Equine gastric ulcers are lesions that occur in the stomach lining of horses, often associated with stress, diet, and management practices. These ulcers can affect horses of all ages and disciplines, leading to varying degrees of discomfort and performance issues. The condition is typically categorized into Equine Gastric Ulcer Syndrome (EGUS), which includes lesions in both the squamous and glandular regions of the stomach. Diagnosis often involves endoscopic examination, and management strategies may include dietary modifications, stress reduction, and pharmacological interventions. This page compiles peer-reviewed research studies and scholarly articles that explore the etiology, diagnosis, treatment, and management of gastric ulcers in horses.
Cooley PL, Wyman M.Three horses were admitted with indolent-like corneal ulcers. All horses were treated topically with antibiotics. Two horses had ulcers with redundant epithelial borders, which were debrided with cotton-tipped applicators after topical anesthesia was induced. One ulcer healed after 2 debridements. Of 2 horses treated surgically, one had complications.
Onderdonk AB.Animal model systems have been used extensively to study both experimental and naturally occurring ulcerative colitis syndromes. Interestingly, despite a variety of different animal species and a broad range of inducing agents, the response of the large intestine has been somewhat predictable. Although there is suggestive evidence for transmissible agents in several of these animal model systems, documentation of a bacterial or viral etiology has remained elusive. Perhaps the best evidence to suggest that bacteria play a role in the development of naturally occurring ulcerative colitis resides...
Collins LG, Tyler DE.Phenylbutazone (PBZ) toxicosis was induced in 9 ponies to further define the clinical and pathologic changes occurring with this syndrome. Six additional ponies were treated with PBZ and a synthetic prostaglandin E2 to determine the role of prostaglandins in the pathogenesis of PBZ toxicosis. Ponies given only PBZ exhibited CNS depression, anorexia, weight loss, diarrhea, cyanotic mucous membranes, and oral ulcers. Total serum protein concentration gradually decreased during the 10-day treatment period. Marked mucosal atrophy, focal erosions, and ulcers characterized the lesions in the aliment...
Adamson PJ, Jang SS.Salmonella arizonae 61:1,5, was isolated in pure culture from the eye of a horse with unilateral ulcerative keratitis. The eye responded well to treatment with atropine sulfate and polymyxin B-bacitracin-neomycin ophthalmic ointments. In swab specimens taken after the lesion had healed, Salmonella was not found to be a constituent of the bacterial flora of the horse's eyes.
Brown CM, Slocombe RF, Derksen FJ.A method of fiberoptic gastroduodenoscopy and biopsy was developed for use in large horses. A 275 cm X 13.5 mm fiberendoscope was used to examine the stomach and proximal portion of the duodenum. Food was withheld for 24 to 48 hours before examination. In more than 50 horses, gastric and duodenal structures were easily visualized. A variety of lesions was detected, including parasitic lesions, gastric ulcers, gastric neoplasia, and pyloric stenosis. Mucosal biopsy specimens were obtained in selected cases.
Breider MA, Kiely RG, Edwards JF.A generalized debilitating disease in a horse was believed to be related to hypersensitivity to migrating strongyle larvae. The clinical signs included weight loss, diarrhea, and ulcers on all 4 coronary bands. The mare's condition deteriorated rapidly, so the mare was euthanatized and necropsied. The major histopathologic findings were chronic multifocal eosinophilic pancreatitis, hepatic portal fibrosis, biliary hyperplasia, and chronic ulcerative eosinophilic colitis. This case was similar to previously reported cases of chronic eosinophilic gastroenteritis in horses. Although the etiologic...
Higgins R, Biberstein EL, Jang SS.Of 24 isolates of nutritionally variant streptococci recovered from equine corneal ulcers, 22 were tested for growth requirements, physiological and biochemical reactions, and susceptibility to different antimicrobial agents. Satisfactory growth was obtained by supplementing blood agar and Todd-Hewitt broth with pyridoxal hydrochloride, and all of the media for the culture and the biochemical testing were supplemented with 0.002% of this substance. Biochemical patterns of 12 of the isolates resembled those of two viridans streptococcal species, Streptococcus intermedius and Streptococcus const...
