Equine Gastric Ulcer Syndrome In Performance Horses

Equine Gastric Ulcer Syndrome (EGUS) has emerged as the most widespread health challenge facing performance horses in the 21st century. With 80% of Thoroughbred horses developing gastric ulcers within mere months of training and endurance horses experiencing prevalence rates soaring from 48% to 93% during competition seasons. This widespread affliction directly compromises athletic performance, compromises animal welfare, and presents substantial economic implications for the global equine industry.

The pathophysiology underlying EGUS centres upon the erosion of the stomach lining due to prolonged exposure to gastric acid in an environment fundamentally incompatible with the horse's evolutionary adaptations. Modern training regimens, housing practices, and feeding protocols create conditions that systematically undermine the natural protective mechanisms horses developed through millennia of continuous grazing behaviour.

Expert Perspective for Equine Gastric Ulcer Syndrome

Dr Aamir Noor, currently serving as Equine Veterinary Surgeon at Al Forsan ,Abu Dhab-UAE brings distinguished credentials to understanding EGUS in performance horses. Having completed his Bachelors in Veterinary Sciences from India, followed by postgraduate studies in veterinary medicine and surgery with equine specialisation, his research focused on Sports medicine regarding musculoskeletal issues that horses are more prone to on the racetrack or in jumping arenas along the pronounced experience in internal medicine—like EGUS and other emerging factors affecting sport horses Dr.Aamir Noor is an UAE MOCCAE registered veterinarian besides FEI Official Veterinarian whilst maintaining membership in the various equine healthcare platforms i.e AAEP etc. Dr.Aamir had his Equine Externship program from reputed Dubai Equine Hospital under the patronage of His Highness Sheikh Rashid Al Maktoum's besides internships program at various equine setups. Dr .Aamir ia an experienced equine veterinarian with immense knowledge about latest trends / innovations in equine health care. He has also been veterinary delegate as well as veterinary services manager at various prestigious FEI equestrian events i.e CSI 5*,CSI 4* including the League of Nations and President's Cup , representing the UAE's commitment to world-class equestrian sport with cutting edge facilities.

The Performance Horse Paradox: Why Athletic Demands Create Gastric Vulnerability

Performance horses face a constellation of risk factors that fundamentally distinguish them from their pasture-kept counterparts. The modern athletic horse exists within an artificial environment designed to maximise performance whilst inadvertently creating conditions predisposing to gastric ulceration. Stall confinement, equine athlete management and training schedules,prolonged periods without food eliminates natural and continuous grazing behaviour, leaving horses with empty stomach hereby results in prolonged exposure to normal acid in stomach. High-energy feeding regimens represent another critical factor. Performance horses require peculiar nutritive profile feed program to fuel athletic demands, typically delivered through grain-based concentrates that produce volatile fatty acids

contributing directly to gastric mucosal damage. These feeding practices, although nutritionally necessary for performance, contribute to development of equine gastric ulcers.

The stress component proves multifaceted, encompassing environmental changes, transportation demands, competition pressure, and social isolation inherent in performance horse management. There are a complexity of factors involved. "The pH of the stomach keeps fluctuating. It depends upon the gastric contents, the amount and type of food they are eating, and the type of stress they are being exposed to besides sport," Dr Noor emphasises.

Chronic administration of Non-Steroidal Anti-Inflammatory Drugs i.e Flunixin Meglumine,Phenylbutazone etc presents an additional challenge, as performance horses inevitably experience musculoskeletal stress requiring pharmaceutical intervention. "Every equine athlete goes through various musculoskeletal problems; it's part of being an athlete, whether human or animal. These drugs tend to be the man made causes for gastric ulcers'," Dr Noor notes.

ESGD Versus EGGD: Understanding Distinct Pathological Entities

Modern veterinary understanding recognises EGUS as encompassing two fundamentally different conditions: Equine Squamous Gastric Disease (ESGD) and Equine Glandular Gastric Disease (EGGD). Each condition requires distinct diagnostic approaches, treatment protocols, and management strategies, reflecting its unique anatomical location and pathophysiological mechanisms.

ESGD affects the non-glandular portion of the stomach, where protective mechanisms against acid exposure remain limited. The horse develop this condition due to increased exposure of squamous mucosa to acid. Diet and Exercise regime also play a pivotal role in developing it.

The innovative concept of creating a "hay mat" emerges as a practical preventive strategy. We must encourage free choice of hay so that equine athletes are not exercised empty stomach.

EGGD presents significantly greater complexity, affecting glandular stomach regions normally equipped with protective mechanisms. "The development of glandular ulceration is poorly understood since this area is normally exposed to high acidic contents. But the reason for this condition is certainly that a protective mechanism has been breached," Dr Noor acknowledges. This condition typically requires more aggressive and prolonged therapeutic intervention, with success rates proving less predictable than ESGD treatment.

