Gastric ulcers in horses: symptoms, treatment options & prevention tips

Stomach ulcer in horses: Definition

➡️ Video tip: What is a gastric ulcer in horses? What does a gastric ulcer look like? In the following video our experts explain to youwhat a gastric ulcer is. You will also learn what a gastric ulcer looks like, how your horse can be helped and what gastric ulcers look like after treatment:

Gastric ulcers in horses are inflammatory and ulcerative changes in the stomach lining caused by excessive stomach acid. Horses are designed to eat for around 16 hours a day, which leads to a continuous production of stomach acid. A lack of feed or incorrect feeding can result in the stomach remaining empty for too long or increased stomach acid production. This excess acid can damage the stomach lining and lead to inflammation and ulcers. Stomach ulcers are painful and can lead to various problems such ascolic, poor performance, loss of appetite and emaciation.

Common types of gastric ulcers in horses

Gastric ulcers in horses are summarized under the generic term Equine Gastric Ulcer Syndrome (EGUS). They can be divided into two main types: Equine Squamous Gastric Disease (ESGD) and Equine Glandular Gastric Disease (EGGD).

Equine Squamous Gastric Disease (ESGD)

ESGD occurs in the glandless mucosa at the front of the stomach, where there is less protection against stomach acid . Primary ESGD is caused byexcessive stomach acid or irritating digestive products, while secondary ESGD can occur with gastric emptying disorders.

Examples of ESGD:

• Competition horse with incorrect feeding: A horse that is often left without food for hours during competitions develops primary ESGD due to attacking stomach acid.
• Stress-induced stomach ulcer: A nervous horse that is stressed by a change of stable will develop ESGD due to increased acid production.
• Secondary ESGD due to gastric emptying disorders: An older horse with gastric emptying disorders develops secondary ESGD due to repeated exposure of the sensitive mucosa to acid.

Equine Glandular Gastric Disease (EGGD)

EGGD affects the glandular gastric mucosa at the back of the stomach, where the highly acidic gastric juice is produced. Ulcers develop in this area if the acid protection mechanism is disturbed.

Examples of EGGD:

• Stable horse with insufficient roughage intake: A horse that receives little roughage develops EGGD due to a lack of protection of the mucous membrane.
• Stress and lack of exercise in a leisure horse: A leisure horse that receives little exercise develops EGGD due to increased stress and reduced mucosal regeneration.
• Medication-induced EGGD: A horse that receives pain medication over a long period of time develops EGGD due to the impairment of the acid protection mechanism.

Symptoms & signs of a stomach ulcer

The symptoms of stomach ulcers in horses (EGUS) are often subtle and not specific to gastric ulcers. How can you still recognize gastric ulcers? As horse owners, we can of course only suspect that our horse might have gastric ulcers. The diagnosis is made by the vet.

The most common symptoms & signs include:

• Loss of appetite: Horses often eat poorly or are picky eaters.
• Weight loss: Inadequate nutrient intake leads to weight loss.
• Poor body condition: loss of muscle mass and a lean appearance.
• Poor coat: Rough, dull coat due to poor nutrition.
• Chronic diarrhea: Persistent diarrhea can indicate digestive disorders.
• Recurrent colic: Repeated colic may indicate peptic ulcers.
• Behavioral changes: Aggressiveness or nervousness due to pain.
• Sensitivity when strapping: Pain in the abdominal area when strapping.

‍Causesof gastric ulcers in horses

Stomach ulcers are often caused by a combination of risk factors:

• Feeding errors: Irregular feeding rhythms, high grain consumption and insufficient access to roughage can irritate the stomach lining.
• Stress: Intensive training, competitions, changes in your social environment or operations can increase stress levels and increase stomach acid production.
• Medication and physical causes: The use of NSAIDs or certain diseases such as colic can damage the stomach lining.

Stomach ulcer diagnosis in horses

➡️ Video tip: Do you suspect a gastric ulcer in your horse? It must now be diagnosed clinically. Gastroscopy is the safest method to reliably detect a gastric ulcer. Even old stomach ulcers can be detected in this way. Watch this video to find out everything you need to know about gastroscopy in horses. Dr. Matthias Niederhofer from the Telgte Veterinary Clinic explains how the gastroscopy works, how you can prepare your horse for it and how you can best help your horse:

Gastroscopy and more

The vetdiagnosesstomach ulcers using a so-calledgastroscopyalso known colloquially as a gastroscopy. This involves inserting a flexible, three-meter-long endoscope into the stomach to view its surface. This examination should be carried out on an empty stomach (food should be withheld for at least 12 hours, water for 2-3 hours). The horse is sedated so that  a complete examination of the entire stomachcan be performed and the integrity of the esophagus can be assessed. Most ulcers occur on the margo plicatus or non-glandular part and present as small erosions or larger areas with signs of bleeding.

