What are some of the common signs that your horse is affected by ulcers? If your horse is losing weight, not eating well, or has developed a coarse coat they may be affected by ulcers.
But these are not the only symptoms that you should be on the lookout for. Every horse owner should be aware of these signs because Equine Gastric Ulcer Syndrome (EGUS) is one of the most common medical conditions in horses.
Researchers estimate that 60-90% of performance horses will develop EGUS at some point. Pleasure horses and foals can also develop ulcers, although the disease is somewhat different.
Domesticated horses are prone to ulcers because of their biology and how we feed and manage them. Horses evolved to spend up to 16 hours a day grazing grass and forages. Their stomach produces acid continuously regardless of whether there is feed in the stomach. 
As a horse grazes, a continuous flow of saliva helps to neutralize stomach acid, keeping the pH level at four or greater for most of the day.  However, problems can occur when a horse has limited access to forage and this acid attacks the lining of the stomach and gut.
The high grain diets often fed to performance horses lead to the production of volatile fatty acids (VFAs). This can further contribute to ulcer development, as VFAs can damage cells of the stomach. 
In addition, stress is a major risk factor for ulcers. Physical and environmental stressors such as intense exercise, stall confinement, and transport stress are common in performance horses and increase the risk of EGUS.
Social stressors, such as changes in the herd group or changes to the environment and routine, can cause stress in the horse.
Signs that your Horse might have Ulcers
Symptoms of EGUS are often subtle and not specific to ulcers. Although most horses show some signs of gastric ulceration, over half of horses with ulcers don’t show any symptoms at all. 
With that said, there are a number of specific symptoms that have been directly linked with EGUS. If your horse shows any of the following signs, you should have him or her evaluated by your veterinarian who can perform an endoscopy to look for ulcers in the stomach and small intestine.
1. Poor Appetite
One of the most common signs of ulcers is the reluctance to finish meals or being a “picky eater”. This is likely a direct result of ongoing abdominal discomfort.
Your horse may start eating his grain ration but then back off. He might also show less interest in eating altogether. Some horses may be fussy about eating hay as well as grain or concentrates.
2. Weight Loss
Loss of appetite goes hand in hand with weight loss, which can occur over time if your horse is not finishing his meals. However, weight loss may also occur from a decreased absorption of nutrients which is linked with more severe cases of EGUS. Nutrient malabsorption happens when the lining of the stomach or small intestine has been damaged.
3. Poor Body Condition
When a horse loses weight due to a lack of appetite and/or malabsorption of nutrients, this can lead to a poor body condition. Your horse may lose muscle over the top line, neck, or hindquarters. You may see more prominent ribs and your horse may have a generally unthrifty appearance.
According to the Henneke body condition scoring system, a horse with a score of 4 or less is considered underweight. If your horse’s body condition declines over a matter of months and the feeding regimen hasn’t changed, having him evaluated by your veterinarian is a good idea.
4. Poor Coat Condition
If your horse has lost some of his usual shine or has developed a coarse coat, this may also be a sign of ulcers. A horse’s coat condition is related to his diet and also to the health of the entire digestive system. Problems on the inside can definitely be reflected on the outside.
A high parasite load and mineral imbalances can also lead to poor coat condition and should be ruled out. The most common mineral imbalances to affect coat quality are low copper and zinc due to high iron intake.
5. Chronic Diarrhea
Horses can have an episode of diarrhea when they are nervous or due to a sudden change in diet. They can also develop diarrhea with certain illnesses such as salmonellosis or coronavirus. However, chronic diarrhea may be a symptom of ulcers.
Researchers aren’t sure exactly why this occurs, but it has been reported widely enough that it is accepted as one of the clinical signs of ulcers in horses. 
6. Recurrent Colic
On the opposite end of the spectrum, some horses with EGUS can develop recurrent (often mild) colic. In one study, 83% of horses with recurring colic were found to have gastric ulcers. Researchers directly linked ulcers to colic in 28% of those horses (as documented by the response to an acid-suppressive treatment). 
Again, researchers aren’t sure exactly why colic occurs with ulcers. However, it’s thought that horses with EGUS may have altered gastrointestinal motility which can then increase their chances of experiencing colic. 
7. Behavioral Changes
When your horse isn’t feeling well, he may display behavior that he may not otherwise show. Any behavioral change in your horse should be cause for concern and warrants further investigation.
