Equine Gastric Ulcers: Symptoms, Treatment Options & Prevention Tips
Gastric ulcers in horses? Learn everything about equine gastric ulcer syndrome (EGUS)—from common symptoms and causes to effective home remedies and veterinary treatment options. Discover practical feeding strategies, management tips, and proven prevention measures to protect your horse’s stomach health. Read now and help your horse feel better!
Table of Contents
Equine Gastric Ulcers: Definition
Equine gastric ulcers are inflammatory and ulcerative lesions of the stomach lining, caused primarily by excessive gastric acid production. Unlike humans, horses are designed to graze for up to 16 hours a day, which leads to continuous acid secretion in the stomach. When horses go too long without forage or receive improper feeding, their stomachs remain empty for extended periods or produce excess acid. This acid can damage the unprotected parts of the stomach lining, leading to painful inflammation and ulcer formation. Gastric ulcers can severely impact a horse's well-being and performance. Common consequences include: Signs of colic, Decreased performance, Loss of appetite, Weight loss and poor body condition
➡️ Video tip: Equine Gastric Ulcers – When Stress Becomes Too Much!
Learn how to recognize, treat, and manage gastric ulcers in horses. Understand the symptoms, how ulcers are diagnosed, and what healing looks like – expert insights to support your horse’s digestive health.
Common Types of Equine Gastric Ulcers
Equine gastric ulcers fall under the broader term Equine Gastric Ulcer Syndrome (EGUS) and are mainly categorized into two forms:
Equine Squamous Gastric Disease (ESGD)
ESGD affects the non-glandular (squamous) portion of the stomach, located in the upper front area. This region has less natural protection against stomach acid, making it more vulnerable.
Primary ESGD is typically caused by excess gastric acid or irritating digestive by-products.
Secondary ESGD can occur when the stomach empties too slowly, causing acid to remain in contact with sensitive tissues.
Examples of ESGD in Practice:
- Competition Horse Without Forage: A performance horse left without hay for long periods during transport or shows can develop ESGD due to unbuffered acid.
- Stress-Induced Ulcers: A sensitive horse experiencing stress from a stable move may produce more acid, leading to ulcers.
- Senior Horse with Delayed Gastric Emptying: Age-related motility issues can lead to secondary ESGD due to prolonged acid exposure.
Equine Glandular Gastric Disease (EGGD)
EGGD affects the glandular (lower) portion of the stomach, where gastric acid is actually produced. Although this area is naturally protected by mucus and bicarbonate, damage can occur if this protective mechanism is impaired.
Examples of EGGD in Practice:
- Low Forage Diet: Horses fed minimal roughage may develop EGGD due to inadequate mucosal protection.
- Leisure Horse with Stress & Limited Turnout: Lack of exercise and mental stimulation can lead to stress and decreased mucosal health.
- Prolonged NSAID Use: Horses on long-term pain relief (e.g., phenylbutazone) may suffer mucosal damage, leading to glandular ulcers.
Symptoms & Signs of Gastric Ulcers in Horses
Recognizing EGUS in horses can be challenging, as signs are often subtle and nonspecific. While only a veterinarian can confirm the diagnosis via gastroscopy, horse owners should watch for these common signs.
Common Signs of Equine Gastric Ulcers:
- Poor Appetite: Horse eats less or becomes picky with feed.
- Weight Loss: Caused by reduced intake and nutrient absorption.
- Poor Body Condition: Loss of topline and muscle mass.
- Dull Coat: Rough or lackluster hair due to nutritional stress.
- Chronic Diarrhea: May indicate digestive upset linked to ulcers.
- Recurrent Colic: Frequent mild colic episodes can signal EGUS.
- Behavior Changes: Increased irritability, sensitivity, or anxiety.
- Girthiness: Flinching or aggression during saddling.
Causes of Gastric Ulcers in Horses
Gastric ulcers in horses are often caused by a combination of risk factors:
Feeding errors:
Irregular feeding schedules, high grain intake, and limited access to roughage (hay or pasture) can irritate the stomach lining and increase acid exposure.
Stress:
Intensive training, competition, changes in herd dynamics, transport, or medical procedures (e.g. surgery) can raise stress levels and stimulate excessive acid production.