Therapeutic Interventions With Evidence-Based Treatment Protocols

Omeprazole remains the cornerstone of EGUS treatment, representing the sole United States Food and Drug Administration-approved pharmaceutical for equine gastric ulcers. This proton pump inhibitor works by irreversibly blocking the production of gastric acid, allowing mucosal healing to occur. "It has been scientifically proven that if we treat equine squamous gastric disease with omeprazole at a dose rate of 4 mg per kg body weight for 28 to 35 days, we will get good healing effects—around 70% to 75% of horses respond well, " .Re-evaluation with gastroscopy pre and post treatment remains gold standard
, Dr.Noor Adds.

EGGD treatment demands more intensive approaches. "Sometimes equine glandular gastric disease is difficult to treat. Why? Because there are multiple factors: it needs prolonged therapy, inadequate acid suppression, and possibly sometimes, along with gastric ulceration, there's a secondary bacterial infection," Dr Noor explains. Extended protocols spanning 8-10 weeks become necessary, with monthly gastroscopic monitoring ensuring treatment efficacy.

Mucosal protectants, including sucralfate, provide additional therapeutic benefits, particularly for glandular lesions where protective mechanism restoration proves crucial. These compounds create physical barriers that protect damaged mucosa, while pharmaceutical intervention addresses the underlying acid production.

Buffer supplements offer valuable adjunctive therapy. Dr Noor advocates for comprehensive supplementation. "We have bicarbonates, probiotics, prebiotics, amino acids like lysine and glutamine, and we have yeast. We also have slippery elm bark, pectin, and lecithin. These supplements possess both healing and anti-inflammatory properties," he outlines.

Prevention Strategies In Addressing Root Causes Rather Than Symptoms

Effective EGUS prevention requires addressing fundamental management practices that predispose performance horses to gastric ulceration. Nutritional management forms the foundation, with Dr Noor establishing clear guidelines. "75% of the horse's diet should be forage. That means if it's a 1,000 lb horse, he should get at least 15 to 19 pounds of hay daily."

Feeding sequence proves critical for gastric health. "We will not feed grain diet first. We will feed hay first then feed and further in same pattern. It should be a cycle. Feeding grain directly on an empty stomach will reduce the pH, which causes triggers gastric anomalies," Dr Noor emphasises.

Pharmaceutical prevention offers additional protection for high-risk horses. Dr Noor identifies two prevention modes. “One is medicinal prevention, like we discussed about omeprazole drug, there is a written preventive and therapeutic dose.

Then comes the other preventive measures like giving buffer supplements like bicarbonates, probiotics, prebiotics, amino acids like lysine and glutamine, and yeast. There are also slippery elm bark, pectin, and lecithin. These ingredients possess healing as well as anti-inflammatory properties. Aloe vera is anti-inflammatory and has a soothing effect. Pectin and lecithin have a mucilage effect—they provide the mucous lining so that acid does not erode the wall of the stomach”.

Behavioural enrichment addresses psychological stress factors contributing to ulcer development. Certain prevention of stress is possible. "Horses are companion animals—they need companionship. This signifies towards horsemanship. If horses are in stalls with no toys, no hay balls, nothing to do, they will be stressed and affected by boredom, "Dr Noor emphasises.

NSAID management requires sophisticated approaches to balancing musculoskeletal treatment needs with gastric protection. Selective COX-2 inhibitors represent a significant advancement. "The newer selective COX-2 inhibitors that are developed block COX-2 specifically and have fewer side effects on the GI tract," he explains.

Future Directions In Integrating Traditional Wisdom With Modern Science

EGUS management continues evolving as understanding deepens regarding the complex interplay between performance demands and gastric health. Emerging nutraceuticals, including liquorice extract, sophisticated amino acid formulations, and novel mucosal protectants, offer promising therapeutic alternatives.

However, technological advancements must complement rather than replace fundamental management principles that respect equine evolutionary adaptations. This is crucial in achieving balance as a preventative strategy. "Anything you try, the management of feeding and exercise is important because the natural horse has his own strategy for living, wellbeing, and nutrition. If we come close to that natural approach, we will have the least amount of these problems “ Dr Noor emphasises.

The future of performance horse gastric health lies in recognising that EGUS represents a management disease requiring systematic approaches that address the root causes of the problem, rather than merely treating symptoms. "It's treatment plus management because, as I told you, this is a man-made thing. If it's man-made, then the sequel is ulceration," Dr Noor concludes.

Success in this area demands collaborative efforts amongst veterinarians, nutritionists, trainers, and owners, each contributing expertise towards creating management systems that preserve gastric health whilst maintaining competitive excellence. The ultimate goal remains developing protocols that honour horses' biological needs whilst meeting the demanding requirements of modern equestrian sport.

UAE has played a significant role in elevating equestrian sports on the global stage.Their deep rooted passion for horses combined with strategic vision,has helped shape the future of equestrian sports globally.