Horses with ulcers may act more aggressively toward other horses, especially at feeding time. A horse with ulcers may rush the feed bucket, paw, threaten neighboring horses, or kick at the walls of his stall. He may also seem nervous or spooky under saddle or just generally appear grumpy with herd mates or handlers.
8. Sensitivity in the Girth Area
If your horse is fussy when the girth is tightened, don’t assume he’s just being difficult or doesn’t want to be ridden. Girthiness is also a sign of ulcers in horses. Though some might think that the stomach is located in the girth area, it is actually the hindgut (specifically the colon) that extends up the length of the underside of the belly, all the way into the girth area.
In one study, 92% of horses with “girthiness” were found to have gastric ulcers. 
9. Stretching as if to Urinate
A horse suffering from EGUS may frequently stretch out like he needs to urinate. This behavior is likely an attempt to relieve discomfort in the abdominal region and is easy to recognize.
It should be noted that horses may also stretch out like this if they are experiencing gas colic. But if your horse displays this behavior on a frequent basis, it could very well be ulcers.
10. 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. 
11. Teeth Grinding
A horse may grind his teeth for several reasons, including anxiety and other painful conditions. However, this behavior also appears to be a common sign of gastric ulcers, especially in foals.
Foals can develop ulcers from sudden weaning practices combined with the feeding of concentrates and bruxism is often a telltale sign of the condition.
12. Excessive Salivation
Did you know that a horse’s salivary glands normally produce almost 40 liters (10 gallons) of saliva per day? This happens in order to moisten food in preparation for its journey through the digestive system. Excessive salivation, or drooling, is never normal in horses though and should always be a cause for concern.
Excessive salivation can be a sign of ulcers in the horse’s mouth, esophagus, or stomach. This symptom also seems to be common in foals with severe ulceration. 
13. Excessive Recumbency
Horses can sleep standing up, but they do need to lay down (referred to as recumbency) for several hours each day to reach full REM sleep. However, if you notice your horse laying down more than usual, this could indicate a medical issue, including ulcers.
14. Poor Performance
Researchers have found a significant association between poor performance in Thoroughbred race horses and EGUS. 
During intense exercise there is an increase in abdominal pressure that causes the stomach to compress. This pushes acid from the bottom glandular region to nonglandular region, putting it in direct contact with intestinal cells that lack natural defenses to neutralize the acid.
Ulcers in the nonglandular region of the horse’s stomach are similar to lesions that cause heart burn or gastric reflux disease (GERD) in human athletes who complain of upper GI pain during exercise.
Researchers believe the link between poor performance in horses and ulcers might also be the result of gastric pain.
Types of Ulcers in Horses
A horse with EGUS can develop ulcers in four main parts of the digestive system:
- Lower part of the esophagus
- Nonglandular region of the stomach
- Glandular region of the stomach
- Upper small intestine
The glandular region of the stomach produces acid but also produces natural defences such as mucous and bicarbonate to buffer the acid and protect the cells in that region. In contrast, the nonglandular “squamous” region is not protected by these factors.
Ulcers also commonly occur in the lower part of the esophagus. This may be due to acid reflux associated with unnatural feeding practices, such as high-grain diets, that can lead to decreased pH in the stomach. Reflux of acidic fluids may also occur with gastric compression during intense exercise, which might explain why so many racehorses develop ulcers. 
Ulcers in the glandular region of the stomach are considered to be a different syndrome from non–glandular ulcers. These ulcers have been associated with the overuse of non-steroidal anti-inflammatories (NSAIDs) such as Bte (phenylbutazone) and Banamine (flunixin meglumine). 
This is one reason it is important to carefully follow the veterinarian’s prescription when administering medication to your horse. Do not combine medications without consulting with a veterinary professional, and do not alter the route of administration or dose given without consult.
Glandular ulcers are not graded on a 1-4 scale in the same way as non-glandular ulcers but are described based on size and appearance when a gastroscopy is performed.
