Modern Treatment Strategies for Equine Squamous Gastric Disease (ESGD)

Once ESGD is diagnosed, treatment focuses on reducing gastric acid exposure and promoting mucosal healing. 

Why Treatment Is Necessary 

Spontaneous healing of squamous ulcers can occur, particularly when horses are turned out to pasture. However, most clinically significant lesions require medical intervention, especially in actively training horses¹. 

Omeprazole: The Cornerstone Therapy 

Omeprazole, a proton pump inhibitor, is considered the treatment of choice for ESGD. By blocking gastric acid production, it creates a favourable environment for ulcer healing ¹. 

Clinical signs often improve within 48 hours of treatment initiation. 

Healing Rates 

Studies have demonstrated impressive treatment success:¹ 

• 57% healing after 2 weeks

• 67% healing after 3 weeks

• 77% healing after 4 weeks in racehorses 

Long-acting intramuscular formulations may achieve healing rates approaching 97%^2. 

Alternative and Supportive Therapies 

Ranitidine, an H2-receptor antagonist, has historically been used but requires more frequent dosing¹. 

Nutritional supplements, probiotics, and buffering agents have shown variable efficacy and should be viewed as adjuncts rather than replacements for proven medical therapy. 

Prevention Starts with Management 

Reducing starch intake, maximizing forage access, minimizing fasting periods, and reducing management stressors are critical for preventing recurrence¹. 

Conclusion 

ESGD is highly responsive to acid suppression therapy, particularly omeprazole. However, long-term success depends not only on medication but also on addressing the underlying management factors that contribute to disease development. 

References

1. van den Boom R. Equine gastric ulcer syndrome in adult horses. The Veterinary Journal. 2022 May 1;283:105830. https://doi.org/10.1016/j.tvjl.2022.105830

2. Gough S, Hallowell G, Rendle D. A study investigating the treatment of equine squamous gastric disease with long‐acting injectable or oral omeprazole. Veterinary Medicine and Science. 2020 May;6(2):235-41. https://onlinelibrary.wiley.com/doi/10.1002/vms3.220