Equine Glandular Gastric Disease: Why Treatment Is More Challenging

While ESGD is primarily an acid-related disorder, EGGD is a more complex disease involving impaired mucosal defence and inflammation. 

A Different Disease Process 

Research suggests that glandular lesions are more closely associated with inflammation and disruption of mucosal protection than with direct acid injury ^1,2. 

This difference explains why EGGD often responds less predictably to traditional acid-suppressive therapies. 

Why Omeprazole Alone Is Often Not Enough 

Although omeprazole remains a central component of treatment, its effectiveness is lower in EGGD compared with ESGD. Treatment durations of at least eight weeks are often recommended². 

The Role of Sucralfate 

Sucralfate forms a protective barrier over damaged mucosa and promotes bicarbonate and mucus secretion. Studies have demonstrated improved healing when sucralfate is combined with omeprazole compared with omeprazole alone¹. 

Misoprostol: An Emerging Option 

Misoprostol enhances mucosal protection and has shown superior healing outcomes compared with omeprazole–sucralfate combinations in some studies³. 

However, it should be avoided in pregnant and lactating mares because of its uterotonic effects¹. 

Is Stress the Missing Piece? 

Increasing evidence suggests that stress plays a significant role in EGGD development. Horses with severe glandular disease appear more stress-sensitive than unaffected controls⁴. 

This highlights the importance of environmental and behavioural management alongside medical treatment. 

Conclusion 

EGGD remains one of the more challenging conditions in equine gastroenterology. Successful management requires a multifaceted approach that combines acid suppression, mucosal protection, stress reduction, and long-term monitoring to achieve optimal outcomes. 

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. Sykes BW, Hewetson M, Hepburn RJ, Luthersson N, Tamzali Y. European College of Equine Internal Medicine Consensus Statement—equine gastric ulcer syndrome in adult horses. Journal of veterinary internal medicine. 2015 Sep;29(5):1288-99. https://doi.org/10.1111/jvim.13578 

3. Varley G, Bowen IM, Habershon‐Butcher JL, Nicholls V, Hallowell GD. Misoprostol is superior to combined omeprazole‐sucralfate for the treatment of equine gastric glandular disease. Equine veterinary journal. 2019 Sep;51(5):575-80. https://beva.onlinelibrary.wiley.com/doi/abs/10.1111/evj.13087

4. Malmkvist J, Poulsen JM, Luthersson N, Palme R, Christensen JW, Søndergaard E. Behaviour and stress responses in horses with gastric ulceration. Applied animal behaviour science. 2012 Dec 31;142(3-4):160-7. https://www.academia.edu/download/50609538/Behaviour_and_stress_responses_in_horses20161129-31300-10u28a5.pdf