How to Prevent Gastric Ulcers in Horses

How to Prevent Gastric Ulcers in Horses

By Dr Duncan Houston

Gastric ulcers are extremely common in performance horses, but they are also frequently misunderstood.

A horse that becomes girthy, difficult to ride, reluctant to eat or inconsistent in competition may have gastric disease. However, those signs can also be caused by lameness, back pain, dental disease, poor saddle fit, training problems or other gastrointestinal conditions.

The other major misunderstanding is that all equine ulcers are simply caused by “too much acid”. Horses have two very different stomach linings, and disease in each region develops for different reasons. That distinction changes how ulcers should be prevented, diagnosed and treated.

Quick Answer

The most effective ways to reduce gastric ulcer risk are to provide frequent access to forage, avoid prolonged fasting, limit large high-starch meals, offer forage before exercise, maintain constant access to water, manage training and transport stress, and use NSAIDs only as directed.

Medication may be appropriate during high-risk periods, but it should support good management rather than replace it. Horses with recurring behavioural changes, poor appetite, weight loss, reduced performance or repeated colic should be examined by a veterinarian and may need gastroscopy.

What Are Gastric Ulcers in Horses?

Equine Gastric Ulcer Syndrome, usually shortened to EGUS, is an umbrella term for erosive and ulcerative disease affecting the horse’s stomach.

The stomach contains two very different regions:

Condition	Where it occurs	What usually drives it
Equine Squamous Gastric Disease, or ESGD	The upper, non-glandular lining	Repeated exposure to acid, fasting, exercise and high-starch feeding
Equine Glandular Gastric Disease, or EGGD	The lower acid-producing lining, including the antrum and pylorus	Failure of normal mucosal protection, stress, inflammation and sometimes medication effects

The upper squamous lining has limited protection against acid. The lower glandular lining normally handles a very acidic environment by using mucus, bicarbonate, prostaglandins, blood flow and rapid cellular repair.

This means ESGD is primarily an acid exposure problem, while EGGD is more accurately considered a mucosal defence problem. A horse can have either condition or both at the same time. (Refubium)

How Common Are Gastric Ulcers?

There is no single percentage that applies to every horse.

A recent veterinary review found published prevalence estimates ranging from approximately:

• 11 to 100 percent for ESGD

• 6 to 70 percent for EGGD

The enormous variation reflects differences in breed, discipline, training intensity, diet, housing, transport, age and the populations selected for gastroscopy.

Racehorses and other intensively managed performance horses generally have the highest prevalence, but ulcers can also occur in pleasure horses, retired horses and horses living predominantly at pasture. (Refubium)

This is why statements such as “90 percent of all racehorses” or “60 percent of all show horses” should be treated as broad estimates rather than diagnostic facts.

Why Do Horses Develop Squamous Gastric Ulcers?

Horses produce gastric acid continuously, including when they are not eating.

Under more natural feeding conditions, repeated forage intake encourages chewing and saliva production. Saliva contains bicarbonate, and the fibrous material within the stomach helps create a barrier between acidic fluid in the lower stomach and the vulnerable upper squamous lining.

Problems develop when this normal protection is disrupted.

Prolonged periods without forage

Alternating periods of fasting and feeding can expose the squamous lining to prolonged acidity. Ulcer risk increases when intervals between forage meals become too long.

Recent recommendations generally support allowing at least eight hours of total foraging time each day and avoiding periods longer than approximately five to six hours without the opportunity to eat forage. Free-choice forage may be appropriate for many horses, although the plan must still account for obesity, insulin dysregulation and laminitis risk. (Refubium)

Exercise and acid splash

During faster exercise, increased abdominal pressure compresses the stomach. Acidic liquid from the lower stomach can move upwards and contact the unprotected squamous lining.

This effect is more pronounced when the stomach is relatively empty. Squamous mucosal exposure to acid also increases as exercise intensity rises. (Merck Veterinary Manual)

High-starch feeding

Large concentrate meals require less chewing than forage, so they stimulate less saliva production.

Starch and sugar can also be fermented within the stomach, producing organic acids that may contribute to squamous mucosal injury.

