Incorporating a Behavioral Medicine Approach in the Multi-Modal Management of Chronic Equine Gastric Ulcer Syndrome (EGUS): A Clinical Commentary
Authors: M. Klinck, A. Lovett, B. Sykes
Journal: Animals : an Open Access Journal from MDPI
Summary
# Editorial Summary: Behavioural Medicine in Equine Gastric Ulcer Management Equine gastric ulcer syndrome encompasses two distinct pathological entities—equine squamous gastric disease (ESGD) and equine glandular gastric disease (EGGD)—both causing significant pain and presenting a complex relationship with physical and psychological stressors. Klinck, Lovett and Sykes review the evidence base and clinical approaches for integrating behavioural medicine into multimodal EGUS management, drawing on current literature and their own clinical experience. The key insight is that whilst some behavioural problems resolve following gastroprotectant therapy and gastroscopic healing, others persist despite apparent ulcer resolution—a phenomenon attributable to pain-related learned and anticipatory behaviours that outlast the original tissue injury. Management of these cases and chronic or refractory EGUS requires a comprehensive approach combining disease treatment, environmental modification, behaviour modification strategies, and selective use of behaviour-modifying pharmaceuticals, with emphasis on improving the horse's overall experience rather than solely resolving gastric lesions. For practitioners, this framework suggests that persistent behavioural or performance problems in horses with EGUS warrant investigation beyond standard endoscopy and gastroprotectant dosing, and that addressing pain-associated learning patterns through environmental and behavioural intervention may be essential to achieving sustained clinical improvement.
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Practical Takeaways
- •Don't assume all problem behaviors resolve when ulcers heal—some horses develop persistent pain-related learned behaviors requiring dedicated behavior modification alongside medical treatment
- •Adopt a multi-modal management approach combining traditional ulcer therapy (gastroprotectants, nutraceuticals, husbandry) with environmental and behavioral interventions to optimize outcomes
- •Manage the horse's overall experience and psychological stress state, not just the gastric pathology, especially in chronic or treatment-resistant cases
Key Findings
- •Problem behaviors persist in some horses despite endoscopic resolution of gastric ulcers, suggesting pain-related learned and anticipatory behaviors develop independent of active disease
- •Complex interplay exists between EGUS and physical and psychological stressors in affected horses
- •Behavioral medicine approach integrating environmental modification, behavior modification, and behavior-modifying medication can benefit chronic or refractory EGUS cases