Medical and physical causes:
The use of NSAIDs (non-steroidal anti-inflammatory drugs) or underlying health issues such as colic can compromise the gastric mucosa and contribute to ulcer formation.
Diagnosing Gastric Ulcers in Horses
➡️ Video tip: Gastroscopy – The Only Reliable Way to Diagnose Gastric Ulcers
Get a clear diagnosis! In this expert video, Dr. Matthias Niederhofer explains how a gastroscopy is performed, how to properly prepare your horse, and why this is the only reliable method to confirm gastric ulcers and start effective treatment. A must-watch for every horse owner!
Gastroscopy and More
Gastric ulcers in horses are diagnosed using a procedure known as gastroscopy—commonly referred to as a stomach endoscopy. During this procedure, a flexible, approximately three-meter-long video endoscope is inserted into the horse’s stomach to visually assess the condition of the gastric mucosa.The gastroscopy must be performed on an empty stomach. Feed should be withheld for at least 12 hours, and water for 2–3 hours prior to the examination. The horse is sedated to allow a thorough and stress-free evaluation of the entire stomach, including the esophageal junction.
Most ulcers occur along the Margo plicatus—the dividing line between the glandular and non-glandular regions of the stomach. Ulcers typically present as small erosions or more extensive lesions with signs of bleeding.
Blood Tests and Further Diagnostics
➡️ Video tip: Blood – the vital fluid with powerful insights!
In this video, you’ll learn how blood work is performed on horses. Dr. Judith Winter from SYNLAB VET explains the process of drawing blood, analyzing it in the lab, and interpreting key blood values to assess your horse’s health and detect underlying conditions.
A blood test can provide valuable clues about potential gastric ulcers in horses. Abnormalities in blood values—such as anemia (low red blood cell count) or reduced albumin levels—may indicate chronic blood loss or inflammation in the gastrointestinal tract. However, a blood test alone is not sufficient to definitively diagnose gastric ulcers.
Fecal samples may also offer limited diagnostic support by detecting blood in the stool. However, a negative fecal test does not rule out gastric ulcers. Fecal testing can be helpful, but it is not a stand-alone diagnostic tool.
Treatment Options for Equine Gastric Ulcers
Medical Treatment
The most common treatment for equine gastric ulcers is medication aimed at reducing gastric acid production and promoting healing of the stomach lining.
The gold-standard medication is Omeprazole, marketed under brand names such as GastroGard® or UlcerGard®.
- Dosage: 4 mg/kg body weight once daily for 28 days, followed by a maintenance dose of 1 mg/kg for another 28 days to reduce the risk of relapse.
- Re-treatment may be necessary if ulcers recur.
- Full acid suppression typically takes effect within 5 days of starting treatment.
- Cost: A full 8-week treatment with GastroGard® costs approximately €1,050.
Administration & Dosage
GastroGard® is administered orally as a paste using a calibrated syringe. Dosage is based on the horse’s body weight and should be given daily, ideally in the morning before feeding. Precise dosing is essential for effective treatment and may be adjusted based on clinical response.
Important Considerations
Omeprazole is a prodrug activated in the stomach’s acidic environment. It works by inhibiting proton pumps responsible for acid secretion. It's crucial to use only veterinary-approved Omeprazole (authorized by regulatory bodies like ZLG in Germany or FDA in the US). Human Omeprazole products are ineffective in horses and should not be used.
Alternative Medications
In certain cases, other drugs may be used depending on the ulcer type and severity:
- Misoprostol: Reduces acid production; useful for glandular ulcers or when NSAIDs are involved.
- Sucralfate: Coats the stomach lining, protecting ulcerated areas from further acid damage.
Natural Remedies for Gastric Ulcers in Horses
In addition to veterinary treatment, natural supplements and home remedies can support healing and reduce discomfort. These remedies may include:
These natural approaches can complement conventional treatments but should not replace veterinary therapy for diagnosed ulcers.
📖 Recommended Reading: Home Remedies for Horses – Natural Solutions for Health and Care
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Follow-Up Care and Monitoring
After the initial treatment of gastric ulcers, a follow-up gastroscopy is essential to ensure that the ulcers have fully healed.
Untreated or partially healed ulcers can become chronic and may require long-term management or veterinary intervention.
