Internal Medicine in Virginia (USA) gaining his Diplomate Registration in Large Animal Internal Medicine in 2004. He has a special interest in equine gastric ulcers, with many peered review publications to his credit including being the lead author on the 2015 European College of Equine Internal Medicine Consensus Statement on EGUS in adult horses.

ILLUSTRATION: Dr. Robin Peterson / istock.com Zuzule photo/The Horse

The Basics of the Equine Stomach

While the equine gastrointestinal tract is very large, the stomach itself is surprisingly small, having a capacity of only 3-5 gallons (12-20 liters). The equine stomach is divided into two distinct regions: the upper (dorsal) and the lower (ventral). A ridge of tissue called the margo plicatus delineates the two sections. In the dorsal region, above the margo plicatus, the stomach is lined with squamous mucosa—a thick layer of skin-like cells. The squamous region of the stomach has no absorptive capacity or secretory activity. Thus, it produces no enzymes or acid to digest feeds and absorbs no nutrients. Food simply passes through this region on its way from the esophagus to the glandular (ventral) region of the stomach, located below the margo plicatus, before flowing into the small intestine.

In the ventral region of the stomach, below the margo plicatus, cells in the glandular mucosa produce hydrochloric acid. It is here the digestive process truly begins when the feed mixes with the gastric juices that fill the glandular region of the stomach. A layer of “slime” containing mucus and bicarbonate coats the glandular region of the stomach, protecting it from the gastric juices it produces, says Sykes. The pH of the gastric juice in the glandular stomach is between 1 and 2—so acidic that if it touched the skin on your hands, it would burn. Below the slime layer, however, the surface of the mucosa itself has a pH of about 7.

PHOTO: Courtesy Christina Weese/portraitsofsaskatoon.com

Diagnosing EGUS: Endoscopy Is the First Essential Step

“Signs that a horse owner or veterinarian might observe in a horse with EGUS, due to either squamous or gladular disease, can vary,” says Dr. Sarah Reuss, equine technical manager with Boehringer Ingelheim Animal Health. “Most commonly, horses show a decline in performance.”

In addition to poor(er) performance, Reuss says other indications of EGUS might include:

An unwillingness to work.
Reluctance to bend or flex.
Bucking/bolting/rearing.
A decline in objective performance measures, such as an uptick in speed or jumping faults.
A crabby attitude, aggression, or displeasure toward being groomed or saddled.
Mild signs of colic (abdominal pain), especially after eating a grain meal.
Weight loss or inappetence, picky eating.
Poor coat condition.
Bruxism (teeth grinding).

Owners or trainers might be eager to jump on the gastric ulcer train when they see some of these signs widely attributed to horses with EGUS; however, only a variable level of evidence supports the association between these clinical signs and EGUS. Further, the large body of work recently done with the Ridden Horse Pain Ethogram (RHpE) clearly demonstrates that many of the above behaviors commonly ascribed to ulcers also occur in horses with musculoskeletal pain, says Sykes. As such, there is a growing awareness that the behavioral signs described are the horse’s language of pain, and that when evaluating a horse demonstrating such signs, a broad range of differentials for pain beyond just EGUS must be considered.

Sarah Reuss, VMD, Dipl. ACVIM,

serves as an equine technical manager with Boehringer Ingelheim Animal Health. She was a clinical assistant professor and chief of the Large Animal Medicine Service at the University of Florida’s College of Veterinary Medicine until transitioning to industry in 2016. Her professional interests include equine gastrointestinal disease, neurology, endocrine disease, respiratory disease, and infectious diseases. She is active in organized veterinary medicine, currently serving as chair of the AAEP’s Horse Owner Education committee, in addition to roles in the ACVIM, AVMA, and Veterinary Leadership Institute. Recently, she has been appointed 2024 vice president of the AAEP; she will serve as the organization’s president in 2026.

Additionally, whether squamous and glandular disease truly present similarly—as this list implies—also remains unclear. For this reason, the current recommendation has not swayed from that of the European College of Internal Medicine Consensus Statement—Equine Gastric Ulcer Syndromes in Adult Horses, in that EGUS cannot be diagnosed based on “characteristic” clinical signs and should be confirmed via gastroscopy.

