Transcript:

[0:00]

Hi everyone, welcome back to Mad Barn Academy. And if you're new here, welcome — we hope to earn your subscription today.

[0:06]

Our video today is part two of the three-part series on equine gastric ulcer syndrome. If you haven't seen part one, go ahead, pause this video, and go watch part one — the link is in the description below. It's really a great lead-up to today's video.

[0:21]

So, our focus for today will be on the diagnosis and treatment of equine gastric ulcer syndrome. Certainly, dietary and management strategies for ulcer prevention also apply to treatment, but it's a lot to cover in one day — so I’ve reserved that topic for our last part three video.

[0:45]

Okay, let's get started. As a really quick review from part one, ulcers can develop in either the squamous or glandular regions of the stomach — or both in some horses. The reason this is important is because the disease processes are different for these different types of ulcers, which means treatment is different. This is why getting a really accurate diagnosis is so important — you want to know what area of the stomach you’re dealing with so that you can correctly treat it and address those underlying risk factors to prevent future ulcers.

[1:24]

So, what clinical signs might a horse exhibit if they’re ulcer-y? Unfortunately, there is a really wide range of clinical signs, and every horse is different in how they present. This can sometimes make coming to a diagnosis — or at least coming to the decision to pursue further testing — a real challenge.

[1:52]

What’s more is that the severity of clinical signs does not always correlate with the severity of ulcers present. Some horses are very stoic and tolerate discomfort better than others. Others are much more “vocal,” if you will, about their discomfort — displaying more irritable signs, aggressive signs, or issues under saddle.

[2:30]

The other thing to think about is that some of these clinical signs are somewhat non-specific. Poor performance could be caused by a whole host of things, and weight loss could be attributed to many different factors. This is why it’s really important to involve your vet in a full work-up to come to an accurate diagnosis so that you know what you’re dealing with.

[2:57]

For diagnosis, gastroscopy is the gold standard for diagnosing gastric ulcers. Gastroscopy is a relatively easy, non-invasive, outpatient procedure performed under standing sedation after a period of fasting. In most cases, horses will be withheld from food for about 12 hours, and from water for a minimum of 4 hours prior to scoping. This is because the stomach has to be empty for us to really get a good visualization of the entire structure — any food in there can obstruct the movement of the scope.

[3:43]

The procedure goes like this: the horse is sedated, the gastroscope is passed up one nostril to the back of the mouth, swallowed into the esophagus, and passed down into the stomach. The stomach is then dilated with air so we can see all the way around it. Once the exam is complete, the air is removed, the stomach is deflated, and the scope is removed. The horse then wakes up.

[4:14]

If ulcers are identified on gastroscopy, the vet will want to grade or describe them. We have an accepted grading system for squamous ulcers that ranges from 0 to 4 — 0 is considered a normal stomach, and grades 1 through 4 describe a range of severity for squamous ulcers.

[4:41]

For glandular ulcers, most often seen around the pylorus, we don’t have a formal grading system at present due to the variability between lesions in this area. Instead, they’re described descriptively — the vet will note how many lesions there are, their severity, and their characteristics (red, elevated, ulcerated, etc.).

[5:31]

Some other diagnostics include the fecal blood test, which is a stall-side diagnostic looking for components of blood in manure — either hemoglobin or albumin. Hemoglobin detection indicates bleeding somewhere in the GI tract, which could be the stomach or intestines. Albumin detection indicates undigested blood, meaning it’s coming from somewhere in the large intestine. While convenient, this test has limitations — it’s not as specific as gastroscopy, can’t identify ulcer type or exact location, and can’t detect non-bleeding ulcers.

[7:10]

Moving on to treatment — there are a few strategies to promote healing in the stomach mucosa: (1) make gastric acid less corrosive, either by neutralizing it or suppressing its production; (2) coat ulcers to protect them from acid so they can heal; and (3) restore balance to innate protective mechanisms, like the mucus-bicarbonate barrier in the glandular region.

[8:07]

Most treatment protocols today focus on three drugs: omeprazole, sucralfate, and misoprostol. Omeprazole suppresses gastric acid secretion and is the gold standard for squamous ulcer treatment. It may be combined with sucralfate for glandular ulcers, or misoprostol — a synthetic prostaglandin — may be used for glandular ulcers.

[8:46]

For squamous ulcers, the traditional omeprazole protocol is a full dose for 28 days, with research showing healing rates of 70–77% in that period. Horses that don’t fully heal may require extended treatment. Many mild cases can resolve within 14 days, making that initial window critical for healing — though treatment length is ultimately at the veterinarian’s discretion.

[9:52]

Historically, there has been concern about “rebound gastric hyperacidity” (RGH) when stopping omeprazole — a surge in acid production after treatment ends, seen in humans. To prevent this, tapering the dose over several weeks was often recommended. However, recent research suggests RGH may be less severe or prolonged than thought, and tapering may not be necessary. Instead, nutritional support during the first 48 hours post-treatment, plus avoiding stressors like exercise and transport, may help prevent recurrence.

[11:16]

For glandular ulcers, omeprazole alone is often ineffective. Combining it with sucralfate or using misoprostol may be more effective. There’s promising research on misoprostol’s superior efficacy, but more studies are needed to confirm it as the best option in all cases.

[11:54]

That wraps up part two. In our final installment, part three, we’ll discuss prevention strategies and dietary management for equine gastric ulcer syndrome — so check back soon. References for today’s video are on screen. Thank you for watching, don’t forget to like and subscribe, explore our other videos, and check the description for links to our blog articles on gastric ulcer treatment. Until next time — see you for part three!