Preventing Gastric Ulcers in Horses
The Importance of Proper Feeding
➡️ Video Tip: Gastric Ulcers – When Stress Becomes Too Much!
A tailored feeding program is crucial for horses with sensitive stomachs or gastric ulcers. In this video, we show you why feeding management is key for ulcer-prone horses.
Learn which feeding strategies to follow and why forage (roughage) should be the cornerstone of your horse’s diet.
Forage
Ad libitum forage feeding: Horses should have constant access to high-quality forage such as hay or haylage to mimic natural grazing behavior. A minimum intake of 1.5% of body weight per day is recommended. For a 500 kg horse, this equals approximately 9 kg of hay or 11–12 kg of haylage daily.
Feeding frequency: Horses should not go longer than 6 hours without forage. Continuous chewing stimulates saliva production, which helps buffer gastric acid and maintain gut health.
Hay nets: Using slow-feed hay nets can extend feeding time and prevent rapid overconsumption without restricting intake.
Concentrate Feeding
Quantity and timing: Concentrates should be fed in small meals, ideally no more than 0.5 kg per 100 kg of body weight per meal. Divide the total daily ration into several feedings to prevent starch overload and minimize gastric stress.
Low sugar and starch content: Choose grain-free or low-NSC (non-structural carbohydrates) feeds. NSC intake should stay below 1 g per kg of body weight per meal to reduce the risk of gastric ulcers.
Oil as an energy source: Adding high-quality oils (like linseed oil) can provide extra calories without increasing starch levels.
Digestible fiber sources: Feeds containing easily fermentable fibers like alfalfa (lucerne) support gut health and provide slow-release energy.
Mineral and Supplementary Feeding
Balanced mineral supplementation: Mineral feeds should offer appropriate levels of major minerals (calcium, phosphorus, magnesium) and trace elements (zinc, copper, selenium), preventing both deficiencies and excesses.
Correct calcium-phosphorus ratio: For adult horses, a Ca:P ratio of 1.5–2:1 is ideal. Imbalances may negatively impact bone health and nutrient absorption.
Vitamins and trace elements: Supplementation should be tailored to the horse’s age, workload, and health status. Senior horses, broodmares, and performance horses may have increased demands.
➡️ Recommended read: Supplements and Mineral Feed for Horses
Learn how to optimize your horse’s health and performance with the right combination of feed additives and balanced nutrition.
Stress Reduction Through Proper Management and Training
Preventing equine gastric ulcers also means reducing stress through appropriate husbandry and training routines.
Training Adjustments
- Gradual progression: Increase workload slowly to avoid overexertion and mental strain.
- Shorter sessions: Frequent, shorter workouts are better tolerated than long, strenuous rides.
- Warm-up and cooldown: Adequate warm-up and post-training cooldown are essential to prevent physical and metabolic stress.
Equine-appropriate husbandry
- Turnout and exercise: Daily access to turnout or paddock promotes gut motility and mental relaxation.
- Social interaction: Horses are herd animals—regular contact with companions reduces anxiety.
- Stable environment: A calm, consistent routine helps minimize environmental stressors.
Stress Management for Horses
Gentle, consistent handling: Use calm training methods based on positive reinforcement. Avoid sudden, stressful situations that could trigger anxiety or digestive disturbances.
Travel and competition-related stress: Minimize stress during transportation or competitions by ensuring adequate rest periods and maintaining familiar routines. Allow horses time to decompress before and after such events.
Regular Check-Ups & Preventive Measures
Veterinary examinations: Routine veterinary check-ups are essential to detect early signs of gastric ulcers. Horses undergoing periods of high stress or intense training should be monitored more frequently.
Endoscopic examinations: If gastric ulcers are suspected, a gastroscopy (gastric endoscopy) can provide a clear diagnosis. This procedure allows direct visualization of the stomach lining.
Gastroprotective agents: During high-stress periods (e.g. before competitions or after a change in stabling), the use of gastric protectants such as Omeprazole can help reduce stomach acid production and lower the risk of ulcer formation.
Ongoing behavioral monitoring: Watch for behavioral changes such as weight loss, reduced appetite, restlessness, or mood swings. Early detection of stress-related symptoms allows for timely intervention.
