EGUS – Equine Gastric Ulceration Syndrome can cause different symptoms, from losing weight to poor performance. We can perform gastroscopy at your yard using a 3.5m video gastroscope. 

Equine gastric ulcers are not all the same. When we do gastroscopy we commonly find in affected horses both squamous and glandular ulcers. We now know that these are very different and they should be treated differently as well. 


Let’s do a gastroscopy! Click on the dots to find out more.

Equine Squamous Gastric Disease (ESGD)

ESGD affects the squamous part of the stomach. It typically occurs after increased exposure to acidic content (ie stomach acid splashing onto the unprotected upper third of the stomach). This condition affects mainly performance horses but also pleasure horses.


Symptoms can be unspecific such as :

  • Loss of appetite
  • Poor performance
  • Colic
  • Irritability and behaviour issues when riding etc.

Equine Glandular Gastric Disease (EGGD)

EGGD is a potential cause of poor performance and girth discomfort with the cause not yet clearly identified. The prevalence can vary depending on the population – for example racehorses 25-47%, sport horses 70%, pleasure horses 57%, foals 6% and even found up to 30% in feral horses. The risk factors associated with glandular disease are the following:

  • Stress (sometimes depending on the trainer, number of handlers, the lack of experience in horses competing)
  • Exercise – horses that are exercised more than 4-5 times per week have an increased risk although it doesn’t seem to be related to the intensity of the exercise. The reason seems to be extrapolated from humans where exercise increases gastric permeability and ultimately compromises the gastric barrier. Antiinflamatories don’t possess such a risk if they are given at the right doses, contrary to general belief.
  • Inflammatory bowel disease – interestingly IBD has lesions very similar to equine gastric disease. It is very possible that horses with gastric ulceration could have more widespread intestinal abnormalities. There have even been reported odd cases of gluten intolerance in horses?

Clinical Signs

Clinical signs are not specific and according to an extensive questionnaire they are generally over-interpreted by owners. Ultimately if you want to know if equine glandular disease is present, gastroscopy is the only way to diagnose it.

The symptoms tend to be:

  1.  Change in temperament (nervousness/agressiveness)
  2. Weight loss or altered eating patterns.
  3. Cutaneous sensitivity like biting the flanks, girthiness, when rugging etc. This is probably caused by referred pain reflexes related to somatic structures such as the skin.
  4. Other symptoms such as colic
  5. Changes in ridden willingness


Following gastroscopy, we would discuss with you the best treatment options. The treatment goal is to achieve acid suppression (omeprazole or misoprostol) and encourage mucosal healing (sucralfate). There are also additional management recommendations that we are likely to advise. We would also advise you on the best prevention practices. 

What drugs do we use to treat equine gastric disease?

Omeprazole is the most commonly used medication for squamous and glandular however it is not so effective in the latter (9-32%). Omeprazole presentations can vary from buffer solutions/buffer paste to granules or injectables. Esomeprazole is an alternative to Omeprazole when this is not so effective. 

Misoprostol is a more recent drug and is proven to be superior to the combination of Omeprazole and Sucralfate (72% vs 20%). There are some risks using this drug as it is abortogenic. 

Sucralfate enhances healing of ulcerated tissue. There are complementary drugs that also can be used but this should be discussed with the veterinary surgeon depending on each case.



  • Minimising changes to routine and avoiding potential stressors
  • Implement rest days during the week
  • Supplementing with oil
  • There may be some dietary supplements that may be of benefit.
The International Society of Equine Locomotor Pathology (ISELP)
British Equine Veterinary Association

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Margo Plicatus


Glandular with stomach liquor

Lesser curvature