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Signs Of Gastric Ulcers In Horses

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What Is Equine Gastric Ulcer Syndrome

Symptoms of Gastric Ulcers in horses?

In order to treat Skippy effectively, its important to understand the overall scope of the problem. First, a gastric ulcer isnt a disease. It simply refers to a lesion or lesions, which, like gastritis, are also part of a syndrome, or a collection of conditions such as the ones Skippy is currently displaying. All of these symptoms can be lumped together under one parent term used to describe ulcers caused by a more specific underlying disease: Equine Gastric Ulcer Syndrome.

Most horse people are familiar with the concept of gastric ulcers. Many trainers and barn managers keep a tube of omeprazole on hand at all times to suppress the production of gastric acid in a horse they suspect may have gastric ulcers. And sometimes, it helps. But its crucial to know what type of ulcer youre dealing with in order to treat it effectively.

What Are The Causes Of Equine Gastric Ulcers

Ulcers are caused by a variety of factors including: diet and feeding management – feeding high levels of concentrates, feed deprivation and types of feeds – stress of training or disease, mechanics of training as well as long term use of medications such as non-steroidal anti-inflammatory drugs like Bute.

Equine Ulcers Signs & Symptoms

How can you tell if your horse has ulcers? The only definitive way to diagnose EGUS in your horse is by having a veterinary checkup to perform a gastroscopy.

Your vet will look into your horses stomach and upper intestine with an endoscope to see whether there are ulcers present, how severe they are and their location.

But even without an exam by your vet, there are some common signs and symptoms to look out for as evidence that your horse may have ulcers. If you think your horse is affected, a visit from the vet to perform a scope is warranted.

Signs and symptoms of gastric ulcers in horses are generally non-specific and can vary greatly between horses. Many horse owners note that their horse is just not looking right.

Some common symptoms include:

  • Poor appetite or picky eating
  • Poor body condition or weight loss
  • Chronic diarrhea

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Q: How Do I Know If My Horse Has Stomach Ulcers

A: Is your horse showing signs of pain and discomfort for no obvious reason? If a few days of treatment with an ulcer medication corrects this behaviour, you can feel confident that the cause was stomach ulcers. A three metre endoscope is used by veterinarians to obtain a positive diagnosis, but placing the horse on an ulcer medication for a few days is valuable when an endoscope is not readily available.

What Is Gastritis In Horses

Tackling Equine Gastric Ulcer Syndrome  Vet Practice News

Gastritis is the general term used to describe inflammation and/or irritation of the stomach lining. Gastritis is simply a condition caused by an underlying disease. Based on Skippys recent weight loss, lackluster coat and behavior changes coupled with his new schedule and feeding habits it seems likely hes suffering from gastritis .

Most horse people would simply say that Skippy has a gastric ulcer , a blanket term commonly used to describe lesions in the gastric mucosa . Thats somewhat accurate, as gastritis may be associated with ulcers, a prevalent problem in the performance horse. But what most horse people dont know is that there are two different kinds of gastric ulcers and you need treat them differently. Ulcers may affect either the upper squamous region or the lower glandular region of the equine stomach. The regions function very differently, so its critical to distinguish between squamous ulceration and glandular ulceration.

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Signs Your Horse Might Have Gastric Ulcers

  • Avoiding grain. Starchy feed triggers more acid release, so grain can upset an ulcery stomach, said Benjamin Buchanan, DVM, Dipl. ACVIM, ACVECC, of Brazos Valley Equine Hospital, in Navasota, Texas. If there isnt enough fiber in their stomach to buffer the acid, theyll learn that they can stop and go eat their hay for a bit, and then come back and finish the grain or just leave the grain altogether because its irritating, he said.
  • Inconsistent grumpiness. Horses could be grumpy and aggressive or they could act normalit depends on whether the stomach is currently feeling irritated, said Buchanan. They could show unpleasant behavior, such as threatening to bite, kick, or buck, with their riders under saddle, handlers on the ground, or even other horses. They might also pin their ears during saddling. Its not a consistent behavior, though, because sometimes their stomach is full of fiber, so it doesnt hurt, he said.
  • Reduced performance. Is your horse not working as well as he used to? Is he resistant or sluggish? Maybe hes also looking a little thin and dull. These are all signs pointing to ulcers, Buchanan explained. When youve got performance problems that you cant block out to any specific sports medicine injury, looking at the stomach is high on the list of things to do, he said.
  • Treatment Of Ulcers In Horses

