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Animals : an open access journal from MDPI2025; 15(20); 3019; doi: 10.3390/ani15203019

Incorporating a Behavioral Medicine Approach in the Multi-Modal Management of Chronic Equine Gastric Ulcer Syndrome (EGUS): A Clinical Commentary.

Abstract: 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 presented to veterinarians with a history of problem behaviors, some of which resolve following gastroprotectant therapy. However, problem behaviors persist in some cases, despite gastroscopic resolution of disease. Some of these horses have pain-related learnt, anticipatory behavior, even after the original source of pain has resolved. Such cases, as well as chronic or refractory EGUS cases, can benefit from a behavioral medicine approach. This includes the management of any underlying diseases, environmental modification, behavior modification, and, in select cases, behavior-modifying medication. This commentary, based on the authors' clinical experiences and current literature, explores how behavioral medicine can be integrated with traditional pharmacologic, nutraceutical, and husbandry strategies for the multi-modal management of EGUS, with a focus on managing the horse's experience to improve case outcome.
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Publication Date: 2025-10-17 PubMed ID: 41153946PubMed Central: PMC12561611DOI: 10.3390/ani15203019Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This research article discusses the integration of behavioral medicine into the comprehensive treatment of Equine Gastric Ulcer Syndrome (EGUS), which includes two related but distinct gastric diseases in horses.
  • The paper emphasizes addressing both the physical condition and associated behavioral issues to improve treatment outcomes for horses suffering from EGUS.

Understanding Equine Gastric Ulcer Syndrome (EGUS)

  • EGUS is a term covering mucosal gastric diseases in horses, primarily split into:
    • Equine Squamous Gastric Disease (ESGD)
    • Equine Glandular Gastric Disease (EGGD)
  • Each condition differs in its underlying pathophysiology and necessitates a tailored approach to management.
  • Both diseases cause pain, which has significant implications for the horse’s welfare and behavior.

Relationship Between EGUS and Behavioral Factors

  • EGUS is influenced by a complex interplay of physical stressors (e.g., illness, environment) and psychological stressors (e.g., anxiety, learned responses).
  • Horses with EGUS often exhibit problem behaviors that may alleviate after treatment with gastroprotectants, supporting the link between gastric discomfort and behavior.
  • In many cases, problem behaviors persist even after gastroscopic healing, suggesting factors beyond physical pain:
    • Learned pain-related behaviors
    • Anticipatory behaviors linked to previous painful experiences

Need for a Behavioral Medicine Approach

  • Traditional management typically focuses on pharmacological and husbandry measures, but this may be insufficient for chronic or refractory cases.
  • Behavioral medicine adds complementary strategies aimed at:
    • Managing underlying diseases comprehensively
    • Modifying the horse’s environment to reduce stress
    • Behavior modification techniques to address learned and anticipatory behavior
    • Use of behavior-modifying medications in select cases to assist in managing symptoms
  • This multi-modal strategy supports improving the horse’s overall experience, contributing to better therapeutic outcomes.

Integration of Behavioral and Traditional Therapies

  • The commentary synthesizes clinical experiences and current literature to advocate for a holistic approach that includes:
    • Pharmacologic therapies such as gastroprotectants
    • Nutraceuticals that may support gastric health
    • Optimized husbandry practices to minimize physical and psychological stressors
    • Behavioral interventions aligned with veterinary treatment to address persistent or learned problematic behaviors
  • Focus is placed on managing the horse’s experience throughout treatment to reduce pain, anxiety, and stress, which can perpetuate or worsen EGUS and associated behaviors.

Clinical Implications

  • Veterinarians are encouraged to assess and address behavioral issues alongside physical treatment of EGUS.
  • This approach may lead to:
    • Improved resolution of gastric disease symptoms
    • Reduction of persistent problem behaviors
    • Better welfare and quality of life for affected horses
  • The commentary provides a framework for practitioners to integrate behavioral medicine practically within their clinical management strategies.

Cite This Article

APA
Klinck M, Lovett A, Sykes B. (2025). Incorporating a Behavioral Medicine Approach in the Multi-Modal Management of Chronic Equine Gastric Ulcer Syndrome (EGUS): A Clinical Commentary. Animals (Basel), 15(20), 3019. https://doi.org/10.3390/ani15203019

Publication

Animals : an open access journal from MDPI
ISSN: 2076-2615
NlmUniqueID: 101635614
Country: Switzerland
Language: English
Volume: 15
Issue: 20
PII: 3019

Researcher Affiliations

Klinck, Mary
  • Mary Klinck, Veterinary Behavioural Medicine Consultant, Vaudreuil-Dorion, QC J7V 0K5, Canada.
Lovett, Amy
  • School of Agricultural, Environmental and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW 2650, Australia.
Sykes, Ben
  • BW Sykes Consultancy, Coffs Harbour, NSW 2450, Australia.

Conflict of Interest Statement

B.S. has current consultancy or research relationships with the following commercial entities: Kelato, Apollo Equine Health, and TeleMedVet. In addition, the author has provided consultancy, research, or educational services to, or received travel support from, the following commercial entities within the past 3 years: Abbey Laboratories, A-Vet, Bemer, Boehringer Ingelheim, Health Food Symmetry, Hong Kong Jockey Club, Mayohealth, Fluxergy, Kentucky Equine Research, and Salfarm. The remaining authors declare no conflicts of interest.

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