“If a horse has known risk factors, such as trailering or competition, and is showing signs such as a change in performance or mild colic, it is prudent to pursue gastroscopy,” says Reuss. “Just like you would pursue radiographs or ultrasound to better characterize a lameness, scoping the stomach to determine the location and severity of ulcers helps us to best treat that horse.”

Endoscopy is the only reliable way to diagnose EGUS, be it squamous or glandular lesions.

Depending on your veterinarian’s preferences, gastroscopy can be performed either on the farm or in a clinic. You’ll need to fast the horse for approximately 14 to 16 hours, but he can have water until just prior to the procedure (depending on your veterinarian’s preferences).

“It is important that the stomach is empty so that all parts can be seen,” Reuss explains. “In most cases this is easier to enforce overnight with the procedure happening first thing in the morning.”

The veterinarian then sedates the horse to approximately the same degree as for a dental procedure and passes the scope through the horse’s nostril and down the esophagus to the stomach. He or she should fully evaluate both the squamous and glandular linings, including the pylorus, which is the opening to the small intestine.

“The entire process takes less than an hour,” Reuss says.

When scoping a horse, veterinarians use the well-described scale of 0 to 4 for equine squamous gastric disease, with 0 being normal and 4 having large or deep bleeding ulcers.

There is currently no agreed-upon scale for glandular ulcers. Instead, veterinarians describe lesions in the glandular region of the stomach based on anatomic location, distribution, severity, and appearance (i.e., hyperemic/hemorrhagic, erosive/ulcerative, fibrinosuppurative, depressed/flat/raised).

“Glandular ulcers can vary from looking like a bruise or blood clot to appearing more like a wound with proud flesh,” says Reuss. “There is ongoing research to determine if these are due to different causes as well as if they will respond differently to treatment.”

She adds that there is no correlation between the severity of the horse’s clinical signs and the grade of ulcers seen in the stomach. Gastroscopy findings dictate how long the horse will be treated with omeprazole and whether he should receive additional drugs, such as sucralfate.

“Going back to the lameness and X ray or ultrasound analogy, think of the stomach similarly,” says Reuss. “When we see signs of EGUS, we look deeper to make a definitive diagnosis, and then we tailor the treatment to the diagnosis. And just like you would recheck the ultrasound of a tendon before putting the horse back to work, we should rescope the stomach at the end of treatment to be sure it has resolved as expected.”

“It is way more frustrating to spend hundreds or thousands of dollars treating an ulcer that was never there to begin with versus pursuing gastroscopy early and knowing exactly what you are treating,”

—Dr. Sarah Reuss

Owners might have cost-related concerns associated with gastroscopy, and our sources all agree that costs associated with diagnosing, treating, and preventing disease recurrence can indeed be substantial. However, establishing an accurate diagnosis from the beginning can help keep long-term costs down.

PHOTO: Getty Images

The Foundations of Squamous Gastric Disease in Horses

Gastric acid contacting and damaging the mucosa is the most common cause of ulcers in the squamous region of the stomach. When horses graze and consume roughage, such as grass hay or alfalfa hay, the fibers form a protective ball of feed. This, along with saliva, which contains large amounts of the buffer bicarbonate, helps buffer the pH of the fluid and effectively stops acid from touching the squamous mucosa under normal conditions.

Risk Factors for Squamous Ulcers in Horses

Management factors such as the amount, type, and timing of roughage provided, the amount of non-structural carbohydrates per meal, and the amount and timing of exercise can disrupt these normal protective mechanisms and cause acid to splash up on the squamous mucosa. Transport is also a recognized risk factor.

Roughage

Adequate roughage is the cornerstone of good gastric health, as well as being one of the 3 Fs (Friends, Forage, & Freedom) essential for good equine well-being. The amount, type, and timing of roughage all influence its ability to protect the stomach.