Management Factors Associated with Ulcers in Horses
EGUS is often considered a manmade problem because the way we care for our horses contributes to the development of the disease. The most common management factors associated with gastric ulcers in horses are:
- Intermittent access to forage
- High-grain diets
- Stall confinement
- Strenuous exercise
- Travel and competition
- Overuse of NSAIDs
- Other stressors (i.e. changes within the herd)
- Concurrent disease
The only way to accurately diagnose equine ulcers is through gastroscopy. This procedure allows your veterinarian to locate and examine lesions in the lower esophagus, stomach, or upper section of the small intestine. Lesions are then scored based on their severity, using one of several different scoring systems.  
Gastroscopy also allows your veterinarian to gather information about the number of lesions your horse is dealing with in order to determine the best course of treatment.
It’s important to note, however, that clinical signs of ulcers don’t always correlate with the severity of the horse’s condition. For example, a horse with minor lesions may show more clinical signs and vice versa.
Supporting Gastric Health
As with many conditions, prevention of equine ulcers is always better than the cure. If you have a performance horse, it’s wise to assume that he is at high risk for developing EGUS and take measures to reduce this risk.
Two good preventative strategies include reducing stress and feeding your horse appropriately.
As previously stated, providing small, frequent meals or free-choice forage can support your horse’s natural digestive function and reduce the risk of developing ulcers.
The equine stomach is relatively small (only 8-12 litres) when compared with other large species (i.e. the 150-litre rumen of a cow). Because of it’s small size, the horse’s stomach cannot handle large amounts of food all at once. Instead, horses need small, frequent forage-based meals throughout the day.
Adding alfalfa hay or pellets into a horse’s diet has been shown to decrease the severity of ulcers and may also be an effective prevention strategy.  Providing feeds high in soluble fibre such as soaked sugar beet pulp has been shown to decrease the risk of EGGD in warmbloods 
For performance horses or those in training, reducing exercise duration or frequency may help to decrease the development of the disease as well. 
You can also support gastric and hindgut health with Mad Barn’s Visceral+.
It should also not be used as a substitute for other good feeding and training practices.
Visceral+ can be fed on an ongoing basis to support gut function and immune health in your horse. Consult with our qualified equine nutritionists to learn how Visceral+ can fit into your horse’s diet.
How to Reduce Risks for Ulcer-Prone Horses
The American Association of Equine Practitioners recommends the following management tips for ulcer-prone horses:
- Allow free-choice access to grass or hay
- Feed smaller, more frequent meals
- Decrease or eliminate grains (especially sweet feeds)
- Decrease stress due to the isolation of stalled horses; have other horses nearby and visible
Though some ulcers may spontaneously resolve on their own, most will need treatment in order to heal, especially when horses remain in training. There are several different approaches to treating ulcers in horses, but the primary one is acid-suppressive therapy. 
The most commonly prescribed ulcer treatment is omeprazole, an FDA-approved proton pump inhibiting drug that has been well studied.  Other drugs may be prescribed depending on the location and severity of your horse’s ulcers. Some of these treatments include histamine blockers, coating or binding agents, synthetic hormones, prokinetic agents, and antibiotics, and a combination of several therapies is used in some instances.
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- Buchanan, BR and Andrews, FM. Treatment and Prevention of Equine Gastric Ulcer Syndrome. Vet Clin North Am Equine Pract. 2004.
- Sykes, BW et al. European College of Equine Internal Medicine Consensus Statement— Equine Gastric Ulcer Syndrome in Adult Horses. J Vet Intern Med. 2015.
- Banse, HE and Andrews, FM. Equine glandular gastric disease: prevalence, impact and management strategies. Vet Med. 2019.
- Francisco AU and Santiago SD. Gastritis, Enteritis, and Colitis in Horses. Vet Clin North Am Equine Pract. 2015.
- Murray, MJ et al. Gastric ulcers in horses: a comparison of endoscopic findings in horses with and without clinical signs. Equine Vet J Suppl. 1989.
- Millares-Ramirez, EM and Le Jeune SS. Girthiness: Retrospective Study of 37 Horses (2004-2016). J Equine Vet Sci. 2019.
- Nicol, CJ et al.Study of crib-biting and gastric inflammation and ulceration in young horses. Vet Rec. 2002.
- Vondron, S et al. Effects of two alfalfa preparations with different particle sizes on the gastric mucosa in weanlings: alfalfa chaff versus alfalfa pellets. BMC Vet Res. 2016.
- Pederson et al. Risk Factors for Equine Glandular and Squamous Gastric Disease in Show Jumping Warmbloods. Equine Vet J. 2018.