Gastric ulcers in horses are one of the most common yet often overlooked health issues, affecting up to 60% of horses. In this guide, we explore the causes, symptoms, prevention strategies, and treatment options to help support your horse's stomach health.

Key Takeaways

  • Gastric ulcers in horses are common and often difficult to detect, with many horses showing few or no obvious symptoms.

  • Proper nutrition plays a vital role in ulcer prevention, including providing continuous access to forage, limiting high-starch meals, and ensuring fresh water is always available.

  • Stress is a major risk factor for equine gastric ulcers, making consistent management and minimising sudden changes important for stomach health.

  • Successful ulcer treatment combines veterinary care with long-term management changes, including appropriate feeding practices, stress reduction, and targeted nutritional support.

Looking to support your horse’s stomach health? Explore our range of digestive supplements for horses.

Did you know? Around 60% of horses suffer from gastric ulcers, and 40% of them show no visible signs. Equine gastric ulcers are one of the most common health concerns for horse owners in the UK, yet they often go undetected for months. It’s important to prevent this discomfort to ensure your horse's well-being and allow it to perform at its full potential.

Let's take a closer look at your horse's stomach and the best practices to protect it.

Understanding the Stomach: The First Step in Digestion

The horse's stomach is a relatively small organ within the digestive system (compared to the intestines) and represents only about 8% of the entire digestive tract. Its capacity is estimated to be between 8 and 15 litres, which corresponds to the horse's natural feeding behaviour: consuming small quantities of feed, mainly fibre, throughout the day.

Whether your horse is eating or not, gastric secretions are continuously produced, day and night. Horses produce between 25 and 50 litres of gastric secretions per day. These secretions are highly acidic and play a crucial role in initiating digestion.

The horse's stomach is divided into two main regions:

  • The glandular region (lower part): this area produces the gastric acid essential for digestion. Because its lining is in constant contact with this acid, it's naturally well equipped to withstand it. However, it has no specific protection against other aggressors, which is why certain substances, such as non-steroidal anti-inflammatory drugs, can irritate this region and lead to glandular ulcers.

  • The squamous region (upper part): no acid is produced in this section, and the lining has little natural protection against acidity. Squamous ulcers therefore develop when this area comes into contact with gastric acid, even though it is not designed to be exposed to it. This is the most frequently diagnosed form of equine gastric ulcer syndrome.

Digestion in the stomach is mainly enzymatic, meaning that enzymes break down concentrated feeds. Forage, however, is not digested in the stomach and continues its digestion further along the digestive tract.

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Symptoms of Gastric Ulcers in Horses: What to Look Out For

Horse ulcer symptoms may be difficult to detect because some horses show very subtle or no clinical signs at all. However,

The following signs may suggest gastric discomfort and warrant further investigation:

  • Reduced appetite or slower eating

  • Weight loss or difficulty maintaining body condition

  • Poor performance or reluctance to work

  • Behavioural changes (irritability, girthiness, sensitivity when saddling)

  • Mild recurrent colic

  • Dull coat or decreased overall condition

  • Teeth grinding or excessive salivation in some cases

If your horse displays one or more of these horse ulcer symptoms, it is advisable to consult your vet promptly.

Diagnosis of gastric ulcers

The only definitive way to diagnose horse gastric ulcers is through gastroscopy, a procedure performed by a veterinarian using a flexible endoscope inserted into the stomach after a period of fasting.

This examination allows the veterinarian to:

  • Identify the presence, location, and severity of ulcers

  • Differentiate between squamous ulcers (ESGD) and glandular ulcers (EGGD)

Accurate diagnosis helps determine the most appropriate horse ulcer treatment for your animal.

Treating Gastric Ulcers in Horses

Horse ulcer treatment depends on the type and severity of ulcers. The most common veterinary treatments include:

  • Proton pump inhibitors - such as omeprazole, which reduce gastric acid production

  • Mucosal protectants - which help protect and heal the stomach lining

Horse ulcer treatment works in two complementary steps:

  • Medication helps heal existing ulcers

  • Changes in feeding practices and stress management are essential to prevent them from coming back.