A minimum of 1.5% bodyweight/day DM of hay is commonly recommended. However, this recommendation is based on dry matter intake, and that all roughage, including hay, includes some water. As such, an easier and more appropriate recommendation is the provision of at least 2% bodyweight/day of a suitable hay as fed. This is approximately 20-25 pounds of hay for a typical 1000–1250-pound horse, each day. Importantly, the definition of what a suitable hay is varies between horses, depending on factors such as their underlying metabolic state and level of exercise, and it is important to match the type of hay to each horse’s needs. In some cases, this means intentionally selecting a lower nutritional quality hay to ensure the metabolic needs of the horse is met while still aiming for a 2% bodyweight/day as fed target.

The type and physical structure of the hay also influence the amount of chewing required to eat. Chewing is essential for gastric health because each chewing cycle produces saliva, which contains bicarbonate as a natural buffer against gastric acid. As such, long-stem, stalkier hay is preferred because it encourages more chewing as well as more effectively forming the roughage ball needed to protect the stomach. Alfalfa has some beneficial properties, over and above grass hay, as it has additional buffering capacity. However, the benefits of this are modest in comparison to the overall benefits of consuming an appropriate amount of hay each day, and ensuring intake of an appropriate amount of roughage should be the first priority in ration formulation.

Pasture turnout is another of the essential 3Fs (Freedom), and has numerous benefits for horses, including increasing the amount of time spent eating. However, pasture turnout itself is not automatically protective against squamous disease, as the length, type, and amount of pasture available all influence chewing behavior and the ability to form a protective roughage ball in the stomach. In many management conditions, the provision of hay in addition to pasture turnout is optimal for gastric health.

Giving free-choice hay does not automatically translate into improved gastric health. Eating hay is a complex behavior, and horses must feel safe and secure to eat normally. As such, addressing the overall housing of horses with a history of squamous disease can have large, positive impacts on eating behavior. For example, horses housed outdoors spend nearly 50% more time eating than horses housed indoors, and horses housed with other horses spend nearly 40% more time eating than horses housed in isolation. This increased time spent eating translates into greater roughage consumption, maintenance of the roughage ball, and greater saliva and bicarbonate production. “Weighing and measuring individual hay intake is a great first step in understanding why an individual horse might have squamous disease, even if it is provided with free-choice hay,” says Sykes. “It’s remarkable how common horses with access to unlimited good quality hay are still consuming significantly less than the target 2% bodyweight/day as fed recommendation. This is because eating is a complex behavior, and when we identify this, it points us to look at the broader aspects of the horse’s environment and their impacts on behavior, as well as considering other potential contributors such as dental disease.”

Carbohydrates

Excessive non-structural carbohydrates (NSCs) have been shown to increase the risk of squamous disease, but NSCs are not inherently bad, and they do not need to be completely avoided. In fact, appropriate amounts of NSCs are important for optimal performance in many of our athletic horses. So, instead of trying to remove NSCs from the diet completely, the recommended approach is to ensure an appropriate amount is fed each meal, with 1 g/kg/meal the upper limit recommended. The adoption of modern, “low carb” diets in U.S. sports and recreational horses means that many horses are safely within the limits under current management conditions. In other usage types, such as high-level eventers, racehorses and endurance horses, higher energy demands mean that NSC loads in diets tend to increase. Rigorously evaluating diets and considering simple strategies such as including oil in the diet or increasing the number of meals/day (smaller meals, more frequently) to maintain the NSC load below 1 g/kg/meal is useful in these populations.

Balancing the relative benefits of different types of hay and NSC load while meeting the overall nutritional needs of any individual horse can be challenging, and consulting your veterinarian or trained equine nutritionist can be beneficial in meeting the competing demands of diet.

Exercise

Exercise plays a key role in the risk of disease, specifically the duration of exercise at a trot or above. During exercise, acid is pushed up from the ventral part of the stomach onto the dorsal, squamous part of the stomach. Squamous ulcers are effectively an acid burn, so the longer this exposure occurs, the more likely a burn (i.e. ulcer) will occur and the worse the burn (ulcer) will be. The exact amount of exercise at which squamous risk increases is not well defined, but current recommendations are to, wherever possible, keep the cumulative duration of exercise at a trot or above to less than a total of 30-40 minutes per day. This is achievable in many recreational and riding horses, often by stepping down to a walk during the cool-down period sooner in the exercise cycle but can be challenging in horses with higher inherent workload requirements (e.g. endurance horses and eventers). In these populations, recognizing the increased risk and adopting additional strategies (such as targeted use of appropriate supplements or omeprazole) warrants consideration.

