Are You Missing These Hidden Signs of Ulcers in Horses?

Gastric ulcers are a prevalent issue in equine medicine, especially among high-performance and stabled horses. Studies suggest that 60–90% of performance horses suffer from Equine Gastric Ulcer Syndrome (EGUS) at some point in their lives. As a veterinarian, recognizing the early and subtle signs of ulcers in horses is essential for effective management and recovery.

This guide delves deeply into clinical signs, behavioral patterns, diagnostic distinctions (such as equine protozoal myeloencephalitis, or EPM, in horses), and the role of supplements in treating gastric ulcers in horses, tailored specifically for veterinary professionals.

Common Clinical Signs of Gastric Ulcers in Horses

Veterinarians often face cases with vague symptoms. Horses are stoic animals, which makes it vital to observe both physical and behavioral indicators. Common clinical signs include:

Behavioral Changes in Horses with Ulcers

Behavioral shifts are subtle but significant. As a vet, understanding these nuances can accelerate diagnosis:

• Increased girthiness or sensitivity while saddling.
• Resistance under saddle, including ear-pinning or bucking.
• Avoidance behaviors: backing away from feed, handlers, or riders.
• Mood swings or signs of depression.
• Sudden aversion to grooming or human contact.

These behavioral changes in horses with ulcers often mimic training or behavioral issues, but a clinical evaluation can confirm gastrointestinal pathology.

Diagnostic Approach for Veterinarians

While clinical signs guide the diagnosis, gastroscopy remains the gold standard for confirming esophageal-gastric junction (EGJ) ulcers. Consider the following steps:

• Physical Exam: Auscultation, palpation, and weight/body score assessment.
• Fecal Tests: Rule out parasitism.
• Blood Work: Anemia or hypoalbuminemia may indicate chronic ulceration.
• Endoscopy: Direct visualization of the gastric mucosa.
• Gastroscopy: Direct visualization of the gastric mucosa to determine ulcer grade (0 to 4).

Ulcer Grading Chart

Veterinary Note: Don’t feed the horse at least 12-18 hours before gastroscopy for optimal visualization.

Do Horses with Ulcers Drink More Water?

One question that is often asked by both clinicians and clients is: Do horses with ulcers consume more water?

Although increased water consumption is not a leading symptom, it may happen in horses that are suffering or adapting to decreased food consumption. Other explanations may include:

• Dietary salt imbalances
• Reduced feed consumption due to ulcer pain
• Environmental changes or stress

Clinical Insight: Rule out other causes of polydipsia, such as PPID, renal dysfunction, or diabetes insipidus, before attributing excessive drinking to gastric ulcers alone.

Differentiating Ulcers from EPM in Horses

EPM (Equine Protozoal Myeloencephalitis) is another condition that shares vague symptoms with ulcers, such as:

 

Veterinary Tip: If neurologic abnormalities (ataxia, facial asymmetry) are observed, place Equine Protozoal Myeloencephalitis (EPM) at the top of your differential list. Confirm with serum and CSF antibody titers.

Gastric vs. Colonic Ulcers: Understanding the Differences

It is critical to distinguish between gastric ulcers (stomach ulcers) and colonic ulcers (hindgut ulcers), as they have different symptoms and require different treatments.

 

Best Supplements for Gastric Ulcers in Horses

Veterinary practitioners often use gastric ulcer supplements in horses as a preventive and adjunctive therapy approach. The supplements maintain gastric health by minimizing acidity and facilitating mucosal healing.

Popular and Vet-Recommended Supplement Categories

• Buffered Antacids: Temporarily neutralize stomach acid (e.g., calcium carbonate).
• Mucosal Coating Agents: Like lecithin and pectin, form a protective lining.
• Amino Acids: Such as L-glutamine to support intestinal repair.
• Probiotics and Prebiotics: Enhance gut flora and improve digestion.
• Herbal Blends: Slippery elm, marshmallow root, and aloe vera have demonstrated beneficial effects.

Veterinarian Guidance: Supplements should be part of a comprehensive protocol that includes pharmaceutical treatment (such as omeprazole and misoprostol), environmental modifications, and stress management.