Blood counts and other tests

➡️ Video tip: In this video you can find out how a blood count in horses is created. Dr. Judith Winter from the SYNLAB VET explains how the blood is taken is taken, examined in the laboratory and what the values in the blood count mean:

A blood count can provide important indications of a possible gastric ulcer in the horse. Changes in the blood valuessuch as anemia (reduced red blood cell count) or low albumin levels can indicate chronic blood loss or inflammation in the gastrointestinal tract. However, a blood count alone is not enough to diagnose gastric ulcers with certainty.

Fecal samples can also only be used as diagnostic support for stomach ulcers if there is blood in the feces. However, if there is no blood in the feces, this does not mean that the horse does not have a stomach ulcer. The fecal sample can support but not confirm a finding as the sole diagnostic tool.

Treatment options for stomach ulcers

Drug therapy 

The most common treatment for stomach ulcers in horses is drug therapy, which aims to reduce gastric acid production and promote healing of the gastric mucosa. The most commonly used drug is omeprazole (known under the trade names GastroGard® or UlcerGard®). It is administered once a day at a dose of 4 mg per kilogram of body weight, and the treatment lasts for 28 days. The dose is then reduced to 1 mg per kilogram of body weight daily for a further 28 days to minimize the risk of relapse. Re-treatment with the higher dose may be necessary if the ulcers recur. The full inhibitory effect on gastric acid secretion is achieved approximately 5 days after the first administration. The cost of an eight-week treatment with GastroGard® is approximately € 1,050.

Administration and dosage

GastroGard® is administered as a paste directly into the horse's mouth. The dosage is based on the horse's body weight, using an application syringe with dosage markings. The treatment should be administered daily, preferably in the morning before feeding. The correct dosage is crucial for the effectiveness of the therapy and can be adjusted individually if the clinical symptoms change.

Important instructions for use

Omeprazole is a so-called prodrug that is converted into its active form in the acidic environment of the stomach, where it inhibits the proton pumps that are responsible for stomach acid production. It is therefore important to only use medication that is approved by the ZLG (Germany) or FDA (USA) to ensure the correct dosage and effectiveness. Omeprazole products for humans are generally ineffective for horses and should be avoided.

Alternative medication

In addition to omeprazole, other medications such as misoprostol and sucralfate can also be used, depending on the type and severity of the stomach ulcers:

• Misoprostol: This medication works in a similar way to omeprazole by inhibiting stomach acid production and is particularly effective for certain types of ulcers.
• Sucralfate: It forms a protective layer over the ulcers in the stomach and thus prevents further damage to the stomach lining.

Stomach ulcer home remedy

Various home remedies can be helpful in the supportive treatment of gastric ulcers in horses. These natural remedies can help to alleviate the symptoms and promote healing.

The following table provides an overview of common home remedies, their effects, recommended dosages and other important information.

➡️ Reading tip: In our article "Home remedies for horses" you can find out which home remedies really work, how to use them correctly and what you should look out for to keep your horse healthy and happy.

Aftercare and control

After the initial treatment, a follow-up gastroscopy should be performed to ensure that the ulcers have healed completely. Untreated or incompletely healed ulcers can become chronic and may require long-term treatment.

Prevention of stomach ulcers

The right feeding

➡️ Video tip: Adapted feeding is crucial for horses with sensitive stomachs or stomach ulcers. In this video, we show you how important feeding is for horses with stomach ulcers. You will also learn what to look out for and why roughage is the most important part of the diet:

Roughage

• Ad libitum roughage: Horses should have access to high-quality roughage such as hay or haylage at all times in order to eat continuously. The recommended amount is at least 1.5% of body weight per day. For a 500 kg horse, this is about 9 kg of hay or 11-12 kg of haylage.
• Feeding frequency: Horses should not be left without roughage for more than 6 hours to promote the continuous production of saliva, which neutralizes stomach acid.
• Hay nets: A hay net can help to regulate feed intake without the horses overeating.