    Treatment of gastric ulcers in horses may vary depending on the severity of the ulcer. Treatment methods may include:

    Acid Inhibitors

    Specific acid inhibitors may be prescribed to your horse to treat his ulcer. Called Proton pump inhibitors, these prescription medications may be given by your veterinarian to decrease the amount of acid that the stomach is producing.

    H2 Blockers

    H2 Blockers are medications that may be chosen by your veterinarian to prescribe to your horse to block any histamine in your horse. Histamine encourages the stomach to produce more acid. Common histamine blockers are ranitidine and cimetidine.


    Antacids are effective at blocking or buffering any stomach acid from affecting your horse. Antacids, though, are only effective for a limited amount of time. Your horses stomach is always producing acid, so large amounts are needed of this type of medication. If your horse is a performance horse, antacids may be beneficial to give sporadically, such as on the day of a performance.

    Changes in Lifestyle

    Effective treatments for ulcers also include making changes to your horses lifestyle. This may include increasing feeding times throughout the day, putting your horse to pasture, lessening his intake of grain, adding supplements, increasing roughage in his diet, and administering probiotics to help his digestion.

    Worried about the cost of Ulcers treatment?

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    Glandular Gastric Ulcers In Horses

    Glandular gastric ulceration occurs less frequently than squamous gastric ulceration, but has been found to be more common than previously thought. The two regions function differently. Unlike the upper third of the stomach which is highly susceptible to damage from stomach acid, the glandular section of the stomach is relatively impervious to it. However, when factors occur which cause the integrity of the mucosal lining to deteriorate, its natural defensive mechanisms to gastric acid are also challenged leading to the development of inflammation and lesions.

    Scientists arent entirely sure what causes this breakdown. They theorize that high dosages or long-term use of non-steroidal anti-inflammatory drugs , such as Bute, may reduce the blood supply to the lining and so contribute. It has also been suggested that, similar to human gastric ulceration, a bacterial infection may also be at play. Despite ongoing investigation, though, that theory has yet to be confirmed.

    Again, the symptoms of EGGUS are consistent with Skippys symptoms and also with those of ESGUS. But because EGGUS doesnt respond to the same treatment methods as ESGUS, you cant simply dose a horse up with omeprazole and assume hell recover.

    Once an endoscopy has determined whether your horse has ESGUS, EGGUS or both its time for your next test: checking to see if he has colonic ulcers.

    What Are The Symptoms

    Gastric Ulcers in Horses

    The clinical signs are variable between horses with some patients displaying no symptoms at all. The signs are as follows but are vague and can be inconsistent

    • Variable appetite
    • Resistance to leg aids or grooming
    • Stereotypies such as cribbing

    The most important consideration is any change in behaviour whether it be appetite, manner, eating behaviour or poor performance.

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    Cribbing Or Other Stereotypic Behaviors

    Stereotypic behaviors, such as cribbing, are repetitive and unnatural behaviors that become increasingly fixed. However, these behaviors only occur in a small percentage horses so this is one of the less common signs of ulcers.

    Dietary factors such as a lack of available forage have been strongly associated with oral stereotypies like cribbing. However, foals with ulcers may crib-bite as well.

    What Are Horse Ulcers

    Horse gastric ulcers are sores that form in the lining of the stomach. Ninety percent of all horses will develop ulcers at some point in their life. Horses have four types of ulcers. Squamous ulcers occur in the upper part of the stomach, close to the esophagus, and are referred to as Equine Gastric Ulcer Syndrome. Glandular ulcers are found in the lower part of the stomach and are referred to as Equine Glandular Gastric Disease. Pyloric ulcers are found in the opening of the stomach to the small intestines.

