Updates on Treatment of Equine Gastric Disease

This article originally appeared in the Summer 2026 issue of EquiManagement. Sign up here for a FREE subscription to EquiManagement’s quarterly digital or print magazine and any special issues.

More information continues to become available on the ever-changing approaches to managing gastric ulcer syndrome (GUS) in horses. In a webinar presented by Epicur, Dave Rendle, BVSC, MVM, CertEM (Int Med), DECEIM, FRCVS, RCVS, presented the latest updates. He stressed that no matter the medical approach, failure to address underlying risk and management factors will interfere with resolution of gastric ulcer disease. Basic management strategies include constant access to forage; elimination of grains, especially starches; minimizing stress in training, competition, travel, and at home; and limiting duration of exercise. He suggested offering two liters of fiber before exercise to provide normal matting lower in the stomach and to control mucosal exposure to acid juices.

Esomeprazole (ESO)

The first medication Rendle reviewed is esomeprazole (ESO). While similar to omeprazole (OMP), ESO is absorbed more rapidly and consistently, is metabolized more slowly, is less affected by feeding, and offers a fivefold greater pronounced acid suppression with a longer time at pH > 4. In essence, ESO is equivalent to a double dose of OMP. Administering ESO resulted in:

• 85% healing of squamous lesions ­compared to 59% using OMP in a study of 73 and 74 horses, respectively.
• 55% healing of glandular lesions compared to 25% using OMP.