Omeprazole is the first-line treatment for equine gastric ulcer syndrome (EGUS) regardless of grade, with the standard treatment dose of 4.0 mg/kg PO q24h for a minimum of 28 days. A dose-response relationship exists for both squamous and glandular ulcers, and the higher dose of 4.0 mg/kg outperforms 1.6 mg/kg for squamous ulcer improvement.Equine Veterina… Both gastro-enteric resistant granule and powder paste omeprazole formulations show equivalent efficacy over 28 days.Journal of Equi…
Equine squamous gastric disease (ESGD) responds more completely to omeprazole than equine glandular gastric disease (EGGD). The percentage of glandular ulcers that improve with acid suppression is significantly lower than for squamous ulcers, and glandular ulcer improvement is not dose-dependent between 1.6 mg/kg and 4.0 mg/kg.Equine Veterina… The glandular mucosa responds poorly to omeprazole monotherapy.Journal of Equi… For EGGD, treatment duration is longer than for ESGD, and sucralfate may be added or alternatives such as misoprostol, a prostaglandin analogue, may be necessary.The Veterinary…
Gastroscopy is the only current method to confirm treatment efficacy and monitor healing progress, and a control gastroscopy is recommended after the treatment course to assess ulcer resolution.Research in Vet…+1 Lesions are graded on a 0–4 ordinal scale as established by the Equine Gastric Ulcer Council (EGUC); this grading system is recommended for squamous mucosa assessment and has higher interobserver reliability than alternative systems.Journal of Vete… Grade ≥2/4 is the threshold used in treatment trials to define clinically significant ulceration requiring therapy.Equine Veterina…
Dietary and environmental management are required alongside pharmacotherapy to prevent recurrence. Known risk factors — high concentrate diets, intense exercise, prolonged fasting exceeding 6 hours, stress, and nonsteroidal anti-inflammatory drug use — should be minimized or eliminated.The Veterinary…+1 Continuous pasture access is considered protective against EGUS, though pastured horses are not entirely free of risk.Journal of the… Approximately 50% of starch-induced ulcers heal with pasture turnout alone, but most ulcers in horses continued in training do not resolve without medical therapy.Research in Vet…
For grade IV squamous ulceration specifically, concurrent structural or outflow abnormalities must be ruled out, as severe ulceration can be associated with gastric outflow obstruction and large-volume net reflux requiring urgent nasogastric decompression prior to initiating medical management.Journal of the…
| Condition | First-Line Drug | Dose / Route / Frequency | Duration | Key Caveat |
|---|---|---|---|---|
| ESGD (any grade ≥2) | Omeprazole | 4.0 mg/kg PO q24h | ≥28 days | Higher dose superior to 1.6 mg/kg for squamous healing Equine Veterina… |
| EGGD | Omeprazole ± sucralfate | 4.0 mg/kg PO q24h ± sucralfate | Longer than ESGD | Poor response to omeprazole alone; misoprostol an alternative The Veterinary… |
| EGGD refractory | Misoprostol | Not specified in sources | — | Prostaglandin analogue; use when omeprazole ± sucralfate insufficient The Veterinary… |
Would you like to discuss the specific dosing protocol and evidence for sucralfate or misoprostol as add-on therapy for refractory EGGD?