Recognising Equine Gastric Ulcers: Clinical Signs and Diagnostic Challenges

One of the greatest challenges in managing equine gastric ulcer disease is that many affected horses show subtle or no obvious clinical signs. 

More Than Just Colic 

Classic signs associated with gastric ulceration include: 

• Recurrent mild colic

• Reduced appetite

• Weight loss

• Poor body condition

• Girth sensitivity¹

However, behavioural changes may be equally important indicators. 

Behavioural Clues 

Affected horses may display: 

• Irritability

• Aggression

• Nervousness

• Teeth grinding

• Self-mutilation

• Poor coat quality¹

Because these signs are often attributed to temperament or training issues, gastric disease may be overlooked. 

The Performance Connection 

Both ESGD and EGGD have been associated with reduced athletic performance². 

Experimental studies demonstrated measurable reductions in aerobic performance in horses with induced gastric ulceration¹. 

Gastroscopy Remains the Gold Standard 

Definitive diagnosis requires gastroscopy using an endoscope at least 2.5–3 metres long to allow visualization of both squamous and glandular regions¹. 

Gastroscopy not only confirms disease presence but also enables lesion grading and treatment monitoring. 

Limitations of Current Diagnostics 

Although gastroscopy is highly valuable, it may underestimate lesion severity compared with histopathology¹. 

Alternative diagnostics such as: 

• Sucrose permeability testing

• Faecal occult blood testing

• Serum biomarkers

have been investigated, but none currently match the diagnostic accuracy of gastroscopy¹. 

Conclusion 

Equine gastric ulcers often present with subtle clinical signs that extend far beyond gastrointestinal discomfort. Gastroscopy remains essential for definitive diagnosis and accurate assessment of disease severity. 

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, Bowen M, Habershon-Butcher JL, Green M, Hallowell GD. Management factors and clinical implications of glandular and squamous gastric disease in horses. Journal of Veterinary Internal Medicine. 2019 Jan;33(1):233-40. https://doi.org/10.1111/jvim.15350