Meschter CL, Maylin GA, Krook L.Three mature Thoroughbred geldings were given 13.63 mg phenylbutazone/Kg bodyweight intravenously for 3 days and repeated in one horse 4 days later. After 4, 7 and 10 days (double treatment), degeneration of the wall of small veins occurred in all horses. The veins were dilated and/or showed hyalin degeneration. The phlebopathy was interpreted to be paramount in phenylbutazone intoxication. All other manifestations, including erythro- and leukodiapedesis, submucosal edema and ulceration of the gastrointestinal mucosa, phlebothrombosis and significant changes in the hemogram and serum chemistry...
McGill CA, Bolton JR.Partial pyloric obstruction causing gastric retention is described in 2 young female horses. Gastric retention was confirmed by contrast radiography of the upper gastrointestinal tract. In both horses a large mass was palpated in the wall of the pyloric antrum at exploratory laparotomy. Post-mortem examination of the first case confirmed that this mass was associated with chronic gastric ulceration. Gastric ulceration was not confirmed in the second case but this horse recovered after the pylorus and duodenum were bypassed by gastro-jejunostomy.
Smith KM, Barber SM.A two year old Thoroughbred gelding, presented with guttural pouch hemorrhage, had the internal and external carotid arteries ligated. Guttural pouch mycosis was detected on endoscopic examination. After one month of topical antifungal therapy, the horse was returned and euthanized because of recurrent epistaxis. A bacterial infection of the guttural pouch with associated ulceration and hemorrhage from the maxillary artery was found at necropsy.A two year old grade gelding had ulceration and hemorrhage from the external carotid artery. Utilizing balloon-tipped catheters and arterial ligation, ...
Acland HM, Gunson DE, Gillette DM.Seven foals aged 18 days to 3 1/2 months had either single or multiple full-circumference segments or long antimesenteric bands of necrotizing duodenitis, sharply delineated from adjacent viable duodenum. Perforation of the necrotic wall had occurred in all foals, leading to acute fibrinous peritonitis. On the mucosal surface severe diffuse, acute inflammation and ulceration involved the anterior half of the duodenum. Two further foals, aged 28 and 30 days, had lesions that are believed to be a chronic form of this disease. Both foals had a thickened duodenal wall, with large areas of mucosa r...
Gunson DE, Soma LR.Acute renal papillary necrosis occurred in five horses given normal therapeutic doses of phenylbutazone and deprived of water for 36 to 48 hours prior to euthanasia. Five horses given phenylbutazone alone and four horses subjected to water deprivation alone did not develop papillary necrosis. Urinalyses were normal prior to water deprivation, and also after water deprivation in the horses that did not receive phenylbutazone, but the water-deprived, phenylbutazone-treated horses had many red blood cells, transitional epithelial cells, and large numbers of oxalate crystals in their urine. Ulcera...
Gross TL, Mayhew IG.Gastroesophageal candidiasis in association with ulceration was diagnosed in 5 foals in which signs of colic had been nonresponsive to medical treatment. The ulceration was found in the stomach of all foals and in the esophagus of 1 foal. Candida colonized hyperkeratotic mucosa surrounding the ulcers, and the associated inflammation resulted in splitting of the mucosal epithelium. Loss of the superficial mucosa may have allowed invasion by bacteria, leading to ulceration.
Moore CP, Fales WH, Whittington P, Bauer L.Gram-negative bacteria were the most common microbial isolates from 38 eyes of 37 horses with ulcerative keratitis. Pseudomonas sp, Enterobacter group, and Acinetobacter sp were the most prevalent. Fungi were cultured from 15 eyes and included 7 genera, with Aspergillus sp being the most prevalent. Ten of the eyes with fungal keratitis had been treated with corticosteroids. Eleven of 38 eyes had mixed bacterial and fungal infections. Clinically, the most severe cases were those in which Aspergillus and gram-negative bacteria existed in a mixed infection. On the basis of susceptibility testing,...
