Update on diagnosis, nonpharmacological treatment and prevention of Equine Gastric Ulcer Syndrome (EGUS)
Authors: Lensing R., Barton A. K.
Journal: Equine Veterinary Education
Summary
# Editorial Summary: Equine Gastric Ulcer Syndrome — Diagnosis and Management Evolution The distinction between squamous (ESGD) and glandular (EGGD) gastric disease has become clinically essential since 2015, as these conditions arise from different aetiological pathways linked to dietary management, training intensity, and iatrogenic factors such as NSAID administration. Whilst gastroscopy remains the diagnostic gold standard, emerging biomarker-based approaches now offer less invasive alternatives for identifying ulceration, potentially expanding screening accessibility across practice settings. Although omeprazole continues as first-line pharmacological therapy for both conditions, cumulative concerns around cost, prolonged human health effects, and sport restrictions have driven investigation into substantive nonpharmacological interventions. This review synthesises current evidence on prevention strategies and management options beyond proton pump inhibitors, offering practitioners a practical framework for tailoring treatment to individual horses and circumstances. For equine professionals, understanding these diagnostic and therapeutic developments is vital for optimising ulcer prevention through management refinement and selecting appropriate interventions when gastric disease is suspected.
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Practical Takeaways
- •Understand that squamous and glandular gastric ulcers have different causes—manage diet, training intensity, and NSAID use strategically to prevent squamous disease, while glandular disease requires different preventive approaches
- •Gastroscopy remains essential for reliable diagnosis, but ask your vet about emerging biomarker tests if non-invasive screening becomes available in your region
- •If omeprazole is unavailable, restricted, or cost-prohibitive, evidence-based nonpharmacological options exist—discuss these alternatives with your veterinarian rather than leaving ulcers untreated
Key Findings
- •ESGD and EGGD are distinct conditions within EGUS with different risk factors including diet, training regimens, and NSAID use
- •Gastroscopy remains the gold standard diagnostic method, though new non-invasive biomarker approaches are emerging
- •Omeprazole is the evidence-based pharmacological treatment of choice for both ESGD and EGGD
- •Nonpharmacological treatments are being investigated as alternatives due to cost, long-term human safety concerns, and sport restrictions on omeprazole