Timing of exercise is another important factor. Horses naturally fast overnight, reducing their roughage intake in favor of resting. If they are exercised first thing in the morning, before an adequate amount of roughage has been consumed, it means that no roughage ball is present in the stomach, resulting in extensive acid splash (image 2). Recognizing this as a risk factor is important in certain populations (e.g. Thoroughbred racehorses that typically work early in the morning) or under certain management conditions (e.g. early morning riding to avoid heat later in the day). When recognized as a risk factor, the addition of pre-exercise feeding, ideally with long-stem alfalfa hay, is a useful intervention to reduce squamous disease risk. Where pre-exercise feeding is not possible, often due to horses having limited appetite in the early morning (e.g. Thoroughbred racehorses), adopting additional strategies (such as targeted use of appropriate supplements or omeprazole) could be added.

Squamous Ulcer Treatment

Acid suppression is the cornerstone of treating squamous ulcers. In the U.S., omeprazole (a proton pump inhibitor that decreases hydrochloric acid secretion by the parietal cells in the glandular mucosa) is labeled at 4 mg/kg for 28 days for the treatment of EGUS in horses and foals older than 4 weeks of age. Sykes advises giving omeprazole first in the morning (before 6:00 a.m.), at least 30 minutes before a forage meal.

“Overall oral omeprazole has a high, nearly 80%, success rate for healing squamous ulcers.”

—Dr. Ben Sykes

“Food interferes with omeprazole absorption and reduces its efficacy in suppressing acid production. By getting in before 6:00 a.m., we get in after the horse has naturally fasted overnight and before they wake up and start eating as part of their natural cycle. It’s important that we feed the horse 30-60 minutes after giving omeprazole as the drug is what’s known as a pro-drug that requires activation to block acid production.” He adds, “Overall oral omeprazole has a high, nearly 80%, success rate for healing squamous ulcers. But it’s important to recognize that treatment of squamous ulcers should ideally be viewed as a short-term measure that’s implemented while management changes are made in the background to prevent recurrence of disease.”

Squamous Ulcer Prevention in Horses

Cornerstone Principles

Long stem roughage (i.e. hay)
- 2% bodyweight per day as fed

Non-structural carbohydrates
- < 1 gram per kilogram bodyweight per meal

Exercise
- <30-40 minutes per day (cumulative) at a trot or above

Other Factors

Feed alfalfa hay first thing in the morning and pre-exercise

Consider appropriate supplements or prophylactic omeprazole when risk factors cannot be adequately addressed

PHOTO: Shelley Paulson

The Foundations of Glandular Gastric Disease in Horses

While we know gastric acid touching the squamous mucosa causes ulcers, we know much less about what causes lesions of the glandular mucosa.

“We often state that glandular disease results when the natural defense mechanisms of the stomach are compromised,” says Dr. Robin van den Boom, an associate professor in the Department of Clinical Sciences at Utrecht University, in the Netherlands. “These mechanisms include the production of the protective mucous layer, and this seems to be dependent on normal blood flow, which in turn is mediated by mediators called prostaglandins.

“There is mounting evidence that stress contributes to glandular disease, but we don’t know (very well) what causes this type of stress,” he adds. “Certainly, exercise can cause physiological stress.”

Robin van den Boom, DVM, PhD, Dipl. ECEIM,

graduated from Utrecht University, in the Netherlands, in 1996 and started his training in equine surgery. He served as head of the Department of Equine Health at the University of Adelaide (Australia) from 2014 to 2017, when he returned to the Netherlands where he’s currently head of the Equine Medicine team at Utrecht University. His clinical and research interests include the equine gastrointestinal tract and dermatology.