Shefstad DK.The lesions caused by larvae of Gasterophilus intestinalis in the cardiac region of the equine stomach were funnel-shaped ulcers surrounded by a rim of hyperplastic epithelial cells. Bacteria were commonly seen on the rim of epithelial cells, at the base of some ulcers, and within the cavities produced by the hooks of the larvae. Cellular debris and mucus were within the ulcer.
Moorthy AR, Spradbrow PB, Eisler ME.Vaginal swabs from 19 mares and penile swabs from 4 stallions were cultured for mycoplasmas. A single semen sample from one of the stallions was also examined. Twelve vaginal swabs and 2 penile swabs yielded mycoplasmas. Ten of the positive vaginal swabs were from mares with vaginitis, or with a history of failure of conception. Two were from apparently healthy mares, but one had been served by an infected stallion. One positive penile swab was from a stallion with ulcerative lesions and the other from a stallion with breeding difficulties. All 14 strains of mycoplasma utilised arginine, and t...
Greatorex JC.The clinical manifestations of a diarrhoeic syndrome of horses with ulceration of the mucosae of the colon and caecum are described. Patients could be divided into three groups according to their presenting symptoms and the disease is probably caused by the thrombo-embolism associated with migrating larvae of Strongylus vulgaris. The differential diagnosis, prognosis and treatment are outlined with particular reference to the use of antithrombotic agents.
McGill CA, Bolton JR.Partial pyloric obstruction causing gastric retention is described in 2 young female horses. Gastric retention was confirmed by contrast radiography of the upper gastrointestinal tract. In both horses a large mass was palpated in the wall of the pyloric antrum at exploratory laparotomy. Post-mortem examination of the first case confirmed that this mass was associated with chronic gastric ulceration. Gastric ulceration was not confirmed in the second case but this horse recovered after the pylorus and duodenum were bypassed by gastro-jejunostomy.
Geelen SN, Sloet van Oldruitenborgh-Oosterbaan MM.A 12-year-old Shetland pony was referred because of weight loss over several months and symptoms of colic. On rectal examination, enlarged mesenteric lymph nodes and an abnormal mass in the left anterior abdominal cavity were palpated. Haematological evaluation revealed leucocytosis (13 G.l-1) and an abnormal electrophoretic pattern (31.8% albumin, 18.8% alpha-globulins, 29.0% beta-globulins, 20.4% gamma-globulins). Peritoneal fluid collected by abdominal paracentesis did not contain neoplastic cells. Gastroscopy was performed and a mass, with areas of ulceration and necrosis, was visualized w...
Dice PF, Cooley PL.This report involves a retrospective study of five horses with an unusual form of progressive peripheral corneal ulcers. These ulcers were located at the perilimbal region of the cornea and spread both centripetally to mid periphery and circumferentially. Lipping of the epithelial edge was observed often. The depth ranged from superficial to mid stroma. Patients ranged from two and a half to eight years, both sexes, and were referred after a variety of antibacterial therapy. Histories were similar in that all ulcers were initially located adjacent to the limbus in one or more quadrants. No tra...
Lotstra RJ, van den Broek J, Power T, Marr CM, Wijnberg ID.Atrial fibrillation is a common equine arrhythmia. Quinidine alone, or with digoxin are common treatments. Studies on outcome in Warmblood populations in which duration of the AF is often unknown are limited. Objective: To identify the factors that are associated with the success of full treatment cardioversion with oral medication, and establish whether there are differences in these factors between institutions. Methods: Retrospective case series using patient records of Equine University Clinic of Utrecht University and Rossdales Equine Hospital, Newmarket. Methods: Forty-nine horses treate...
Nishita T, Anezaki R, Matsunaga K, Orito K, Kasuya T, Sakanoue H, Matsunaga A, Arishima K.Although endoscopy is the definitive diagnostic method for the detection of colonic ulcers, the equipment required for performing the test is costly and difficult to use. Therefore, a simple cost-effective and reliable screening test for intestinal tract bleeding is needed. To this end, we measured carbonic anhydrase isozymes (CA-I and CA-II) originating from erythrocytes by ELISA in order to determine if they could be used as markers of occult blood in feces. For fecal extract preparation, 2 g of feces were mixed with 4 ml of 0.01 M Tris-HCl (pH 8.0) containing 0.01% thimerosal. The concentra...
