Equine gastric ulcer syndrome and the challenges facing clinicians
Authors: Spanton Jess
Journal: UK-Vet Equine
Summary
# Editorial Summary: Equine Gastric Ulcer Syndrome and Clinical Management Equine gastric ulcer syndrome remains the most prevalent gastric condition in horses, yet clinicians often struggle with diagnosis, treatment decisions and long-term management. Spanton's comprehensive literature review clarifies the distinction between equine squamous gastric disease (ESGD) and equine glandular gastric disease (EGDD), highlighting that primary ESGD—driven by prolonged mucosal acid exposure in otherwise normal gastrointestinal tracts—accounts for the majority of cases, whilst secondary squamous disease emerges from delayed gastric emptying associated with conditions including inflammatory bowel disease, pyloric stenosis, severe EGDD and gastric impaction. By systematising the current evidence base around clinically relevant questions, this work provides practitioners with a framework for distinguishing between syndrome types, which carries important implications for targeted therapeutic intervention and prognosis. Understanding whether ulceration stems from acid exposure alone or reflects underlying motility or inflammatory pathology fundamentally changes management strategy—from simple acid suppression and dietary modification to addressing the primary driver of delayed emptying. For farriers, nutritionists and rehabilitation specialists working alongside veterinary colleagues, this refined classification offers clarity on the multifactorial nature of gastric disease and supports more integrated, evidence-based approaches to prevention and recovery across the therapeutic team.
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Practical Takeaways
- •Understand that EGUS has two distinct presentations (squamous vs. glandular) requiring different diagnostic and management approaches
- •When treating squamous gastric disease, investigate for underlying causes of delayed gastric emptying rather than assuming primary acid exposure alone
- •Current literature provides evidence-based guidance to address common clinical questions about treatment and management protocols
Key Findings
- •Equine gastric ulcer syndrome is the most common disease of the equine stomach
- •EGUS is classified into two distinct syndromes: equine squamous gastric disease and equine glandular gastric disease
- •Primary squamous gastric disease results from prolonged gastric acid exposure to otherwise normal mucosa
- •Secondary squamous gastric disease occurs secondary to delayed gastric emptying from inflammatory bowel disease, pyloric stenosis, severe glandular disease, or gastric impaction