Practical Diagnosis of Gastric Ulcers in Pigs

Gastric ulcers are frequently encountered in pigs, yet many affected animals show few or no obvious clinical signs until lesions become severe. As a result, diagnosis often depends on combining clinical observations with post-mortem findings and targeted examination of the stomach. Since lesions are typically confined to the pars esophagea, careful evaluation of this region is essential for accurate diagnosis. A systematic diagnostic approach helps veterinarians assess disease severity, identify herd-level problems, and support management decisions aimed at reducing production losses. 

Recognising Clinical Suspicion 

Clinical presentation varies according to the severity and duration of ulceration. Peracute and acute cases may result in sudden death due to severe gastric haemorrhage, often without preceding clinical signs¹. In contrast, pigs with chronic ulceration may present with less specific signs that can easily be overlooked during routine herd examinations. 

Clinical findings that should raise suspicion include: 

• Reduced feed intake and growth performance

• Pallor of the eye, oral, or vulvar mucous membranes

• Weakness and reluctance to walk

• Recumbency

• Anorexia

• Melena

• Anaemia characterised by reduced haematocrit, haemoglobin, and erythrocyte count

• Teeth grinding associated with gastric pain

• Greenish vomiting caused by bile staining¹ 

It is important to recognise that pigs with extensive erosive lesions may continue to appear clinically normal when blood loss is minimal¹. Therefore, the absence of obvious clinical signs does not exclude significant gastric disease. 

Post-Mortem Examination 

Necropsy remains an important method for confirming gastric ulceration. Lesions are generally confined to the pars esophagea surrounding the oesophageal opening¹. 

A healthy pars esophagea appears smooth and white. Early lesions are characterised by thickening, elevation of the mucosa, and yellowish discoloration caused by exposure to hydrochloric acid and bile. Continued irritation leads to progressive erosion and ulcer formation, producing crater-like lesions that may involve large blood vessels and result in severe haemorrhage¹. 

Ulcers vary considerably in size, depth, and number. Large ulcers often have smooth, raised edges, and extensive lesions may involve most or all of the pars esophagea. Healed lesions frequently leave puckered or star-shaped scars, while severe scarring may narrow the oesophageal opening because of stenosis¹. 

Importantly, the absence of clotted blood within the stomach should not be interpreted as evidence against gastric ulceration because bleeding may be intermittent¹. 

Endoscopy and Slaughterhouse Evaluation 

Endoscopic examination provides an opportunity to assess the pars esophagea in live pigs. This technique allows direct visualization of erosions and even small bleeding vessels¹. It is relatively straightforward to perform once mastered; however, several practical limitations should be considered. 

Successful examination requires an empty stomach and adequate restraint under anaesthesia. Feed withdrawal before endoscopy may increase movement of gastric acid and bile into the proximal stomach, potentially increasing the likelihood of ulcer formation during the monitoring period. 

Examination of stomachs at slaughterhouses provides valuable herd-level information and remains an important diagnostic tool for identifying macroscopic lesions. After opening and cleaning the stomach, the pars esophagea can be visually assessed and classified according to lesion severity¹. 

Two scoring systems are described for practical evaluation. One system grades lesions from 0 to 4, ranging from healthy gastric mucosa to ulcers affecting more than 66% of the pars esophagea^1,2. Another categorizes lesions as 0 (healthy mucosa), 1 (keratosis), 2 (erosion or mild ulcer), and 3 (severe ulcer)¹. 

Practical Clinical Insights 

Accurate diagnosis depends on evaluating both individual animals and herd-level patterns. 

Practical considerations include: 

• Include gastric ulceration among differential diagnoses for unexplained anaemia, melena, poor growth, or sudden death.

• Carefully inspect the pars esophagea during every necropsy, even when gastric haemorrhage is not immediately evident.

• Use slaughterhouse findings to monitor lesion prevalence and identify herd-level trends over time.

• Apply lesion scoring systems consistently to support objective assessment and comparison between groups.

• Recognise the strengths and limitations of endoscopy when selecting diagnostic methods for live animals.

A structured diagnostic approach combining clinical assessment, post-mortem examination, endoscopy when appropriate, and slaughterhouse surveillance enables veterinarians to identify gastric ulceration more reliably and supports informed herd health management decisions. 

References 

1. Krepelková Z, Novotný J, Bárdová K, Link R, Csörgö A. Gastric ulcers in pigs–a review. Folia veterinaria. 2024 Jun 27;68(2):33-42. https://sciendo.com/pdf/10.2478/fv-2024-0015 

2. Marchini CF, Martins PM, Rabelo RN. Prevalence of gastric lesion in pigs. Investigação. 2017;16(8):50-5. https://www.academia.edu/download/125964557/963.pdf