Lloyd KC, Wheat JD, Ryan AM, Matthews M.Sudden onset of hematuria was associated with mucosal ulceration of the proximal portion of the urethra in 1 stallion and 3 geldings. Hematuria was observed characteristically and consistently at the end of urination. Mucosal ulceration was identified endoscopically in the proximal portion of the urethra at the level of the ischial arch. Biopsy of an ulcerated area of the proximal urethra in one gelding revealed transitional cell carcinoma. Treatment regimens varied from systemic antimicrobial and/or vasoactive therapy to diversion of urinary flow via a temporary perineal urethrostomy. Hematur...
Hondalus MK, Lofstedt J.A 16-year-old pony with signs of intermittent abdominal pain was treated with phenylbutazone in excess of the recommended dosage. Endoscopy revealed ulceration of the esophagus, stomach, and proximal portion of small intestine. The pony developed diarrhea. Salmonella typhimurium was isolated from the blood and feces. Treatment included fluids, trimethoprim-sulfadiazine, sucralfate, and ranitidine hydrochloride. The diarrhea resolved, as did the gastrointestinal ulceration. This case was unusual because septicemia with salmonellosis is an uncommon finding in adult equids. Also, complications co...
Greatorex JC.The clinical manifestations of a diarrhoeic syndrome of horses with ulceration of the mucosae of the colon and caecum are described. Patients could be divided into three groups according to their presenting symptoms and the disease is probably caused by the thrombo-embolism associated with migrating larvae of Strongylus vulgaris. The differential diagnosis, prognosis and treatment are outlined with particular reference to the use of antithrombotic agents.
Murray MJ, Ball MM, Parker GA.A 3-month-old foal with a history of persistent fever and leukocytosis was found to have pneumonia, ulceration of the squamous portion of the stomach, and dilatation of the distal portion of the esophagus. The foal was euthanatized and necropsied. The distal portion of the esophagus was severely dilated, and there was severe ulceration and mural thickening of the stomach at the cardia. Because of the severe gastric ulceration and mural thickening, the gastroesophageal junction was fixed in an open position, permitting gastroesophageal reflux. The megaesophagus and pneumonia were considered to ...
Hoerdemann M, Yarbrough T.To describe the technique, postoperative complications, and outcome after autologous fascia lata grafting with conjunctival flap overlay in horses with ulcerative keratitis and keratomalacia. Methods: Retrospective case series. Methods: Eleven horses with ulcerative keratitis and keratomalacia. Methods: Horses included had undergone fascia lata grafting with conjunctival flap overlay due to impending or recent corneal perforation. Preceding therapy, lesion characteristics, postoperative complications, and short- and long-term outcomes were recorded. Results: Postoperative complications include...
Swerczek TW.Unexplained clinical signs of weight loss and emaciation were reported in a herd of Thoroughbred horses grazing spring pastures on a central Kentucky farm, even though supplemental grain and hay were provided. Results: A buttercup plant, Ranunculus bulbosus L, was abundantly present in all pastures and paddocks on the farm. All horses, especially lactating mares and their foals, had mild to severe weight loss as assessed by body condition. Seven mares on the farm had been confirmed pregnant between 30 and 45 days of gestation, but were later found to have aborted. Two 2-year-old fillies develo...
Williams Louie E, Nieto J, Wensley F, Morgan JM, Finno CJ, Berryhill EH.Omega-3 fatty acid and alpha-tocopherol supplementation reduces gastric ulcer formation in humans and rodents; however, efficacy of prevention in horses is unknown. Equine Omega Complete (EOC) is an oral supplement containing omega-3 fatty acids and alpha-tocopherol. Objective: Determine if EOC supplementation prevents gastric ulcers and increases serum alpha-tocopherol concentrations in healthy horses. Methods: Nine thoroughbred geldings; 5-13 years old. Methods: Prospective randomized block design, repeated in crossover model. Horses were administered EOC, omeprazole, or water PO for 28 ...
