Horse Ulcers

Complete Guide to Horse Ulcers.

Horse ulcers or equine gastric ulcers are very prevalent in the horse world, and it seems like almost every rider has to deal with the issue at some point.

Do you think your Horse has ulcers?

We started this project a number of years ago and with the help of some local vets and riders, we have compiled a significant amount of information about horse ulcers, their cause, their treatment and most importantly prevention. I always recommend you use this information in conjunction with your vet, but this may give you a start into understanding what is happening with your horse and answer some questions about equine gastric ulcers.

So what is an ulcer?

I’m going to try and make this as simple as possible.  It is, however, important to know some of the science and biology behind the issues of digestion in our horses and for this article specifically information about ulcers.

Simply put an ulcer is a hole in the mucus (snot) layer that protects the actual stomach from the acid inside.  The stomach is like a bag…and its full of acid.  The acid is there for the purpose of digestion, and in horses is constantly being produced…somewhere in the neighbourhood of 16 gallons a day.

Here are a couple more facts!!

Equine Gastric Ulcer Syndrome is the collective term used to describe the various issues and the subsequent symptoms related to what’s commonly called an ulcer. Simply put ulcers, or gastric ulcers, are erosions, or other compromises to the lining in the stomach wall. Ulcers are primarily caused by diet and stress, both of which can be mitigated by proper care and maintenance.  

What Causes Ulcers

There are a number of different factors that are at the root of ulcers in horses.  There is a consensus though among most that the cause is unknown and rather there are a number of risk factors and potential causes.  The actual scientific medical reason for the ulcer is known, and that’s acid in places it shouldn’t be, but why is a different story.  Here are the main ones…

  • Stress.  Stress seems to be one of the leading causes of ulcers in horses.  This really shouldn’t surprise anyone seeing as stress is a huge health factor in humans as well.  The simple fact is stress hormones at high levels are dangerous for the overall health of your horse, including ulcers.
  • Diet.  Horses produce a large quantity of stomach acid and its production is continuous.  Because horses are a grazing animal their guts are designed to handle constant digestion and grazing.  This happens because horses produce stomach acid constantly. If they aren’t constantly grazing these acids aren’t buffered by the mix of continuous hay/grass and saliva.  Many performance horses get higher density feedings in the form of alfalfa cubes or grains and it doesn’t take them very long to eat it.  Then they go long stretches without eating anything.  They also compete at a high level which helps push the stomach acids further up the stomach lining to places that are less protected.
  • Bacteria.  There are a number of new studies that are showing certain types of bacteria that can live in the harsh acidic environments in the stomach, and some of these might be contributing to the environment needed for an ulcer to occur.

The Types of Ulcers

So what type of ulcer does my horse have?

There are two main areas that horses can get ulcers.  One is the colon and these are known as colonic ulcers located in the hindgut.  These are similar to colitis and are essentially the same as gastric ulcers in that the protective lining of the colon has been compromised.  Ulcers in your horse’s stomach can also lead to the development of hindgut or colonic ulcers. More than 50 percent of performance horses, for example, have both gastric and colonic ulcers. Hindgut ulcers are harder to diagnose, which is why veterinarians may suggest treatment for them as a precaution.

Equine Gastric Ulcer Syndrome is the main medical name given to ulcers in the stomach area of horses.  There are two types of gastric ulcers one is Equine Glandular Gastric Ulcer Syndrome (EGGUS) and the other is Equine Squamous Gastric Ulcer Syndrome (ESGUS).  

Glandular Ulcer (EGGUS)

A Glandular Ulcer is located in the lower part of your horse’s stomach. EGGUS is a rare form of Equine Gastric Ulcer Syndrome because the glandular lining can withstand harsh acids and is less susceptible to developing a sore or lesion. EGGUS occurs more often in racehorses than endurance horses.

Squamous Ulcer (ESGUS)

Squamous Ulcers are located in the upper part of your horse’s stomach. It’s thought of as a continuation of the lining in the esophagus.  Research has shown that ESGUS is significantly higher in number than EGGUS.  In fact, 60 to 80 percent of the horses that show symptoms of Equine Gastric Ulcer Syndrome, are diagnosed with squamous ulcers.

This picture is from the ready supp page here if you want to check them out.

Symptoms of Horse Ulcers

Are you concerned that your horse has ulcers? With the frequency of ulcers in horses, it is something that every horse owner deals with and looks for.

The main symptoms of horses with ulcers are typically to do with signs of pain, appetite and overall grumpiness. Your horse is in pain, and eating can be painful and riding can be painful. On top of that relief from the pain can be hard to come by at times, and even made worse by trying to fix it. If you suspect any of these symptoms it’s time to contact your vet.

How to Identify if Your Horse Has Ulcers

Horse owners don’t like them, horses especially don’t like them, but ulcers are an often-unavoidable situation in every horse’s life. To be exact, somewhere between fifty and ninety percent of all horses will suffer from an ulcer – with even more horses exhibiting the telltale symptoms. Horses that race or perform under stress are more likely to develop this terrible condition.

