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Ulcers in horses: Why and what to do?

Endoscopic procedure reveals nearly 90 percent of examined racehorses and up to 60 percent of performance horses have gastric ulcers.

Many trainers discuss with their veterinarian or nutritionist that their horses are just not performing, not eating up and just doesn’t look right. The problem, pure and simple, could be gastric ulcers. The story is not unique It can be told for an estimated 90 percent of racehorses. They are suffering from equine gastric ulcer syndrome (EGUS) -an ulceration of the oesophageal, gastric or duodenal mucosa.

Other performance horses used for showing, and even some pleasure-riding horses, may have an incidence ranging from 37 percent to 60 percent. Even more important, this syndrome doesn’t affect only the equine athlete. Studies have shown that all horses are at risk, from newborns and yearlings, with occurrence rates of up to 50 percent.

Diagnosing Ulcers

Horses differ from humans because they secrete stomach acid continuously, even when not eating. When horses are unable to access food on a continual basis, such as when grazing, the pH balance of the stomach changes drastically, and gastric juices begin to attack the stomach mucosa. The squamous portion of the horse’s stomach, the most common part to be affected, lacks the buffer bicarbonate and protective mucous coating to protect the stomach lining from acid normally secreted during the digestive process.

Clinical signs of ulcers

Adult Horses Poor appetite, Colic, Decreased performance, Attitude change, Poor body condition and Weight loss

Foals Intermittent nursing, Poor appetite, Intermittent colic, Poor body condition, Diarrhoea, Teeth grinding, Salivation, Pot belly and rough hair/coat

What do we know?

Diet and feeding behaviour are known to affect the occurrence of gastric ulcers. Horses on pasture have the lowest incidence of ulcers compared to those athletes that need “high-energy” concentrates (a smaller portion of their diet is hay). Thus, it is believed the increased rate of ulcers in horses is due to a combination of factors including:

  • A high-concentrate diet with low-roughage intake (constantly stabled) Withholding feed during competitions
  • Continuous acid secretions by the stomach and the lack of buffering of the acid by grass and/or hay
  • Other factors which induce a stressful environment including stall confinement, long-distance transportation, stable changes, training and competition.

Any horse not eating is at risk for ulcers.

The aforementioned signs are not unique to gastric ulcers but fit many of the common complaints veterinarians hear from owners and trainers. These include poor appetite, poor physical condition, weight loss, personality changes, poor performance and even mild-to-severe colic. However, owners and trainers should be suspicious of Ulcers if any or all of the signs are observed or reported in the horse.

How to confirm Ulcers

There is only one sure way to confirm ulcers, Esophagogastroscopy, or simply “stomach scoping,” is the only means to prove whether ulcers exist or not. No food is to be fed six to eight hours before scoping. A light sedative is given five minutes before the passing of the three-meter scope, similar to passing a stomach tube, down the horse’s oesophagus. It is extremely common that the horses scoped have severe ulceration of the squamous part of the stomach area where 80 percent of the ulcers are found in adult horses.

The severity of stomach ulcers is rated in grades from an inflamed but intact epithelium (Grade 0 ulcer), superficial erosions of the mucosal surface (Grade 1 ulcer) to single superficial erosions of the mucosal surface (Grade 2 ulcer) to multiple actively haemorrhaging hyperaemic (Grade 3 ulcer).

How do we treat Ulcers?

Now that the condition of horse is known, how is he to be treated? The acid pump in the horse’s stomach producing gastric juices needs to be suppressed. Pasture and free access to hay is the most natural and least ulcerogenic environment. Forage consumption not only slows speed of feeding, but also stimulates saliva that acts as a protective buffering agent. Racehorses and performance horses generally heal faster if removed from training and competition. Non-steroidal anti-inflammatory drugs, such as phenylbutazone, are believed to contribute to the formation of gastric ulcers.

Horses with documented gastric ulcers have responded to histamine H2-receptor antagonists, such as cimetidine and ranitidine, commonly known as H2 blockers. Although H2 blockers may provide limited, symptomatic relief, they block only one of several sites that stimulate acid production and may not heal the underlying gastric lesion. Antacids need to be given every two to four hours in a volume of 200g at each treatment to be effective.

A newer approach to the treatment of gastric ulcers is the introduction of the proton-pump inhibitors, also referred to as the acid-pump inhibitors. This is the “gold standard” for ulcer treatment in humans and promises to be a cure for ulcers in horses. The major advantage is this treatment has the same active ingredient, omeprazole, as in human ulcer medication. Administered daily, the acid-pump will effectively block the production of gastric acid throughout the 24 hours after administration. The only problem that arises with the use of these products is that they have to be taken off these medications prior to competition. This increases the risk of the ulcers reoccurring or not healing properly and thus will affect performance.

For the holistic person several herbs have been used to aid in the treatment of symptoms of ulcers in horses. Comfrey leaf, Marshmallow Root, Liquorice, Meadowsweet and Slippery Elm have all show signs of mucilaginous properties, which aid in providing a mucous layer over the stomach lining. One thing to point out is that they have not been proven on horses yet. However there is research being conducted on the effectiveness of herbs on treating ulcers in horses. The results should be published within a few years. One thing to remember herbal preparations do not work as quickly as prescription drugs so if you choose an alternative therapy to treat your horse give it time to work. Also consult your veterinarian with respect to the treatment you are giving your horse as some preparations may negatively interact with other medications you may be treating your horse with.


To face fact most horses have ulcers to some degree. Apart from seeking advice from your local veterinarian a diet that has plenty of access to pasture and hay will save you a lot of problems. If your horse is diagnosed with severe ulcers consult your veterinarian on the best way to treat your horse.


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2 Responses to Ulcers in horses: Why and what to do?

  1. Avatar for Lindsey
    Lindsey March 14, 2014 at 6:22 am #

    Do they need Vitamins and joint supplements?

    • Avatar for Michelle Tones
      Michelle Tones March 14, 2014 at 9:11 am #

      This will depend on the horses current diet and the vitamins and minerals he is currently receiving. To check if your horses diet is balanced please use our online nutrition program – Nutrikey http://www.hygain.com.au/nutrikey/

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