Rethinking equine gastric ulcer syndrome: Part 2 – Equine squamous gastric ulcer syndrome ( <scp>ESGUS</scp> )
Authors: Sykes B. W., Jokisalo J. M.
Journal: Equine Veterinary Education
Summary
# Editorial Summary: Equine Squamous Gastric Ulcer Syndrome Sykes and Jokisalo's examination of equine squamous gastric ulcer syndrome (ESGUS) establishes that ulceration of the squamous mucosa differs fundamentally from glandular ulceration in prevalence, aetiology and therapeutic response, necessitating distinct clinical approaches. Through literature review, the authors synthesise current understanding of ESGUS pathophysiology, identifying that the non-glandular squamous region's vulnerability to acid exposure—exacerbated by prolonged fasting, high-grain diets, and intense exercise—underpins disease development in ways that contrast sharply with glandular pathology. The distinction matters considerably for practice: squamous ulcers respond well to acid suppression and dietary modification, whereas glandular disease requires different intervention strategies, making accurate diagnosis via gastroscopy essential rather than presumptive treatment. For farriers, physiotherapists and coaches working alongside veterinary teams, understanding that poor performance, behavioural changes and training-related discomfort may stem from ESGUS—particularly in competition horses—supports early recognition and referral before secondary musculoskeletal compensations develop. Management centring on increased forage availability, reduced concentrate meals, and exercise modification alongside veterinary acid suppression offers substantially better outcomes than treating ESGUS protocols that fail to distinguish between mucosal regions.
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Practical Takeaways
- •Recognize that squamous and glandular gastric ulcers are distinct conditions requiring different diagnostic and management approaches
- •Apply ESGUS-specific risk factor assessment and prevention strategies rather than treating all gastric ulcers uniformly
- •Tailor treatment protocols based on the location of ulceration (squamous vs. glandular) for improved clinical outcomes
Key Findings
- •ESGUS and glandular gastric ulceration differ significantly in prevalence, risk factors, and treatment response
- •ESGUS is a distinct clinical syndrome affecting the squamous gastric mucosa with specific pathophysiological mechanisms
- •Risk factors, prevention strategies, and therapeutic approaches for ESGUS require differentiation from glandular disease