One commonly cited risk threshold is:

• More than 1 gram of starch per kilogram of body weight in a single meal

• More than 2 grams of starch per kilogram of body weight per day

These are not universal ration limits for every horse, but they are useful warning thresholds when assessing ulcer risk. (Refubium)

Limited access to water

Water should be continuously available wherever practical, including in the paddock.

Intermittent water access has been associated with a greater likelihood of clinically relevant gastric disease. Water restriction can also increase stress and contribute to dehydration, particularly during travel and competition. (Refubium)

Why Do Horses Develop Glandular Gastric Disease?

EGGD is more complicated.

The glandular stomach is designed to tolerate acid, so simply reducing acid exposure does not fully explain why lesions develop. Disease appears to occur when the protective mucus-bicarbonate barrier, mucosal blood flow, prostaglandin activity or epithelial repair mechanisms are disrupted.

Important risk factors may include:

• Frequent exercise

• Psychological or environmental stress

• Multiple riders or changing caretakers

• Competition and travel

• Unpredictable routines

• Intensive housing

• Inappropriate NSAID use

• NSAID administration combined with fasting

• Other inflammatory or gastrointestinal disease

In one study population, exercising five or more days per week was associated with a substantially increased risk of EGGD. That does not establish a universal rule that every horse requires three days off, but it does support reviewing exercise frequency and recovery when glandular disease keeps returning. (Refubium)

Stress reduction appears especially important for EGGD, while feeding and acid-exposure management remain particularly important for ESGD. (Refubium)

What Are the Signs of Gastric Ulcers?

Adult horses with gastric disease may show:

• Reduced appetite

• Slower eating

• Leaving concentrate feed

• Mild weight loss

• Difficulty maintaining body condition

• Recurrent mild colic

• Reduced performance

• Reluctance to move forward

• Girthiness

• Ear pinning during saddling

• Tail swishing

• Bucking or resistance under saddle

• Increased sensitivity around the abdomen

• Behavioural changes

• Stereotypical behaviour such as crib-biting

• Intermittent loose manure

The difficulty is that none of these signs is specific to gastric ulcers.

A horse with severe lesions may show surprisingly little outward discomfort. Another horse with dramatic behavioural changes may have only mild gastric findings or no significant ulcers at all. Clinical signs do not reliably predict the location or severity of the lesions. (Refubium)

The mistake I see most often is diagnosing ulcers from behaviour alone.

Girthiness can be caused by back pain, saddle problems, rib pain, skin disease, reproductive behaviour, previous negative experiences or anticipation of uncomfortable work. Bucking and poor performance require assessment of the entire horse, not just the stomach.

Can Gastric Ulcers Be Diagnosed Without Gastroscopy?

Gastroscopy remains the most reliable and definitive diagnostic method.

A long endoscope is passed into the stomach after appropriate feed withdrawal. The veterinarian can then examine:

• The squamous mucosa

• The margo plicatus

• The glandular mucosa

• The antrum

• The pylorus

• The proximal duodenum where visible

This matters because a horse may have:

• ESGD without EGGD

• EGGD without ESGD

• Both diseases

• No meaningful gastric disease despite suspicious signs

Blood tests, faecal tests, saliva tests and behavioural questionnaires cannot currently replace gastroscopy. Several less invasive biomarkers are being investigated, but they are not yet reliable enough for routine diagnosis. (Refubium)

What about a treatment trial?

When gastroscopy is unavailable, a veterinarian may sometimes recommend a controlled treatment trial.

Improvement after several days of acid suppression may support the suspicion of gastric disease, but it does not prove:

• That ulcers were definitely present

• Where they were located

• How severe they were

• Whether another condition improved at the same time

• Whether the ulcers have healed

A treatment response should not become a permanent substitute for diagnosis when the signs recur.

The Most Effective Ways to Prevent Gastric Ulcers

1. Keep Forage Available

Forage is the foundation of gastric ulcer prevention.

For most adult horses, the total daily forage supply should be at least approximately 1.5 percent of body weight on a dry-matter basis, unless a veterinarian or nutritionist has prescribed a different plan.