Risk Factors for Glandular Ulcers

As discussed above, management factors are the primary determinants of risk for squamous disease. In contrast, the management factors associated with glandular disease are less well defined, and the disease seems to be more individual horse-centric. “Because of the strong management associations, I think of squamous disease as being 80% management and 20% horse; there are some individual horses that appear more predisposed, but overall, it is the management factors that determine disease risk,” Sykes says. “In contrast, glandular disease appears to be much more individually horse focused and as a result, I think of it being 80% horse and 20% management,” he adds.

Of the management factors identified for glandular disease, exercise frequency is one of the most consistent effects, with horses exercising 4-5 or more times per week having a greater risk of ulcers developing in the glandular mucosa. Looking at it another way, rest days are important for gastric health, and every horse should have 2-3 rest days per week. “I consider rest days to be days where a horse does not work physically or mentally. So, if a horse is completely relaxed and happy to hack out on a trail, then, within reason, that can be considered a rest day. As soon as the horse must think about what it is doing, or it is trotting, then I consider it a work day,” Sykes says.

A second important risk factor is the number of trainers, handlers, or riders a horse has. The more people working with the horse, the greater his risk of having glandular ulcers.

“This emphasizes the importance of the horse-human interaction or bond and the need for predictable routines to help minimize the horse’s stress level,” says van den Boom.

Lastly, the concurrent presence of other diseases, such as lameness or poor saddle fit, that cause pain can be a major contributing factor to glandular disease risk. “Data is coming through the publication pipeline that shows that horses with concurrent musculoskeletal disease are less likely to respond to pharmaceutical therapy for glandular gastric disease,” notes Sykes. “This highlights how important it is that we look at managing the whole horse when managing glandular gastric disease, instead of just focusing on treating the stomach. We must manage the whole horse, including concurrent diseases such as musculoskeletal and dental disease, and ensure that every horse has an appropriately fitting saddle, bridle, and bit.”

Glandular Ulcer Treatment in Horses

Pharmacologic therapies for glandular disease include omeprazole (mentioned above), sucralfate, and, to a lesser extent, misoprostol. Acid suppression is the cornerstone of treating EGUS in horses, be it glandular or squamous disease.

Sucralfate is a compound that has many proposed mechanisms of action, including creating a physical barrier that blocks acid diffusion from the lumen of the stomach to the mucosa.

Misoprostol is a prostaglandin E1 analog that has multiple proposed mechanisms, including improving blood flow to the glandular mucosa and enhancing mucosal resistance to injury. Current research suggests there is no clear advantage of one treatment approach over the other, except that monotherapy with oral omeprazole is inferior to other options available. The different pharmaceuticals have advantages and disadvantages, so work closely with your veterinarian to develop a program that best meets your and your horse’s needs, individually.

Pharmacologics

Omeprazole: A proton pump inhibitor that decreases hydrochloric acid secretion by the parietal cells in the glandular mucosa.

Sucralfate: A compound that physically blocks acid diffusion from the lumen of the stomach to the mucosa and stimulates acid-buffering bicarbonate production in the stomach.

Misoprostol: A prostaglandin E1 analog that has multiple proposed mechanisms, including improving blood flow to the glandular mucosa and enhancing mucosal resistance to injury.

“Because glandular disease is so individually horse-centric, trying to just treat the stomach without looking at the big picture means it’s far more likely that treatment will fail, or if it does succeed, that glandular disease will recur.”

—Dr. Ben Sykes

In summary, little is known about how glandular disease develops or how to best treat it, but stress related to exercise and handling can exacerbate it. “A holistic approach that encompasses all aspects of the horse’s life, not just treating the stomach, is important for optimizing the chances of a successful therapeutic outcome,” says Sykes. He adds that in addition to investigating for and managing any concurrent musculoskeletal or oral diseases, optimizing the 3F’s is a cornerstone of glandular gastric disease management. Friends as a form of stress relief, forage as a well-being tool to reduce boredom and frustration, and freedom, both in the form of turn-out and freedom of choice, all play critical roles in reducing behavioral stress. “Because glandular disease is so individually horse-centric, trying to just treat the stomach without looking at the big picture means it’s far more likely that treatment will fail, or if it does succeed, that glandular disease will recur.”

