Since the first Gastric Ulcer Awareness Month in 2007, it has been well documented that
approximately 60 per cent of performance horses are affected by gastric ulcers. Despite
this, it is believed that it is still one of the most under-recognised problems in the equine
The main reason for this lack of detection is likely to be the vague and non-specific nature
of the symptoms, which are often put down to back pain or behavioural issues.
Using a 3m video endoscope is the only way to definitively diagnose the presence of ulcers.
Gastroscopy is usually performed under standing sedation but it is a relatively quick
procedure which is painless for the horse.
Sally Cobbald MA Vet MB Cert EP MRCVS is a partner at Catley Cross Equine Vets on the
Essex-Suffolk border. The practice purchased a 3m gastroscope (used to diagnose the
presence of ulcers) two years ago. Here Sally answers some key questions about ulcers.
When do you recommend scoping?
We see a wide range of presentations but a common scenario when we would recommend
scoping is if the rider is experiencing performance issues with their horse.
The horse may be proving difficult to train, performing below par, or showing unusual bad
behaviour such as bucking or rearing. We have also investigated horses presenting with
unusual behaviours such as resentment of girth tightening or general “grumpiness” around
the stable, and found ulcers in some of these cases.
Other common reasons to gastroscope a horse would be during the investigation of poor
appetite, weight loss, poor condition, or recurrent colic.
Faced with any of these problems, we discuss the horse’s history with the owner and then
perform a clinical examination. There are other tests that we might perform first to rule out
other issues. For example, for a horse showing unusual bad behaviour and resistance to
work we would want to first rule out dental problems, back issues or lameness, or in a
horse that was losing weight or had a poor appetite we would start with a general
examination and usually blood tests before scoping. If no other obvious cause is found then
Typically what percentage of horses that you scope have ulcers?
I would say that we find ulcers in up to 80% of the cases that we scope. This is obviously a
higher percentage than the prevalence of ulcers in the general horse population as we tend
to scope horses that present with the type of clinical problems mentioned earlier.
What types of horse do you most commonly scope?
Very much across the board. From young to old and from elite sports horses and
racehorses to pleasure horses and ponies. We have performed gastroscopy on donkeys too.
What treatment do you usually recommend?
We would usually recommend a course of omeprazole which is a highly affective medicine
licensed to treat this condition and involves giving an oral paste daily for up to four weeks.
This is sometimes combined with other ulcer medications such as sucralfate and in a few
rare cases antibiotic treatment may be indicated.
What management changes or husbandry tips can you recommend to prevent recurrence?
In addition to a course of medicine we emphasise how important it is to address the horse’s
diet and management. These changes are an extremely important part of treatment and
Increasing the horse’s intake of roughage such as hay and chaff, and reducing starchy
carbohydrates in the hard feed is important. Horses should be allowed constant access to
forage so that they can “trickle-feed” as they would do in their natural environment. It is
advisable to feed hay and if possible a feed of chopped fibre such as chaff prior to exercise
as this helps to protect the stomach from acid (which is continually produced in the horse’s
stomach) when the horse is worked. Allowing the horse more time at grass will also help,
as will taking steps to minimise the stress resulting from travelling.
We usually recommend re-scoping, typically after 4 weeks of treatment. In those horses
treated we usually see a great improvement if not complete resolution of the ulcers.
In the majority of cases we also see an improvement in the clinical signs; the appetite may
be improved, the horse may have started putting on weight, and its performance or
Some horses do require further medical treatment to prevent recurrence but we are often
pleasantly surprised at how well the problem can be prevented with an adapted
Case study
I have recently treated a young thoroughbred gelding used for eventing. His rider reported
that he had been increasingly reluctant to go forward over the previous few months and
was generally very grumpy around the stable and when ridden. This had all started not long
A general clinical examination and blood test was unremarkable so we carried out a
gastroscopy. The horse had grade 3 lesions in the fundus and pylorus. This horse improved
markedly after a month of treatment with omeprazole along with management changes.
When we re-scoped him after a month the lesions had healed and the rider reported that he
was much happier in himself and going forward much better. He is now performing well and
We have seen several cases of ulcers in horses that have changed yards or ownership not
long before signs became apparent. No matter how carefully the owner tries to make the
transition, travelling a horse and taking it to a new yard can be a stressful event. I now put
ulcers high up my list of possible diagnoses for sudden behavioural or performance changes
in a horse, especially if there has been a recent change in management or stressful event.
And finally
As a profession I believe we as vets are now much more aware of the very varied signs that
gastric ulcers can cause. Diagnosis has been made much easier with the wider availability
of 3m video endoscopes such as the one we have at Catley Cross Equine. Treatment is
usually very rewarding as it not only improves the horse’s welfare enormously but it can
really make a difference to the owner and rider too. As we have discussed, the presenting
signs are very variable. I would urge anyone who thinks that their horse may be showing
such signs to discuss the case with their vet.
[Side Box] How are ulcers graded?
Ulcers are graded according to severity. 0 = a healthy stomach and 4 = severe ulceration.
The location within the stomach is also noted.
April 2012
Further information from Jane Manningor Sally Cobbald
Catley Cross Equine Vets has six Equine Vets and offers an ambulatory equine service to
clients within a 40 mile radius along with extensive on-site facilities for the investigation
and treatment of more involved cases. Seefor more details