For a 500-kilogram horse, that equates to at least approximately 7.5 kilograms of forage dry matter each day. The actual as-fed weight will be higher because hay and haylage contain water.

The goal is not merely reaching a daily kilogram target. The forage also needs to be distributed so the horse does not finish everything in two hours and then stand without food for the rest of the night.

Useful strategies include:

• Free-choice hay where appropriate

• Multiple forage meals

• Several feeding stations

• Appropriately selected slow feeders

• Overnight hay management

• Pasture access

• Separating bullied horses at feeding time

Slow feeders should not be made so restrictive that the horse becomes frustrated or is unable to consume enough forage. Positioning also matters for horses with neck, back or dental problems. (Refubium)

What if the horse is overweight or insulin dysregulated?

Do not simply remove forage for long periods.

The safer approach may include:

• Forage analysis

• Soaking hay where appropriate

• Selecting lower-energy forage

• Weighing the ration

• Using multiple feeding periods

• Carefully selected slow feeders

• Managed pasture access

• Veterinary or nutritionist supervision

Ulcer prevention should not be achieved by worsening obesity or laminitis risk, and weight loss should not be achieved by leaving the stomach empty for prolonged periods.

2. Avoid Riding on a Completely Empty Stomach

A small forage meal before exercise can help reinforce the fibrous layer within the stomach and reduce acid movement towards the squamous lining.

A practical strategy is to offer a modest amount of hay around 20 to 30 minutes before work. The amount should be enough to create stomach fill without giving the horse a large meal immediately before strenuous exercise.

Recent reviews support providing fibre shortly before exercise as part of ESGD prevention. (Refubium)

The same principle applies to transport. When safe and practical, horses should have access to forage during travel rather than being transported for hours on an empty stomach.

3. Reduce Large Starch Meals

Some performance horses need additional energy beyond what forage alone can provide. That does not mean all of that energy must come from large grain meals.

Consider:

• Dividing concentrate into smaller meals

• Increasing meal frequency

• Using highly digestible fibre sources

• Using beet pulp where appropriate

• Selecting lower-starch feeds

• Using added oil as a controlled calorie source when suitable

• Reviewing whether the horse genuinely needs the current amount of concentrate

A recent study involving show-jumping Warmbloods found that dietary adaptation towards a lower-starch ration was associated with improved gastric health and reduced ridden pain behaviour, although the study population was small. (Refubium)

The ration should be balanced as a whole. Simply removing grain without replacing protein, vitamins, minerals or necessary calories can create a different set of problems.

4. Maintain Constant Access to Water

Horses should have access to clean, palatable water:

• In the stable

• In the paddock

• During transport stops

• At shows

• During hot weather

• After exercise

Check that:

• Troughs have not frozen

• Automatic drinkers are functioning

• The horse knows how to use unfamiliar drinkers

• Water tastes acceptable at competition venues

• Subordinate horses are not being blocked from the trough

• Buckets are cleaned regularly

A horse may have water technically available while still drinking far less than normal.

5. Review Exercise Frequency and Intensity

Exercise is beneficial and should not be treated as inherently harmful. The problem is repeated high-intensity work without sufficient recovery or stomach protection.

Review:

• The number of training days each week

• Fast-work frequency

• Jumping frequency

• Competition schedule

• Travel days

• Recovery days

• Whether the horse is worked before eating

• Whether workload suddenly increased

• Whether the horse is becoming progressively more reluctant

For horses with recurring EGGD, incorporating consistent lower-stress days and genuine recovery days may be particularly valuable.

For horses prone to ESGD, limiting unnecessary high-intensity work and ensuring forage is present before exercise may reduce acid exposure.

6. Reduce Psychological and Environmental Stress

Stress cannot always be eliminated, and not every horse experiences the same situation in the same way.

Possible stressors include:

• Social isolation

• Frequent stable changes

• Unfamiliar handlers

• Multiple riders

• Inconsistent routines

• Prolonged confinement

• Bullying within a group

• Loss of a companion

• Repeated transport

• Busy warm-up arenas

• Painful training

• Lack of turnout

• Inadequate sleep

Practical strategies include:

• Maintaining predictable feeding and training times

• Using a small number of consistent handlers

• Providing visual and physical contact with compatible horses

• Allowing safe turnout

• Avoiding sudden unnecessary management changes

• Ensuring the horse can rest properly

• Addressing pain early

• Allowing recovery after travel and competition

• Avoiding punishment for pain-related behaviour

Turnout alone does not guarantee protection. A horse can live outside and still develop ulcers if forage access, social stability, workload or other management factors remain unsuitable.

