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12.5.2022 Treating Equine Gastric Glandular Disease

Sharing The Science

A few weeks ago I visited a client whose horse had been diagnosed multiple times with gastric ulcers. Several times over the past few years he has been scoped, treated, and re-scoped clear, only for the ulcers to return a few weeks or months later. Thankfully the owner can recognise the symptoms. Now, we all know that there’s likely to be an underlying musculoskeletal cause for the recurring problem, and indeed the horse is under good quality veterinary care for these. However, I was intrigued on this occasion to hear that the horse has been given a different treatment for the ulcers. Being me, I had to take a look in more detail.

That’s how I came across this study, published a couple of years ago, on using misoprostol to treat equine gastric glandular disease (EGGD) as oppose to equine squamous gastric disease (ESGD). It’s a relatively small study, but with very promising results. The thinking, as I understand it, is that EGGD is more linked to inflammation than to ulcers. Here’s an article I came across that explains it well, I think.

Varley G, Bowen IM, Habershon-Butcher JL, Nicholls V, Hallowell GD. Misoprostol is superior to combined omeprazole-sucralfate for the treatment of equine gastric glandular disease. Equine Vet J. 2019 Sep;51(5):575-580. doi: 10.1111/evj.13087. Epub 2019 Mar 21. Erratum in: Equine Vet J. 2020 Nov;52(6):894. PMID: 30809869.

You can access the article here.



Previous studies have demonstrated a poor response to healing of gastric glandular lesions with oral omeprazole and other medications.


To evaluate the efficacy of two novel treatments (misoprostol M and combined omeprazole-sucralfate OS) in horses for gastric glandular disease.

Study design

Prospective, clinical study.


Sixty-three sports horses with grade >1/4 glandular disease were identified by gastroscopy. Horses received either 5 μg/kg of misoprostol per os BID 1 h prior to feeding or a combination of 4 mg/kg enteric coated omeprazole per os SID and 12 mg/kg sucralfate per os BID where drugs were given 1 h prior to feeding and sucralfate given 60 min after omeprazole; allocation was dependent upon centre. Gastroscopy was repeated at 28-35 days. Evaluators of the gastroscopy images were blinded to the treatments the horses received and images were reviewed independently.


The most common presenting sign in both treatment groups was poor performance (Overall – 65.1%; M – 60.5% and OS – 75%). Overall healing (P<0.001; OR = 11 2.8-45) and improvement (P = 0.006; OR = 11 1.9-59) of lesions were associated with resolution of clinical signs. Misoprostol was shown to be superior to combined omeprazole-sucralfate both for healing (M – 72% 95% CI 43-67 and OS – 20% 95% CI 7-41; P<0.001) and improvement (M – 98% 95% CI 90-100 and OS – 65% 95% CI 43-83; P<0.001).

Main limitations

Relatively small, clinical study, reliance on client questionnaire data, clients not blinded to the treatments the horse received, diet could have affected drug pharmacodynamics although mimics clinical practice and no validated scoring system available for glandular lesions.


These results suggest that gastric glandular disease does indeed result in clinical signs. In this population of horses, misoprostol was superior to omeprazole and sucralfate and warrants further evaluation in a large scale, multi-centre trial.

© Sue Palmer, The Horse Physio, 2021

Treating your horse with care, connection, curiosity and compassion

May 12, 2022
Sue Palmer