    But why are ulcers so prevalent in horses?

    Compared to other large animals, the horses stomach is on the smaller side. In fact, because of the size of their stomach, experts recommend horses should eat smaller meals more often.

    A horses stomach acts like two stomachs in one. The upper portion of the stomach is called the squamous. It does not produce any digestive acids and therefore does not have a protective lining. It is particularly vulnerable to ulcers. The lower portion of the stomach is known as the glandular. It produces digestive acid twenty-four seven and, as a result, has a protective lining.

    Squamous ulcers occur during a horses movement when acid splashes up onto the upper portion of the stomach where there is no protective lining and causes irritation. In some cases, it produces an ulcer. Even though movement can result in ulcers developing, they are preventable.

    Figure 2 The Equine Stomach with permission from Jean Abernethy

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    Diagnosis Of Ulcers In Horses

    If you suspect your horse has a gastric ulcer, make an appointment with your veterinarian. An ulcer can be serious, and sometimes fatal if medical attention is not given in time. Your medical professional will ask questions pertaining to his health history, look closely at his clinical signs, perform blood work, urinalysis, biochemistry profile, and other laboratory testing in order to rule out any other illnesses and come to a preliminary diagnosis.

    Your doctor may perform specific diagnostic testing using enhanced diagnostic equipment. He may use a gastroscope, which is an approximately 2 meters-long endoscope into the stomach of your horse. This is currently the most accurate and definitive diagnostic test used to confirm the presence of a stomach ulcer or ulcers.

    This test will confirm the specificities of the ulcers, such as size, severity, and precise location. Typically, ulcers are found in the upper portion of the organ however, ulcers can also be found in the lower section, including the duodenum. The ulcer will be classified between the areas of 0-4, with a 4 having severe lesions. He will communicate with you the extent of the ulcer and let you know the options for treatment.

    Signs Of Stomach Ulcers

    A Closer Look: Gastric Ulcer Formation  The Horse

    Signs of ulcers in adult horses can be vague and may include:

    • Acute or recurrent colic, particularly after eating.
    • Loss of body condition.
    • Changes in attitude.
    • Frequent lying down.

    Horses with gastric ulcers may be reluctant to eat grain or may take more time than usual to eat the grain. Gastric ulcers also occur along with many other conditions. Horses are often placed on preventative or treatment doses during hospitalization.

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    Symptoms Of Ulcers In Horses

    If your horse is showing signs of an ulcer, make an appointment with your veterinarian. There are many different symptoms of ulcers therefore, it is important to observe your horse and note any different signs or behaviors. Symptoms may include:

    • Colic after eating
    • Nursing or eating for very short time periods
    • Grinding of the teeth
    • Agitation, as if in pain


    There are several different types of digestive ailments that can affect horses. Like ulcers, these conditions can cause pain and discomfort within the stomach and gastrointestinal tract. Types include:

    • Diarrhea

    What Are Gastric Ulcers Or Equine Gastric Ulcer Syndrome

    Gastric ulcers or EGUS can be caused by prolonged exposure of the stomach lining to gastric juices resulting in ulceration and sometimes bleeding. The horses stomach can broadly be divided into two sections the upper non-glandular region where food enters the stomach, and the lower glandular region where hydrochloric acid is produced. Although the lower region is constantly exposed to acid, it generally has adequate protection and lesions are most commonly found in the upper region. Lesions in the lower region are unlikely to be diet related and may be more common in foals and older horses.

    Get in touch with our expert nutritionists for more information on gastric ulcers in horses.

  • How nutrition plays a role

    Long term nutritional management plays a key role in helping to reduce the risk, frequency and severity of gastric ulcers. New research in collaboration with SPILLERS is the first to show that changes in the diet can help to manage gastric ulcers post omeprazole treatment. In this study, a change in diet maintained the beneficial effects of omeprazole 6 weeks after treatment had stopped. In contrast, horses in the ‘no diet change’ group had regressed and at the end of the study, there was no significant difference between pre and post treatment gastric ulcer scores.