Glandular Ulcer Prevention

Cornerstone Principles

Ensure adequate rest days
- 2-3 rest days per week
Optimize environment and reduce behavioral stress
- Minimize the number of handlers and riders
- Focus on the 3Fs
  - Friends to reduce behavioral stress
  - Forage as a well-being tool
  - Freedom of movement and choice
Identify and treat concurrent issues
- Musculoskeletal disease
- Oral disease
- Ensure appropriate saddle, bridle, and bit fit

Other Factors

Adjunctive strategies such as playing relaxing, low-tempo music and massage have been shown to reduce stress levels in horses.

Sykes suggests to consider appropriate supplements when risk factors cannot be adequately addressed, choosing supplements that have been specifically shown to benefit in glandular gastric disease. He also notes that low-dose, prophylactic omeprazole is not recommended for glandular disease.

Both music and massage therapy are easy to implement into a horse’s daily routine.

“I also believe that herd composition and probably size of the pen/paddock/pasture also play a role in glandular disease in terms of stress,” adds van den Boom.

PHOTO: Shelley Paulson

Managing Refractory Cases

Although most horses improve with treatment, approximately 30-40% of cases of gastric disease do not respond completely to pharmaceutical treatment. Management of these horses can be challenging and requires a shift in mindset from focusing on the appearance of the stomach to considering the impact of ongoing disease on the horse. In essence, it requires a shift from treating the stomach for a cure to treating the horse symptomatically. The main elements of therapy described above remain, but refractory disease places even greater emphasis on optimizing management. This is both to reduce to ongoing drivers of disease, but also to improve the horse’s resilience and ability to tolerate disease if it persists.

Focusing on the 3Fs is especially important in building resilience. As highly sentient beings, horses can experience a wide range of emotions, including optimism, which is protective against pain. Optimizing the 3Fs and the general environment also likely improves sleep quality. Chronic pain and sleep deprivation can be self-perpetuating, but both are improved with positive environmental modification.

Managing the pain-based trigger horses experience during exercise, which is the most common time when the disease manifests itself behaviorally, is another key factor for managing the impact of disease. Consult your veterinarian to discuss the best approach, potentially using a range of supplements with known symptomatic benefits and appropriate target pharmaceuticals (omeprazole or sucralfate), for your individual circumstances.

Lastly, recognizing and managing the behavioral aspects of disease is key for managing refractory disease. As discussed below, a heightened sense of awareness of the horse’s language of pain and positive reinforcement training are cornerstones.

Managing Behavioral Aspects of Gastric Ulcers in Horses

Many horses with gastric ulcers show rapid and complete improvement of undesirable behaviors with successful treatment. Others are slower to respond, and it is not uncommon for certain behaviors, especially ground behaviors like girthiness, to persist beyond the resolution of the disease.

In managing persistent behavioral disease, it is essential to recognize two key elements;

Behavioral signs often attributed to ulcers are not specific to ulcers and can be caused by any source of pain (especially musculoskeletal and oral).
Undesirable behaviors, such as girthiness, can be learnt, anticipatory responses.

Behavioral signs are the horse’s language of pain and appropriately evaluating the whole horse for other potential causes of pain is the first step in investigating horses where the undesirable behavior persists beyond apparent resolution of the gastric disease. It is not uncommon for multiple pain-based problems to be present in riding horses, and long-term success relies on identifying and managing all potential causes of pain, not just a focus on gastric disease.

Likewise, recognizing that some undesirable behaviors, especially ground-based behaviors, can be learnt anticipatory response is important for the successful management of cases where undesirable behavior persists. Importantly, traditional training methods, which largely rely on negative reinforcement, are not effective in managing anticipatory, fear-based behavior. Instead, the focus should be on the use of positive reinforcement training methods. Time and patience are essential to reshape negative behavioral associations. In some cases, specific medications might be indicated during the retraining phase.

PHOTO: Getty Images

Stomach Supplements for Ulcers in Horses

Supplements play important roles in managing ulcers in horses, including disease prevention, symptomatic management, and bridging through management changes as horses transition off treatment into a long-term management phase. But selecting a supplement can be difficult with many making huge claims with no evidence to support these claims.