Concentrated feed

• Quantity and frequency: Concentrates should be fed in small portions. Ideally, less than 0.5 kg of concentrated feed per 100 kg body weight per meal. The daily ration should be divided into several meals.
• Low sugar and starch content: Concentrated feed with a low sugar and starch content is preferable. The daily intake of non-structured carbohydrates (NSC) should be less than 1 g per kg body weight per meal.
• Oil as an energy source: If required, a high-quality oil can be used as an energy source to keep the starch content low.
• Digestible fiber sources: Concentrates should contain easily digestible fiber sources such as alfalfa to optimize energy intake.

Mineral and supplementary feed

• Balanced mineral supply: Mineral feed should contain all the necessary minerals such as calcium, phosphorus, magnesium, and trace elements in balanced quantities to avoid deficiencies or excesses.
• Correct ratio of calcium to phosphorus: The ideal ratio for adult horses is 1.5-2:1. Deviations can impair health.
• Vitamins and trace elements: The vitamin supply should be tailored to the specific requirements of the horse, depending on its age, use and state of health.

➡️ Reading tip: In our article "Supplementary feed and mineral feed for horses" we explain how you can optimally support your horse's health and performance with supplementary feed and mineral feed!

Stress reduction through adapted posture and training

There are various measures that can be taken to prevent stomach ulcers in horses by reducing stress, appropriate husbandry and training:

Adapted training

• Gradual increase: Intensify the training slowly and in a controlled manner to prevent overloading and stress.
• Shorter units: Shorter, more frequent training sessions are better than long, strenuous sessions.
• Warming up and cooling down: The horse should be warmed up and cooled down sufficiently before and after training.

Species-appropriate husbandry

• Exercise and exercise: Regular free exercise promotes digestion and reduces stress.
• Social interaction: Horses should have regular contact with conspecifics to minimize stress.
• Calm and constant environment: Stable and low-stress housing conditions promote well-being and prevent stress.

Stress management

• Gentle, consistent handling: Calm training with positive reinforcement and avoiding sudden, stressful situations.
• Travel and competition stress: Minimize stress caused by travel or competitions by taking sufficient rest and sticking to your usual routines.

Regular checks and further preventive measures

• Veterinary examinations: Regular vet examinations will help detect early signs of stomach ulcers. If your horse is undergoing stress or intensive training, it should be checked more frequently.
• Endoscopic examinations: If stomach ulcers are suspected, a gastroscopy (gastroscopy) can be performed to examine the stomach directly and make an accurate diagnosis.
• Gastroprotectants: In stressful phases (e.g. before competitions or when changing stables), the use of gastroprotectants such as omeprazole can be useful to reduce stomach acid production and lower the risk of stomach ulcers.
• Stress management: Regular monitoring of the horse's behavior for symptoms of stress, such as weight loss, loss of appetite or restlessness, can enable early action to be taken.
• Individual adjustments: Regularly adapt management (husbandry, training, feeding) to the horse's current needs and state of health to avoid unnecessary stress.

Stomach ulcer in horses: Summarized

Gastric ulcers in horses are a common condition that can be promoted by factors such as stress, inappropriate feeding and intensive training conditions. Early detection of symptoms, such as loss of appetite, weight loss or changes in behavior, is crucial to prevent more serious health consequences. Proper husbandry, adequate feeding with roughage and a low-stress environment are important preventive measures. In addition, regular veterinary examinations and, if necessary, the use of stomach protectors such as omeprazole should be considered. Good management can effectively prevent gastric ulcers and ensure the horse's long-term well-being

Stomach ulcers in horses: The most important questions and answers

What is the difference between GastroGard and UlcerGard?

• UlcerGard® is used to prevent stomach ulcers (1/4 injection per day)
• GastroGard® is used for treatment (1 injection per day).

Both have the same active ingredient, but differ in their application.

How quickly does GastroGard work in horses?

GastroGard usually starts to inhibit stomach acid production after about 5 days, but the full effect can take several weeks depending on the severity of the ulcer.

Can you ride a horse with stomach ulcers?

Yes, but only after consultation with the vet. In the case of acute ulcers, it is better to take a break so that the horse can recover. However, light exercise is usually helpful.

Can stomach ulcers in horses be cured?

• Yes, with the right treatment (medication, feeding, husbandry) most stomach ulcers heal. Mild ulcers heal faster, severe ones take longer.
• Small ulcers can often heal on their own, but you should always consult your vet to prevent them from getting worse.