Leleu C, Couroucé A.Equine squamous gastric disease (ESGD), as part of the equine gastric ulcer syndrome (EGUS), are common in racing horses. The use of buffering feed supplements to treat and/or prevent gastric ulcers is an option to control this condition. Objective: The purpose of this study was to evaluate the effect of a 30-day supplementation with a blend of magnesium oxide (MgO) on ESGD scores in trotters under training. Methods: Forty-two young trotters were submitted to a gastroscopic evaluation to assess their ESGD score and were randomly assigned in a group supplemented with MgO or in a control group. ...
Kramer AJ, Meziara Wilson T, Kimura S, Groover E, DeLeon-Carnes M, Neto RLALT.A 23-y-old gelding was presented to a veterinary teaching hospital with a history of chronic, refractory diarrhea. Clinically, the horse was in poor body condition, with a thickened and corrugated large intestine identified by transcutaneous abdominal ultrasonography. At postmortem examination following euthanasia, the large colon and cecum had segmental thickening of the intestinal wall with innumerable mucosal ulcers and prominent polypoid mucosal masses. Many mesenteric and hepatic lymph nodes were enlarged. Histology revealed granulomatous and ulcerative typhlocolitis and granulomatous lym...
Tesena P, Vinijkumthorn R, Preuksathaporn T, Piyakul P, Chotikaprakal T, Sirireugwipas R, Wong-Aree K, Prapaiwan N.Phenylbutazone (PBZ) is a widely used nonsteroidal anti-inflammatory drug for horses. However, because of its gastrointestinal side effects, its administration requires careful attention in veterinary practice. Malondialdehyde (MDA) is a serum biomarker associated with increased damage to the equine gastrointestinal system. This study investigated the hematological effects and alterations in the gastrointestinal tract and assessed serum MDA concentrations following repeated oral PBZ administration at clinical doses. Fourteen horses were randomly divided into control and treatment groups. All h...
Medina B AL, Faleiros RR, Martínez A JR.Equine Gastric Ulcer Syndrome (EGUS) occurs with variable prevalence in horses, donkeys, and mules. Due to the particularities of the mucous membranes, the syndrome is made up of Squamous Gastric Disease (ESGD) and Glandular Gastric Disease (EGGD). Given the multifactorial nature and multiple classification systems of the syndrome, significant differences have been reported between prevalence studies performed ante mortem, which are even more remarkable when compared with postmortem evaluations. This study aimed to determine the presence and grade of squamous gastric disease in horses, donkeys...
Campbell MLH, Sykes BW.Prioritising equine welfare, making evidenced-based policy, and consistent decision-making across sports are crucial to maintaining the social licence for equestrian sport. Regulations on the use of omeprazole during competition differ; all regulators argue that their rules prioritise welfare. This discrepancy is a matter of concern to the public and equestrian stakeholders. Objective: To apply Campbell's Ethical Framework for the use of Horses in Sport to the question: 'Should the use of omeprazole be allowed during equestrian competition?' Methods: A desk-based ethico-legal study. Methods: C...
Botía M, Muñoz-Prieto A, Martínez-Subiela S, Martín-Cuervo M, Hansen S, Manteca X, Cerón JJ, López-Arjona M.Equine gastric ulcer syndrome (EGUS) is a frequent disease in horses that comprises two different entities: equine squamous gastric disease (ESGD) and equine glandular gastric disease (EGGD). This disease considerably reduces the quality of life of affected horses and can negatively affect performance. Saliva contains biomarkers, such as oxytocin, that have been used as a welfare indicator and can develop a function as a protective factor against stress-induced changes in gastric function due to its gastric antisecretory and antiulcer effects. The objective of this work was to evaluate changes...