7. Use NSAIDs Carefully

NSAIDs such as phenylbutazone and flunixin are valuable medications. They should not be portrayed as drugs that inevitably cause ulcers whenever they are used.

Risk becomes greater when:

• The dose is excessive

• Two NSAIDs are combined

• NSAIDs are given with corticosteroids

• Treatment continues longer than intended

• The horse is dehydrated

• The horse is fasting

• Kidney or gastrointestinal disease is already present

• Medication is given without veterinary oversight

Inappropriate NSAID exposure can impair prostaglandin-dependent mucosal protection, particularly within the glandular stomach. NSAIDs combined with feed deprivation are especially concerning. (Merck Veterinary Manual)

Do not automatically add acid-suppressing medication to every NSAID course. The need for gastric protection depends on the drug, dose, duration, horse and underlying disease.

8. Use Proven Preventive Medication When It Is Genuinely Needed

Management changes are essential, but some horses remain at substantial risk during:

• Intense training

• Racing

• Multi-day competitions

• Prolonged transport

• Hospitalisation

• Stall confinement

• Major environmental changes

• Periods of predictably reduced forage intake

In these circumstances, a veterinarian may recommend preventive omeprazole.

The US product distinction matters

ULCERGARD® is FDA-approved for the prevention of gastric ulcers in otherwise healthy horses exposed to stressful conditions. Its US label provides omeprazole at a preventive dose of 1 mg/kg once daily during the stressful period. The labelled product is intended for horses weighing at least 600 pounds, with veterinary advice required for smaller horses. (DailyMed)

GASTROGARD® is a prescription omeprazole product approved for the treatment of gastric ulcers and prevention of recurrence. Its US treatment label uses 4 mg/kg once daily for 28 days, followed where indicated by 2 mg/kg once daily for at least another 28 days to reduce recurrence. (DailyMed)

As of April 2026, Gastrobim is also FDA-approved as a bioequivalent generic prescription omeprazole paste for treatment and prevention of recurrence. This means the claim that GASTROGARD® is now the only FDA-approved treatment product is no longer current. (U.S. Food and Drug Administration)

These are US approvals. Product names, doses, legal categories and available formulations differ between countries.

Prevention is not the same as treatment

Giving a preventive dose to a horse that already has established ulcers may result in inadequate treatment.

Similarly, using a full treatment dose indefinitely without diagnosis, review or management changes is not a sensible prevention strategy.

Does Omeprazole Work Equally Well for Every Type of Ulcer?

No.

Oral omeprazole is highly effective for many horses with ESGD because sustained acid suppression allows the squamous lining to heal.

EGGD is often more difficult. Acid suppression remains important, but the underlying problem also involves glandular mucosal defence, inflammation and stress. Some glandular lesions respond incompletely to four weeks of omeprazole alone.

Veterinarians may recommend:

• A longer treatment course

• Repeat gastroscopy

• Sucralfate

• Misoprostol

• Another acid-suppressing protocol

• Investigation for concurrent intestinal or inflammatory disease

• More substantial management changes

Treatment selection depends on the location, appearance and depth of the lesions, as well as the horse’s history. EGGD may require six to eight weeks or longer before treatment success is assessed. (Merck Veterinary Manual)

Do not add misoprostol or other human ulcer medication without veterinary direction. Some medications have important reproductive and human-exposure risks.

Does Alfalfa Prevent Gastric Ulcers?

Alfalfa, also called lucerne, contains relatively high amounts of calcium and protein and can temporarily buffer gastric acidity.

This may make alfalfa useful for some horses, particularly as part of a forage-first ration or as a small pre-exercise meal.

However, the answer is more nuanced than “alfalfa prevents ulcers”.

