Misoprostol is superior to combined omeprazole-sucralfate for the treatment of equine gastric glandular disease.
Authors: Varley G, Bowen I M, Habershon-Butcher J L, Nicholls V, Hallowell G D
Journal: Equine veterinary journal
Summary
# Editorial Summary: Misoprostol Superior to Omeprazole-Sucralfate for Equine Gastric Glandular Disease Poor performance affected two-thirds of 63 sports horses enrolled in this prospective comparison of two treatment protocols for gastric glandular lesions (grade >1/4), with traditional acid-suppression therapy having shown limited efficacy in previous work. Over a 28–35-day treatment window, horses received either misoprostol at 5 µg/kg twice daily or combined omeprazole (4 mg/kg once daily) with sucralfate (12 mg/kg twice daily), with blinded gastroscopic reassessment revealing substantially different outcomes: misoprostol achieved 72% complete healing and 98% improvement overall, compared to 20% healing and 65% improvement with the omeprazole-sucralfate combination (P<0.001 for both). Notably, both complete lesion resolution and improvement correlated significantly with clinical sign resolution, establishing a legitimate pathophysiological link between glandular disease and ridden performance. For practitioners managing glandular disease in performance horses, these findings suggest misoprostol represents a materially more effective therapeutic option, though the authors appropriately highlight limitations (small sample size, centre-dependent allocation, unblinded clients) that warrant confirmation through larger, multi-centre trials before wholesale protocol revision.
Read the full abstract on PubMed
Practical Takeaways
- •Misoprostol is significantly more effective than omeprazole-sucralfate for treating gastric glandular disease in sport horses and should be considered as a first-line treatment option
- •Poor performance in sport horses should raise suspicion for gastric glandular disease, as it was the presenting sign in two-thirds of affected horses in this study
- •Gastric glandular lesions do produce clinically recognizable signs; successful treatment correlates with resolution of performance issues
Key Findings
- •Misoprostol achieved 72% healing rate compared to 20% for omeprazole-sucralfate combination (P<0.001)
- •Misoprostol showed 98% improvement rate versus 65% for omeprazole-sucralfate (P<0.001)
- •Poor performance was the most common presenting sign across both treatment groups (65.1% overall)
- •Overall healing and improvement of lesions were significantly associated with resolution of clinical signs (P<0.001)