Vinijkumthorn R, Prapaiwan N, Chotikaprakal T, Prompiram P, Phaonakrop N, Roytrakul S, Tesena P.Phenylbutazone (PBZ) can potentially induce gastrointestinal ulceration, and early detection of PBZ-induced gastroenteropathy will be useful for the diagnosis, treatment, and prevention of PBZ toxicity. Objective: To identify putative proteins associated with equine gastric ulcer syndrome after clinical dose (4.4 mg/kg) administration of PBZ by proteomic study. Methods: In vivo experiments. Methods: Proteomic analysis using LC-MS/MS compared protein expression in serum and faeces of seven PBZ-treated horses with seven placebo-treated controls, and a novel putative biomarker was validated via...
This study arises from the search for non-invasive diagnostic alternatives for equine gastric ulceration (EGUS), which is prevalent, clinically variable and only confirmed by gastroscopy. The aim is to quantify five salivary biomarkers (IL1-F5, PIP, CA VI, serotransferrin, albumin) under clinical conditions by validated assays and analyse their diagnostic value. Horses were grouped in No EGUS (neither clinical signs of EGUS nor gastric lesions), EGUS non-clinical (apparently no clinical signs of EGUS but with gastric lesions), and EGUS clinical (obvious clinical signs of EGUS and with gastric ...
Morales CJ, Sykes BW, McKemie DS, Kass PH, Knych HK.Current treatment options for equine gastric ulcer syndrome (EGUS), such as omeprazole-a proton pump inhibitor (PPI)-have notable limitations, including the need for administration on an empty stomach. Potassium-competitive acid blockers (P-CABs), such as vonoprazan, are a newer class of acid suppressants that offer several advantages over PPIs in humans and may provide similar benefits in horses. Objective: To describe the pharmacokinetics and effect of a single oral dose of vonoprazan on intragastric pH in horses. We hypothesised that vonoprazan would follow linear kinetics across the doses ...
Willette J, Guinn A, Munsterman A.Impactions of the jejunum are rarely described in the literature. The current case series describes six cases of adult horses with jejunal impactions with feed material diagnosed by exploratory celiotomy. Horses underwent exploratory celiotomy based off of their degree of pain despite medical management and concerns for a primary strangulating small intestinal lesion. All jejunal impactions were relieved via manual decompression of the impaction into the cecum. None of the cases underwent a resection or anastomosis at the site of impaction. All horses were treated with gastroprotectants (omepr...
Klinck M, Lovett A, Sykes B.Equine gastric ulcer syndrome (EGUS) refers to mucosal gastric disease in horses, including equine squamous gastric disease (ESGD) and equine glandular gastric disease (EGGD), which present as two distinct disease entities differing in pathophysiology and approach to disease management. Both diseases are a source of pain in affected horses, partly explaining why EGUS continues to receive substantial attention in the equine medical, welfare and equitation research sectors. There is a complex interplay between EGUS and a variety of physical and psychological stressors. Horses with EGUS are often...
Hansen S, Tecles F, Cerón JJ, From C, Carstensen H, Muñoz-Prieto A.The number of horses with equine squamous gastric disease (ESGD) and equine gastric glandular disease (EGGD) recurrence when pharmacological treatment is discontinued is high. Objective: To examine if a commercially available nutraceutical compound containing lecithin, pectin, and meadowsweet could prevent recurrence of both ESGD and EGGD after omeprazole treatment, evaluated by repeated gastroscopic examinations and saliva biomarkers. Methods: Blinded, randomised, placebo-controlled clinical trial. Methods: Thirty horses of mixed breeds and sex with a recent diagnosis and treatment of both ES...
Goetz M, Cremoux M, Lassalle L, Douet JY.To assess the efficacy and safety of Rose Bengal and green light corneal cross-linking (RGX) as an adjunctive treatment for complicated corneal ulcers and stromal abscesses in horses. Methods: A retrospective analysis included 81 horses (82 eyes) treated with RGX between 2018 and 2024. Cases involved complicated corneal diseases such as melting keratitis, fungal keratitis, deep stromal defects, and stromal abscesses. Treatment consisted of topical or iontophoretic administration of 1% Rose Bengal followed by green light irradiation (550 nm; 150 J/cm) for 10 min. Most procedures (76.8%) w...