Recent research has produced conflicting findings:

• Alfalfa may provide useful acid buffering

• Pelleted alfalfa has been associated with improvement in some glandular disease studies

• Coarse alfalfa chaff or forage has been associated with glandular antral lesions in some populations

• The physical form, particle size, total ration and ulcer location may all matter

Alfalfa is therefore not a universal treatment for every horse with suspected ulcers. It should be selected according to the horse’s complete ration, body condition, metabolic health and whether squamous or glandular disease is the primary concern. (Refubium)

Do Ulcer Supplements Work?

Some supplements may support gastric health, but the evidence is inconsistent.

Ingredients that have been investigated include:

• Pectin-lecithin complexes

• Calcium and magnesium buffers

• Sea buckthorn

• Beta-glucans

• Hyaluronic acid

• Aloe vera

• Licorice extracts

• Oils and fatty acids

• Various botanical combinations

The problems are that:

• Many studies involve small numbers of horses

• Formulations differ substantially

• Some studies combine supplements with management changes

• Improvement is not the same as complete healing

• A result from one formulation cannot be applied to every product containing a similar ingredient

• Supplement labels may imply far more than the evidence supports

Aloe vera, for example, produced some improvement in one study but was inferior to omeprazole for treating squamous ulceration. Some omega-3 formulations have failed to prevent ulcer formation. (Refubium)

Supplements should not replace gastroscopy and proven treatment in a horse with clinically important disease.

A beautifully branded bucket cannot out-negotiate stomach acid. The stomach, rather rudely, has never read the marketing copy.

How Worried Should You Be?

Low Risk

The horse:

• Is bright and eating normally

• Maintains weight and condition

• Performs normally

• Has reliable forage and water access

• Experiences only occasional transport or competition

• Has no recurrent colic or behavioural change

What to do: Continue a forage-first management plan and review feeding, travel and medication practices before high-risk periods.

Moderate Risk

The horse has:

• Mild intermittent girthiness

• Occasional reluctance to finish concentrate

• Reduced enthusiasm during training

• A recent increase in workload

• Frequent transport

• Longer periods without forage

• A recent management or social change

What to do: Correct obvious risk factors immediately and monitor closely over the next several days. Arrange a veterinary assessment if signs persist for more than a few days, recur with exercise or become more noticeable.

High Risk

The horse has:

• Recurrent mild colic

• Definite weight loss

• Persistent appetite reduction

• Repeated behavioural changes

• Significant poor performance

• Increasing resistance under saddle

• Previous confirmed ulcers

• Recent intensive competition or hospitalisation

• Ongoing NSAID use

• Signs that return after stopping ulcer treatment

What to do: Arrange a veterinary examination promptly, ideally within several days. Gastroscopy should be strongly considered rather than repeatedly guessing from the symptoms.

Critical

The horse has:

• Severe or persistent colic

• Repeated violent rolling

• Collapse

• Marked abdominal distension

• Significant reflux

• Inability to swallow

• Profound weakness

• Rapid deterioration

• A foal with severe bruxism, salivation, repeated recumbency or failure to nurse

What to do: Contact an equine veterinarian immediately. Do not assume severe abdominal pain is “just ulcers”.

When Is This an Emergency?

Gastric ulcers are often chronic and do not usually cause a sudden life-threatening emergency in adult horses.

However, severe clinical signs may indicate:

• Intestinal obstruction

• Strangulating colic

• Gastric distension

• Enterocolitis

• Peritonitis

• Gastric outflow obstruction

• Severe systemic disease

• Rare gastric or duodenal perforation

Seek immediate veterinary care if your horse develops:

• Persistent or severe abdominal pain

• Repeated rolling or throwing itself down

• Collapse or inability to stand

• Heart rate remaining markedly elevated

• Absent or greatly reduced manure production

• Severe sweating

• Marked abdominal distension

• Profound depression

• Signs of shock

• Rapidly worsening clinical signs

Adult horses with severe colic may also have gastric ulcers, but the ulcers are often not the primary cause of the acute pain. Treating severe colic with ulcer paste while delaying an examination can be dangerous. (Merck Veterinary Manual)

Foals need special caution

Foals can develop more serious ulcer complications than adult horses, including reflux, oesophageal injury, gastric outflow obstruction and perforation.