As a horse owner, it is absolutely imperative that you understand what symptoms to look out for. If gone untreated for too long, ulcers can worsen and cause serious intestinal disturbance for the horse. Without treatment, it is almost impossible for the ulcers to heal on their own. If you can recognize the early warning signs, you can mean the difference between a miserable horse and a happy horse.

Before we go any further, it is important to understand the different types of horse ulcers. Only then can we properly identify and treat this horrible condition.

Stomach Ulcers

The ulcers horses develop and the ulcers humans develop are quite similar. And while most ulcers grow inside the horse’s stomach, they have also been known to form in the colon. The correct term for ulcers in horses is “Equine Gastric Ulcer Syndrome.” However, there are two branches of this, which are dependant on where exactly inside the stomach the ulcers have formed.

Equine Glandular Gastric Ulcer Syndrome relates to the lower part of the horse’s stomach and is the rarer of the two types. Because the lower region of the stomach lining is much more suited to handling the corrosive stomach acids, it is less prone to being afflicted by sores or lesions. This is something more common with horses that participate in racing.

Equine Squamous Gastric Ulcer Syndrome is when the upper section of the horse’s stomach lining forms the nasty ulcer lesions. Because this area is less protected from acid, this is the most suffered type of ulcer – roughly between 60 and 80 percent.

Hindgut Ulcers

It is important to recognize the difference between ulcers in the stomach and ulcers in the hindgut, specifically in the colon. These are known commonly as colonic ulcers. Because of their tricky location inside the horse’s body, these types of ulcers are difficult to asses and to detect and are often confused for ulcers in the foregut. But these are extremely dangerous. The large intestines are responsible for the horse’s digestive system. If this system is compromised it can be disastrous for the horse.

Luckily, the symptoms of hindgut ulcers are more server and more easily noticeable. If you suspect your horse is showing any of the following signs, contact your veterinarian immediately. You may need to schedule an ultrasound.

  • Recurring lack of appetite
  • Lethargy
  • Sporadic fever
  • Bouts of colic
  • Edema on the belly because of protein loss in the blood
  • Weight loss
  • Thin body

If any of these signs are in addition to loose manure, large fecal balls, or rampant diarrhea (liquid on the horse’s inner thighs and legs), seek the professional opinion of your veterinarian as soon as possible. If you are in doubt whether your horse suffers from foregut or hindgut ulcers it is important to check to know for sure. This will involve an ultrasound to check the outer layer of the colon for any abnormalities. Once the condition is identified, treatment can start.

Signs of Stomach Ulcers

The worst possible thing you can do is to ignore the early warning signs of equine gastric stomach ulcers. If left untreated, hindgut ulcers may also form, and this is incredibly problematic for the horse. Keep a lookout for these signs. If you see any – or even suspect something is wrong, seek medical advice from a professional asap.

All forms of ulcers have similar symptoms. These include but are not limited to:

  • Diarrhea
  • Drained energy and lack of stamina
  • Lying down more frequently
  • Reduced appetite
  • Cribbing and/or weaving
  • Colic
  • Shifts in attitude
  • Poor performance
  • Loss of weight and/or muscle
  • Hair becoming dull
  • Grinding of the teeth
  • Anemia
  • Discomfort
  • Reluctant to bend legs too much
  • Occasional lameness in the hind end

Some of these symptoms are vague and may not necessarily mean your horse has ulcers. However, if they persist for days or weeks it can very well be ulcers. Keep your eyes open and be attentive to your horses at all times. If one of these symptoms rears its head, you must act fast. It is always better to have a small veterinarian bill for a false alarm than a seriously sick horse.

Recognizing Ulcers In Your Horse

recognizing an ulcer in horses can be difficult. The signs that your horse is experiencing a stomach or colon issue like ulcers can also be the result of other issues as well.  Sometimes we also attribute behavioural and training issues as medical issues and vice-versa, which can make it difficult.

Here are some of the commonly recognized signs that your horse could be suffering from a gastric and/or colonic ulcer:

  • changes in attitude
  • poor appetite
  • decreased performance and energy
  • a decline in body condition

And here are some additional ways your horse may signal it has a digestive issue, but that is often overlooked:

  • girthy and sensitive in the flank area
  • stall vices like cribbing and weaving
  • unwillingness to work

If you notice any of these symptoms in your horse, it’s important to have your vet check for ulcers so that you can either begin treatment or rule it out as a cause before moving on to other possibilities.

Even Amy Fleming talks about horse ulcers in Heartland

Remedies for ulcers

There are a number of remedies for ulcers and there are also a number of preventative things we can do.  The biggest thing is you want to start slow and try some things to see if you get any difference in the behaviour of your horse.  You can try a few things on your own, but it is always best to consult your vet.  If you do get your vet involved you are best to get a definitive diagnosis so you know for sure.  Obviously, this is the most expensive option but no one ever said anything about owning a horse being cheap.  It just simply isn’t.

Natural Remedies and Treatments

This is by no means an exhaustive list and I will add to it as I find more.  But here are the main ones.

Natural remedies and treatments include but are not limited to aloe vera juice, slippery elm, marshmallow, licorices, peppermint tea and proper diet scheduling.  