“The benchmark for selecting a supplement should be looking for a product that is backed by peer-reviewed, published studies,” says Sykes. “It’s not enough for a company to say they’ve done research; it should go through the peer review and publication process for external validation. In fact, I’ve seen some companies claim they’ve done research, which they have, but the results were negative, yet they still promote the product as research-backed. This really is a shameful trick on well-meaning owners who just want the best for their horses,” he adds. “I also want to choose supplements that have been studied in real-life clinical populations, not artificial models of disease, as these most accurately reflect the conditions under which the target population of at-risk horses live. This is important because EGUS is a multi-factorial disease and replicating this complexity is impossible in a disease model. Lastly, going all the way back to the beginning of any conversation about EGUS, it is important that the supplement selected has been studied in the relevant disease condition (i.e. squamous or glandular) because it’s not possible to extrapolate from one to the other, as is the case in all aspects of EGUS.”

Currently, only a small handful of the many supplements marketed to prevent gastric ulcers in horses are supported by published, scientific studies. As with all aspects of care of your horse, consult your veterinarian regarding supplement selection. In this case, a few minutes invested in discussion can save hundreds of dollars in choosing the wrong product for your horse.

Bear in mind that nutritional supplements do not go through the same approval process as FDA-approved drugs. Nor do they have to meet the same manufacturing standards. Always look for supplements from reputable manufacturers supported by published research to back up their claims rather than testimonials.

“And, if it sounds too good to be true, with a supplement promising to cure all, then it almost definitely is,” says Sykes.

PHOTO: Getty Images

Concluding Thoughts

Separating squamous and gastric disease is the first step in understanding EGUS, with this distinction flowing through all aspects of disease management. That separation is best made via gastroscopy, along with consideration of other potential pain-based causes of undesirable behavior, and from there, working with your veterinarian is essential to select the best treatment option and identify appropriate management strategies for reducing the risk of disease recurrence.

Changes in management form the cornerstone of reducing the risk of disease recurrence and addressing symptomatic behaviors. Specific behavioral management can also be important in addressing anticipatory, learnt behavior in some cases. Lastly, supplements and specific pharmaceuticals can serve as important management tools where disease persists despite treatment, when transitioning from treatment to long-term management, or when changes in management are not enough to prevent disease recurrence.

SPONSOR MESSAGE

Kelato Animal Health is an Australian-owned company with over 35 years of expertise in equine health, gut health, and nutrition. Kelato has earned an international reputation for quality, innovation, and value by achieving real and measurable results for horses across a range of disciplines and geographies.

Kelato believes in developing products with foundations in research and has collaborated with Dr. Ben Sykes, a world-leading expert on Equine Gastric Ulcer Syndrome (EGUS).

Based on his extensive research and internationally published findings in this field, Dr. Sykes endorses Kelato’s PROTEK GI, the ultimate supplement for horses supporting total digestive health and those with gastrointestinal disease.

PROTEK GI redefines equine gastric ulcer management. Unlike traditional approaches that focus solely on stomach acid suppression, PROTEK GI’s unique alkaline slime barrier helps coat the stomach lining and buffers acid, supporting the horse’s natural defences against acid burn. PROTEK GI also delivers a holistic solution that supports hindgut health through the inclusion of prebiotics and probiotics, promoting a balanced hindgut environment.

Developed in collaboration with Dr. Sykes and supported by peer-reviewed clinical studies, PROTEK GI assists in reducing the risk of recurrence of gastric ulcers following omeprazole treatment. Clinically, horses supplemented with PROTEK GI often show rapid improvement in appetite, coat condition, attitude, and overall digestive resilience.

By targeting both the stomach and hindgut, PROTEK GI provides a smarter, evidence-based way to support horses, helping them stay healthy, happy, and ready to perform.

Credits

Stacey Oke, MS, DVM, is a practicing veterinarian and freelance medical writer and editor. She is interested in both large and small animals, as well as complementary and alternative medicine. Since 2005 she’s worked as a research consultant for nutritional supplement companies, assisted physicians and veterinarians in publishing research articles and textbooks, and written for a number of educational magazines and websites.