Equine ulcer treatment needs prescription omeprazole paste for squamous cases, adding sucralfate for glandular cases, plus strict diet for 4 to 8 weeks.
An equine gastric ulcer is a painful lesion that directly impacts performance, appetite, and behavior. The road to recovery is precise: the correct FDA-approved drug for the specific ulcer type, locked to a strict daily schedule, paired with mandatory management changes that stop the problem from returning. Treatment without addressing diet and stress usually fails.
Why Diagnosing Ulcer Type Matters First
Treating equine ulcers without knowing the type is the most common cause of treatment failure. A veterinary gastroscopy is required to distinguish between Equine Squamous Gastric Disease (ESGD) and Equine Glandular Gastric Disease (EGGD), because the drug protocols differ significantly.
ESGD affects the squamous mucosa (upper stomach) and is highly responsive to omeprazole alone. EGGD affects the glandular mucosa (lower stomach) and is much less responsive to omeprazole by itself — it typically requires a second drug, sucralfate, to achieve healing. Skipping the scope and guessing the type wastes time and money.
The Drug Protocol for ESGD and EGGD
Squamous ulcers (ESGD) respond reliably to omeprazole alone, while glandular ulcers (EGGD) require omeprazole combined with sucralfate. The timing of administration is just as critical as the dose.
| Drug | FDA Approved? | Key Dosage | Primary Use |
|---|---|---|---|
| Omeprazole (Paste) | Yes (US) | 4 mg/kg once daily (treatment) 2 mg/kg once daily (maintenance) |
ESGD primary treatment |
| Sucralfate | No (adjunctive) | 12 mg/kg twice daily (BID) | EGGD (added to omeprazole) |
Omeprazole must be administered on an empty stomach — ideally early morning, one hour before feeding — to ensure contact with the acid-producing cells. For EGGD, sucralfate coats the glandular lining and is given twice daily alongside omeprazole. The expected treatment duration is 28 days for ESGD and 45 to 60 days for EGGD. After the initial course, a recheck gastroscopy is recommended. If healing is confirmed, a maintenance dose of omeprazole (2 mg/kg) for 2 to 3 months helps prevent recurrence when training resumes.
Dietary And Management Changes Are Mandatory
Drugs cannot cure ulcers if the horse’s management continues to cause them. The dietary rules are non-negotiable and directly influence healing speed and long-term soundness.
- Continuous forage access: Horses must have hay or pasture available 24/7. Gaps longer than 6 hours between meals significantly increase stomach acidity. Split concentrate rations into 3 or more small meals per day, not 2.
- Starch restriction: Total daily starch intake must stay under 2 g per kg of body weight. No single meal should exceed 1 g per kg. Replace grain calories with corn oil or flaxseed oil.
- Pre-exercise feeding: Feed 2 liters of un-molassed chaff or alfalfa within 30 minutes before work. This traps acid and physically prevents splashing onto the sensitive squamous lining.
- Water access: Fresh water must be available 24/7. Horses without constant water access are 2.5 times more likely to develop ulcers.
- Stress reduction: Minimize intense training during the treatment period. Pasture turnout, social contact, and a consistent routine are powerful healing tools.
Beyond medication, long-term gastric health relies on consistent diet and gut support. For ongoing digestive health during and after treatment, explore our top equine ulcer supplement recommendations to support your horse’s recovery.
FAQs on Equine Ulcer Treatment
Can I treat my horse’s ulcers without a vet?
No. A veterinary diagnosis via gastroscopy is essential to confirm ulcers and distinguish between ESGD and EGGD. Using the wrong drug or dosage delays healing and allows the condition to worsen. Prescription omeprazole paste is the only FDA-approved treatment and requires a veterinarian’s guidance for proper dosing and follow-up.
How long do horses need to be on ulcer medication?
Standard treatment for squamous ulcers (ESGD) runs 28 days. Glandular ulcers (EGGD) require a longer course of 45 to 60 days due to slower healing rates of the glandular tissue. After the initial treatment period, a maintenance phase at a lower dose for 2 to 3 months is often recommended to prevent recurrence.
What happens if I just change the diet without drugs?
Dietary changes alone will not heal existing ulcers. They are a critical supporting measure, but the stomach lining needs the acid suppression provided by omeprazole to recover. Without the drug, the constant acid exposure prevents the damaged tissue from repairing, even with perfect management.
References & Sources
- UC Davis Center for Equine Health. “Equine Gastric Ulcer Syndrome.” Comprehensive guide on EGUS diagnosis, treatment protocols, and management.
- Merck Veterinary Manual. “Gastric Ulcers in Horses.” Professional reference on clinical signs, medical treatment, and dietary management.
- National Library of Medicine (NCBI). “Equine Gastric Ulcer Syndrome: An Update.” Peer-reviewed research on treatment efficacy and sucralfate protocols.