Pathogenesis of equine squamous and glandular gastric disease
Authors: Hallowell Gayle
Journal: UK-Vet Equine
Summary
Hallowell's 2018 review fundamentally reframes our understanding of equine gastric disease by establishing that squamous and glandular ulceration arise from entirely different pathological mechanisms. Whilst squamous disease results from acid-induced hyperkeratosis and mucosal erosion—where management focuses on reducing gastric acidity and acid exposure through feeding and medication strategies—glandular disease is inflammatory in nature and driven primarily by reduced mucosal blood flow, potentially representing localised inflammatory bowel disease rather than simple acid damage. This distinction has significant implications for treatment: glandular lesions respond poorly to omeprazole monotherapy and require alternative pharmaceutical approaches alongside aggressive stress reduction, with healing timelines considerably longer than squamous disease. For practitioners, this means diagnostic differentiation between gastric regions is essential, as recommending proton pump inhibitors alone for suspected glandular disease may delay recovery and mask the underlying inflammatory pathology. Understanding that acid may inhibit rather than cause glandular healing reshapes management protocols across veterinary, farriery and coaching disciplines, particularly regarding stable design, exercise scheduling and nutritional support during treatment.
Read the full abstract on the publisher's site
Practical Takeaways
- •Do not assume glandular gastric disease has the same cause or responds to the same treatment as squamous disease—inflammatory pathology requires different management strategies focused on stress reduction
- •Acid suppression alone (omeprazole) is insufficient for glandular disease; healing is slower and requires multimodal treatment approaches
- •Consider reduced gastric blood flow and possible inflammatory bowel disease as underlying causes when diagnosing glandular lesions, rather than assuming acid-related pathology
Key Findings
- •Squamous gastric disease is acid-induced causing hyperkeratosis, erosions and ulceration, while glandular disease is inflammatory in origin without ulceration
- •Risk factors for squamous disease relate to acidic pH and acid exposure, whereas glandular disease pathogenesis involves reduced gastric glandular blood flow
- •Glandular mucosa has protective factors against acid in health, distinguishing its disease mechanism from squamous mucosa disease
- •Management and treatment recommendations differ significantly between regions: glandular disease requires stress minimization and alternative approaches beyond omeprazole monotherapy