Individualized management: Adapt your horse’s feeding, housing, and training programs regularly based on its health status and current workload. This helps avoid unnecessary strain and promotes well-being.
Summary: Gastric Ulcers in Horses
Gastric ulcers are a common health issue in horses, often triggered by factors like stress, inappropriate feeding practices, and intensive training schedules. Early recognition of symptoms—such as appetite loss, weight loss, or behavioral changes—is critical to prevent more serious complications.
Preventive care includes:
- Providing species-appropriate housing
- Ensuring a constant supply of roughage
- Avoiding long fasting intervals
- Maintaining a calm, consistent environment
Regular veterinary checks and the strategic use of gastric protectants like Omeprazole may also be warranted. With proactive and tailored management, equine gastric ulcers can be effectively prevented or treated—helping ensure your horse’s health, performance, and overall quality of life.
Equine Gastric Ulcers: FAQ
What is the difference between GastroGard and UlcerGard?
UlcerGard is used for the prevention of gastric ulcers (¼ syringe per day).
GastroGard is used for the treatment of diagnosed ulcers (1 syringe per day).
Both contain the same active ingredient (Omeprazole) but differ in dosage and application.
How quickly does GastroGard work in horses?
GastroGard typically begins to reduce acid production within 5 days. Full healing may take several weeks depending on the severity of the ulcer.
Can you ride a horse with gastric ulcers?
Yes, but only after consulting a veterinarian. During acute phases, a rest period is often recommended. Light exercise is usually beneficial once pain is managed.
Are gastric ulcers in horses curable?
Yes, with the right treatment plan, including medication, feeding adjustments, and management changes. Mild ulcers often heal faster, while severe ones may require longer therapy. Always consult a veterinarian.
What should not be fed to a horse with ulcers?
Avoid high-starch concentrates, grain-heavy mixes, molasses, sugary feeds, long fasting periods, acidic silage or haylage, and excessive amounts of alfalfa.
Which herbs help with gastric ulcers in horses?
Soothing herbs such as chamomile, lemon balm, licorice root, flaxseed, slippery elm bark, and anise can support healing. Always coordinate supplementation with an equine nutritionist or veterinarian.
Which medication is commonly used for treatment?
Omeprazole is the standard treatment, available under brand names like GastroGard or as a generic. It reduces gastric acid and promotes healing of the stomach lining.
What behaviors may indicate a gastric ulcer?
Affected horses may show girthiness, teeth grinding, decreased appetite, poor performance, yawning, excessive licking or chewing, behavioral changes, and mild colic symptoms.
How much does GastroGard cost for a horse?
Costs vary depending on supplier and treatment length. One injector (1-day dose) costs around €30–40. A 28-day treatment course can cost approximately €800–1,100. Generic options are often more affordable.
What worsens gastric ulcers in horses?
Risk factors include long fasting periods, intense exercise on an empty stomach, travel stress, limited forage availability, and processed or sugary feeds.
How soon can improvements be seen with GastroGard?
Acid suppression begins within hours. Clinical improvements such as increased appetite or reduced discomfort often appear within 3 to 5 days.
What are the most common symptoms of ulcers in horses?
Loss of appetite, sensitivity when saddling, reduced willingness to work, sudden aggression, frequent yawning, dull coat, weight loss, and recurring mild colics.
How long does it take for ulcers to heal?
With proper treatment, uncomplicated ulcers can heal in 3 to 4 weeks. Severe cases may take longer and require ongoing veterinary supervision.
Can an ulcer heal on its own?
In very mild cases, spontaneous healing is possible with optimal feeding and stress reduction. However, treatment is typically necessary to avoid relapse.
What is the total cost of treatment with GastroGard?
A full treatment course (including initial therapy and possible maintenance) ranges from €1,000 to €1,500, depending on the horse’s weight and condition.
How should GastroGard be administered correctly?
Administer once daily in the morning, before feeding, directly into the mouth. Do not mix with feed. Ensure the full dose is consumed.
What are the key symptoms of gastric ulcers in horses?
- Decreased appetite
- Girth sensitivity
- Unwillingness under saddle
- Performance drop
- Teeth grinding
- Yawning or licking
- Weight loss
- Dull coat
- Recurrent mild colic episodes