  • Base as much of the diet on forage as possible, maintaining a high fibre, controlled starch diet
  • Ensure water is available at all times
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    Gastric Ulcers May Be Accompanied By Hindgut Ulcers

    By now it should be clear that you need to have a vet diagnose not only the presence of gastric ulceration, but the specific type of gastric ulcer or ulcers your horse could be suffering from before you can select an appropriate and effective treatment plan. But guess what: once a gastroscopy has determined whether your horse has ESGUS, EGGUS or both its time for your next test: checking to see if he has colonic ulcers.

    Gastric and colonic ulcers frequently go hand-in-hand, with prevalence rates as high as 54% in performance horses. Colonic ulcers or ulcers in the hindgut are harder but not impossible to diagnose, and they have several possible causes, ranging from overuse of NSAIDs, parasite burden, or hindgut acidosis usually as a result of large grain feeds . Many of the warning signs for colonic ulcers are similar to those signifying possible gastric ulcers, including:

    • Weight loss
    • Behavior indicating discomfort around the flanks, often characterized by a dislike of
    • brushing/blanketing
    • Low-grade anemia

    Diarrhea, intermittent or acute, and recurrent mild colic episodes signal a clear hindgut problem, and absolutely warrant further investigation to determine if colonic ulcers are present.

    Good Horsemanship Does Not Rule Out Gastric Ulcers

    Equine Gastric Ulcer Syndrome: A Pain in the Gut?

    Szepesi is an avid believer in good horsemanship and likes to keep her horses in the most natural environment possible while combining it with the standards of the high-performance sport.

    “We have a small operation at Litchfield Hills Dressage so we can give the horses individualized care and provide a healthy environment. They go out twice a day in large grass fields for total of 6-8 hours per day. They have free choice hay when not out on grass , and multiple feedings per day of an all-natural diet ,” Szepesi explained. “The barn design is very open, with lots of natural light, run outs attached to stalls, no solid walls between stalls so the horses can see each other. The training schedule is riding 4-5 times a week with sessions in the dressage ring, together with hill work and field work so theres a variety. We go to Wellington, FL over the winter and rent a place with ample grass turn out where the horses can have the same care schedule as back home.

    Despite Alix’ dedicated efforts to give her horses a natural lifestyle in an environment as close to what mother nature intended, one of her horses struggled with gastric ulcers. Finding relief took her on a roller coaster ride in the equine pharmaceutical world that only drained wallets instead of finding solutions.

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    Diagnosis Of Gastric Ulcers In Horses

    In order to definitively diagnose a stomach ulcer your veterinarian will need to perform a gastric endoscopy. To perform this, your horse will require fasting for 12 hours and have water withheld for 4 hours prior to the procedure. Your horse will then be sedated to reduce stress. Your vet will then enter a small camera through your horses nostril down to the stomach. This camera will allow your veterinarian to observe the esophagus and stomach lining. This will show them damage or ulcerations and enable them to make a diagnosis and determine the severity of disease.

    Prescribe Omeprazole To Treat Ulcers

    The main treatment for gastric ulcers is Omeprazole. Omeprazole is an acid reducer. Because the equine stomach produces acid around the clock, Omeprazole has significant benefits. In a serious case of gastric ulcers, Omeprazole is usually administered for at least thirty days.

    Now here is where things get tricky. It is important to consult a veterinarian. If your horse is on a thirty-day regimen of Omeprazole, you do not want to stop administering the drug cold turkey.

    Why is this a problem?

    When the treatment with Omeprazole is stopped suddenly without tapering the dose off, it can result in the horses stomach going into overdrive, producing acid. This results in a much worse reoccurring case of gastric ulcers, not the desired outcome!

    Secondly, extended use of Omeprazole can result in your horse suffering dramatic weight loss and loss of body condition. This occurs due to a lack of digestive acids to begin the digestive process so the horse can absorb the needed nutrients from his feed.

    As you can see, there is a delicate balance here that needs to be achieved, and if you lack the necessary experience to strike that balance, you need to consult a vet.

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