Urgent signs in a foal include:

• Failure to nurse

• Interrupted nursing

• Teeth grinding

• Excessive salivation

• Milk or fluid coming from the mouth or nostrils

• Repeated dorsal or sternal recumbency

• Colic

• Diarrhoea

• Weakness

• Abdominal tenderness

A symptomatic foal should be assessed promptly rather than monitored at home for several days.

What Should You Do if You Suspect Ulcers?

1. Assess the horse’s immediate condition

Check:

• Appetite

• Water intake

• Manure

• Temperature

• Resting heart rate

• Signs of colic

• Body condition

• Current medications

• Whether the horse is safe to exercise

A horse with active colic, fever, marked appetite loss or significant weight loss needs veterinary assessment rather than a feeding experiment.

2. Stop unnecessary high-intensity work

If the horse has become painful, resistant or clearly unwell, do not continue hard work to see whether it “warms out of it”.

Gentle turnout or walking may be appropriate for a comfortable horse, but exercise recommendations should reflect the horse’s clinical condition.

3. Correct obvious feeding gaps

While arranging veterinary advice:

• Maintain access to water

• Avoid prolonged periods without forage

• Divide large concentrate meals

• Avoid exercising on an empty stomach

• Do not make abrupt ration changes

• Do not give excessive electrolyte paste to a horse without water

4. Review every medication and supplement

Record:

• Product name

• Active ingredient

• Dose

• Frequency

• Duration

• Last dose

• Reason for use

Include phenylbutazone, flunixin, firocoxib, corticosteroids and over-the-counter supplements.

5. Arrange a veterinary examination

Gastroscopy is particularly valuable when:

• Signs keep recurring

• Treatment has previously failed

• Behaviour is severe

• The horse is losing weight

• Performance has declined substantially

• EGGD is suspected

• Long-term medication is being considered

• The horse requires repeated omeprazole courses

6. Recheck confirmed disease

Feeling better does not prove the lesions have healed.

Repeat gastroscopy may be appropriate when:

• Lesions were severe

• EGGD was present

• Clinical signs persist

• The horse must return to intense work

• Treatment has been extended or changed

• Ulcers repeatedly recur

What Else Can Look Like Gastric Ulcers?

Before blaming the stomach, consider:

Musculoskeletal pain

Back, sacroiliac, limb or hoof pain can cause:

• Girthiness

• Bucking

• Reluctance to move forward

• Poor transitions

• Reduced performance

• Behavioural change

Saddle fit problems

A poorly fitting or unstable saddle may create almost identical ridden signs.

Dental disease

Painful teeth can cause:

• Slow eating

• Dropping feed

• Weight loss

• Poor performance

• Resistance to the bit

Other gastrointestinal disease

Important possibilities include:

• Parasite disease

• Inflammatory bowel disease

• Sand accumulation

• Right dorsal colitis

• Hindgut acidosis

• Liver disease

• Recurrent intestinal displacement

• Enterocolitis

Respiratory or cardiac disease

A horse performing below expectations may have:

• Equine asthma

• Upper airway obstruction

• Exercise-induced pulmonary haemorrhage

• Exercise-associated arrhythmia

Training and behavioural factors

Fear, confusion, fatigue and previous painful experiences can persist even after a medical problem has resolved.

The presence of ulcers does not prove that every behavioural problem is caused by those ulcers. The clinical relevance of gastroscopic lesions must be interpreted alongside the whole horse. (Refubium)

Common Mistakes Horse Owners Make

Assuming every difficult horse has ulcers

Ulcers are common, but so are lameness, back pain, dental disease and saddle problems.

Treating without identifying the ulcer location

A treatment plan that works well for ESGD may be inadequate for EGGD.

Using a preventive dose to treat established ulcers

Prevention and treatment doses are not interchangeable.

Stopping treatment as soon as behaviour improves

Clinical improvement can occur before mucosal healing is complete.

Continuing the same management after treatment

Ulcers commonly return when the feeding, exercise or stress pattern that contributed to them remains unchanged.