Relying on medication alone, without addressing the horse's diet and environment, almost always leads to recurrence once the treatment is stopped. If you're based in the UK, your vet can advise on the most appropriate licensed treatment options available.

If your horse shows horse ulcer symptoms or lives in a risk-prone environment, do not hesitate to consult your veterinarian, who can recommend an appropriate management and horse ulcer treatment plan tailored to your horse's individual needs.

close up of horse and foal

How to Prevent Gastric Ulcers in Horses

While gastric ulcers in horses are common, the risk can be reduced through good nutrition, effective stress management, and targeted digestive support. Here are some practical ways to help protect your horse's stomach health.

1. Nutrition: a key factor in equine stomach health

A balanced diet adapted to the horse and its natural feeding behaviour is one of the most effective ways to support equine stomach health and reduce the risk of horse gastric ulcers.

Key nutritional principles include:

  • Prioritise forage (grass, hay, etc.) - should form the foundation of the diet as it is the most natural feed for horses. It stimulates saliva production (around four times more than concentrates for the same weight), and saliva acts as a natural buffer that helps neutralise gastric acidity.

  • Manage concentrate (starch) intake carefully - for horses that require concentrates, starch intake should be carefully controlled, ideally kept under 100g per 100kg of body weight per meal. High-starch or large concentrate meals can increase acid production and raise the risk of gastric discomfort.

  • Avoid long fasting periods - because the horse's stomach continuously produces acid, long fasting periods increase the risk of ulcer development. Horses should have regular access to forage, including overnight, to help maintain a healthy stomach environment. concentrate meal to help buffer gastric acidity.

  • Never feed concentrates on an empty stomach - concentrates should always be given alongside or after forage. For example, ensure hay is available before morning concentrate meals to help buffer gastric acid and protect the stomach lining.

  • Fresh, good-quality water - should always be available, including during turnout. Studies have shown that horses deprived of water while in paddocks are more likely to develop gastric discomfort.

2. Limiting stress as much as possible

Horses are naturally sensitive animals and can easily experience stress, especially when their environment changes.

Stress is one of the major risk factors for horse gastric ulcers: when a horse is stressed, its body releases cortisol, a hormone that reduces the production of prostaglandins, substances that normally help protect the gastric lining. The result is a rise in stomach acidity, which increases the risk of ulcers.

It is therefore important to minimise stress whenever possible:

  • Allow your horse to have regular contact with other horses.

  • If outdoor living is not possible, choose facilities where horses at least have visual contact with their peers.

  • Try to limit stressful situations such as frequent transport, sudden environmental changes, or abrupt dietary transitions.

3. Nutritional supplements to support equine stomach function

Depending on your horse's lifestyle, sporting goals, or the management conditions of the stable, it may not always be easy to provide a perfectly adapted diet or completely avoid stressful situations.

Digestive supplements for horses such as Ekygard+, can help provide additional comfort for your horse as part of a broader management plan.

Ekygard+ offers an enhanced triple support by:

  • Helping to buffer gastric acidity

  • Supporting the stomach mucosa

  • Balancing the digestive flora

Ekygard+ integrates all the ingredients recommended by the ECEIM (European College of Equine Internal Medicine Consensus statement (2015)) for horses prone to gastric discomfort.

It can be used:

  • Year-round for horses whose lifestyle or environment may increase their risk of developing gastric ulcers

  • During or after a treatment for gastric acidity over several months

  • During periods of increased stress such as transport, competitions, intense training, change of food, or moving to a new stable over several months

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Support Your Horse’s Stomach Health

Gastric ulcers are a common concern in horses, but the risk can be significantly reduced through appropriate nutrition, stress management, and early recognition of symptoms.

Looking for additional digestive support? Explore our range of equine digestive supplements, including Ekygard+, to help maintain your horse's gastric comfort.

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Written by: Cécile Le Bras, Equine Nutrition Expert (Guest Author)