Nutritional Facts for Horses with the Signs of Gastric Ulcers

A strategic dietary plan is central to the prevention and management of gastric ulcers. Veterinarians should consider the following nutritional guidelines:

• Free-choice forage access: Hay, particularly alfalfa, serves as a natural buffer against stomach acid.
• Tiny, frequent meals avoid prolonged fasting intervals and decrease acid buildup.
• Low-starch, high-fiber diets: Limit cereal grains and substitute with high-fiber ingredients.
• Fat calorie sources, such as vegetable oils or rice bran, are more safely used for energy than carbohydrates.
• Digestion supplements: Enzymes in the digestive tract or yeast cultures may help support nutrient absorption and gut health.

Feeding Tip: Consider soaking hay or feeding haylage to horses with a history of colic or those prone to impaction.

Environmental and Management Factors

Stress is a significant trigger for the development of gastric ulcers in horses. Veterinarians should advise clients on minimizing stress through effective management practices:

• Turnout time: Daily access to pasture reduces confinement-related stress.
• Social interaction: Horses are herd animals and benefit from companionship.
• Routine: Maintain consistent feeding, training, and turnout schedules to ensure optimal care and management.
• Minimize NSAID use: Use COX-2 selective drugs where appropriate.
• Travel stress reduction: For competition horses, provide rest periods between events and ensure forage availability during travel.

Stable Management Tip: Encourage clients to assess stable noise, lighting, and ventilation as environmental stressors.

Treatment Planning and Medication Protocols

After confirmation via gastroscopy, tailor your treatment approach:

• Omeprazole (FDA-approved): 4 mg/kg PO q24h x 28 days.
• Sucralfate: 20 mg/kg PO TID for 7–14 days for glandular protection.
• Misoprostol: 5 mcg/kg PO BID (especially effective for glandular ulcers).
• Follow with a tapering dose of omeprazole to avoid rebound acid hypersecretion.
• Recheck Endoscopy: Recommended after 3–4 weeks to assess healing progress.

Role of Veterinary Distributors in Treatment Access

Veterinary distributors play a crucial role in providing prompt access to essential drugs, diagnostics, and supplements for the control of equine ulcers. Collaborating with reliable distributors ensures:

• Faster delivery of prescription medications, such as omeprazole or sucralfate.
• Regular stock of gastroscopy equipment and consumables.
• Quality assurance on equine-specific supplements.

Choosing distributors who specialize in equine care ensures consistency in product quality and availability, a key aspect for managing long-term conditions like EGUS.

Preventive Measures for Ulcers in Equine Patients

Veterinarians should emphasize proactive strategies to minimize recurrence:

• Feed continuous forage access (alfalfa helps buffer stomach acid).
• Avoid long fasting periods or meal gaps.
• Reduce your starch intake and opt for fat-based calorie sources instead.
• Limit NSAIDs or use selective COX-2 inhibitors.
• Address travel, social isolation, or competition-related stress.
• Encourage daily turnout and environmental enrichment.

Client Education Tip: Use printed feeding guides and ulcer symptom trackers to help owners monitor their horses’ progress.

Final Thoughts

Gastric ulcers in horses present a multifactorial challenge, requiring vigilance and a proactive veterinary approach. From clinical signs observation and behavioral idiosyncrasy to combining gastroscopy and the right choice of supplements, all elements matter.

Differentiating ulcers from diseases such as equine protozoal myeloencephalitis (EPM) in horses also provides proper treatment channels. With the assistance of reputable veterinary distributors, clinics can optimize care and provide guaranteed results.

Do you need quality veterinary tools, supplements, or educational support? DVM Central offers trusted resources for veterinary professionals specializing in equine care.

FAQs

1. What causes gastric ulcers in horses?

A number of factors, such as high-stress situations, irregular feeding regimens, intense training, and restricted access to forage, may contribute to the formation of gastric ulcers in horses. Other causes, such as some medications (e.g., NSAIDs), may also lead to the formation of ulcers.

2. Can horses with ulcers still perform?

Ulcers in horses can cause a decline in performance as a result of pain. Signs include reluctance to work and trouble with training. Medication and dietary modifications can help treat and manage ulcers, thereby enhancing performance.

3. How are ulcers diagnosed in horses?

The gold standard for diagnosing ulcers in horses is gastroscopy, a procedure that uses a small camera to examine the stomach lining. Veterinarians may also use physical exams and blood work to rule out other conditions.

4. Are there natural supplements for managing gastric ulcers in horses?

Yes, several natural supplements can help manage gastric ulcers in horses. These include probiotics, mucosal protectants (like slippery elm), and amino acids (e.g., L-glutamine), which support healing and reduce acid production.