Riding before the horse has eaten

Fast exercise on an empty stomach increases acid exposure to the squamous lining.

Feeding two large grain meals per day

Dividing concentrate and replacing some starch calories with digestible fibre is usually more stomach-friendly.

Relying entirely on supplements

Some products may support management, but few have evidence comparable to approved acid-suppressing medication.

Giving NSAIDs without recording the dose

Double dosing commonly occurs when several owners, riders or staff members medicate the same horse.

Assuming pasture alone prevents ulcers

Turnout can help, but it does not guarantee sufficient forage intake, social stability or protection during intense work.

A Practical Daily Prevention Checklist

A sensible routine for an ulcer-prone horse should include:

• Adequate forage for body weight

• No prolonged fasting periods

• Clean water available continuously

• Smaller concentrate meals

• A lower-starch ration where possible

• Forage before exercise

• Safe turnout and social contact

• Predictable handlers and routines

• Appropriate recovery days

• Careful NSAID use

• Monitoring of appetite and body condition

• Early assessment of pain or performance changes

Before travel or competition, also check:

• Hay is available before departure

• Forage can be offered during transport where safe

• The horse will drink unfamiliar water

• Feeding times will remain as consistent as possible

• Preventive medication has been discussed in advance

• Competition medication rules have been checked

• The horse is not already showing signs of illness

Will a Horse With Gastric Ulcers Be Okay?

Most horses with uncomplicated gastric ulcers have a good outlook when the disease is correctly identified and both treatment and management are addressed.

ESGD often responds well to acid suppression and improved feeding management.

EGGD can be more persistent and may require:

• Longer treatment

• Additional medication

• Reduced exercise frequency

• Improved stress management

• Repeat gastroscopy

• Investigation of concurrent disease

Recurrence is common when the original risk factors return. That does not mean treatment failed. It means the stomach has been placed back into the conditions that caused or maintained the disease.

Frequently Asked Questions

Can gastric ulcers heal without medication?

Some mild squamous lesions may improve when forage access, diet and workload are substantially corrected. However, withholding effective treatment from a horse with significant clinical disease is not appropriate. Severe, persistent or glandular lesions usually require veterinary treatment.

Should horses have hay available all night?

Many horses benefit from overnight forage access. The amount and delivery method should be adjusted for body condition, metabolic health and total daily energy requirements. The horse should not finish the entire ration early and then remain without forage for most of the night.

Should I feed alfalfa before riding?

A small forage meal before work is a reasonable strategy for horses at risk of ESGD. Alfalfa may provide additional buffering, but its suitability depends on the whole ration and the type of gastric disease. Long-stem grass hay may also provide useful stomach fill and chewing.

Can I prevent ulcers using omeprazole every day?

Preventive omeprazole may be appropriate during defined high-risk periods. Continuous use should be discussed with a veterinarian, particularly if the horse repeatedly develops signs whenever medication stops. Recurring signs should prompt investigation of the diagnosis and management rather than indefinite blind treatment.

Does girthiness prove my horse has ulcers?

No. Girthiness can occur with gastric disease, but it can also result from saddle fit, back pain, rib pain, skin sensitivity, reproductive behaviour or learned anticipation. Gastroscopy is required to confirm gastric lesions.

The Real Takeaway

Gastric ulcer prevention is not about buying the most expensive supplement or keeping every horse permanently on omeprazole.

The strongest prevention plan is built around the horse’s biology:

• Frequent forage

• Continuous access to water

• Smaller, lower-starch meals

• Forage before exercise

• Appropriate training and recovery

• Stable social relationships

• Predictable routines

• Careful medication use

Most importantly, do not treat every behavioural or performance problem as proof of ulcers. Gastric disease is common, but it is only one part of the clinical picture.

Correct diagnosis tells you whether the horse has squamous disease, glandular disease, both or something entirely different. That distinction is what turns ulcer management from guesswork into proper veterinary care.

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Concerned that your horse’s appetite, behaviour or performance could be related to gastric ulcers? ASK A VET™ can help you organise feeding patterns, medication history, competition schedules and ongoing signs so you can decide whether management changes, preventive support or an in-person gastroscopy are needed.