  1. Slippery Elm.  This coats the intestinal tract and gives it a chance to heal.
  2. Aloe Vera gel or Juice. Researchers from the University of Adelaide in South Australia concluded that “The inner leaf gel of the aloe vera plant has been reported to be effective in the prevention and treatment of gastric ulcers in man and in animals in experimental models. Its anti-ulcer properties have been attributed to a variety of possible mechanisms, including antioxidant activity, anti-inflammatory properties, cytoprotective and mucus-stimulatory effects, and its ability to regulate gastric acid production,” It was tested against the main drug remedy called omeprazole.
  3. Marshmallow Root.  Has been shown to soothe the entire digestive tract.
  4. Licorice.  This has been shown to help reduce stomach acid by producing mucus that acts as an anti-inflammatory.  This should, however, be used only as a temporary solution and not long-term.
  5. Magnesium.  Although you may not look at this as a natural remedy, electrolytes and minerals are certainly naturally occurring in the body of your horse.  The thing with magnesium is that when horses are low in magnesium they show the same behavioural signs.  So it would be worth consulting your vet to see if this could help, of being part of the issue.  I have an article on magnesium as a supplement and you can check that out. Magnesium is also known as a calming agent and can help to keep your horse’s nerves under control. This along with appropriate ulcer intervention can go a long way for a nervous horse with ulcer pain.

Tips for Natural Ulcer Prevention

The best ulcer prevention tip is to simply allow your horse to be a horse. Try to implement as many of the following prevention tips as possible. Your horse will thank you.

  • Allow play time, including maximum turn out time with other horses
  • Limit the use of drugs, especially Bute and Banamine, unless absolutely necessary
  • Use natural remedies or herbs for pain control when possible
  • Avoid allopathic ulcer drugs as much as possible. They change the natural pH of the horse’s digestive tract
  • Feed a more natural diet, including having hay in front of your horse 24/7. Use of slow feeders allows the horse to eat small amounts often, which prevents digestive acids from burning their stomachs
  • Minimize stress, drugs, vaccinations, and toxins (especially chemical wormers and fly sprays)
  • If possible, also filter the horse’s water
  • Always make sure your horse has just eaten before you train or show

Medical Remedies for Equine Gastric Ulcers

The main medical remedy for gastric ulcers in horses is omeprazole. Always check with your equine veterinarian and use a product that is labelled specifically to prevent and/or treat equine gastric ulcers and approved by the FDA or ruling body.  Omeprazole is currently the only drug approved for the treatment of gastric ulcers.

Using medication that is designed to reduce acid production, like Ranitidine or Cimetidine is usually reserved for horses with clinical disease, or if factors related to the cause of the ulcer cannot be mitigated. This is especially true for certain racehorses and shows horses in a busy show season.

Can I use Antacid for My Horses Ulcer?

Antacids in your horses feed is mostly ineffective because the acid produced from the feed itself during feeding will buffer the antacid. It’s also not typically a recommended treatment because of the way a horse’s stomach works, they secrete acid all the time, and you would have to give multiple treatments throughout the day.

Preventative Care for Horse Ulcers

So what should we do?

One of the biggest things about ulcers is that there are a number of preventative things we can do.  Preventative care should become a core part of your horse’s daily life after recovering from ulcers and before they get one.  Many of the changes you’ll put in place relating to how and when you feed your horse. Veterinarians also recommend supportive care, such as digestive supplements, to reduce your horse’s ulcer risk factors as well.

The first thing you can do is remove your horse from heavy work and/or competition and give them a high-roughage, low-concentrate diet. This will be more in line with the natural eating and activity habits of the horse. After the problem starts to correct you can begin to add in more work and supplements for the horse. It is a delicate balance and with the help of your vet you may need to implement a new schedule for your horse.

While doing this it is important to remove as many of the risk factors as you can.

Risk factors for ulcers include:

  • Limited turnout
  • Adjustments in diet or routine
  • high levels of travel or intense competition schedule
  • grain-based or unprocessed grain feeds
  • Too much exercise and training
  • Weight gain and loss regiments
  • Significant use of NSAIDs

Horses are grazers and as such should have food on a constant basis.  The ideal situation is to not have long gaps between feedings.  Hay nets will help to elongate the time it takes for your horse to eat its meal.  Multiple smaller feedings will be better than single large feedings.

What to Feed a Horse With Ulcers

As listed above there are a number of natural remedies that you can start to implement in tot he horses diet and see what results you get. Along with removing the risk factors, you can begin to add things that will help with your horses digestion. Feeding type and timing is the most important thing. Long periods of time without roughage are the single biggest risk factor and you will need to address that. A hay net could be a great start to helping elongate the time that your horse is eating.

There are also a number of supplements like magnesium from local tack stores that you can add to your horse’s diet to help it with its digestion and daily health.

One such supplement is Kauffman’s Equine Gold for digestive health.

For more information about ulcers and what to do visit our main ulcer page and check out these other articles.


Can You Ride a Horse With Ulcers?

The short answer is yes, but the long answer is obviously more complicated than that. We wrote another supplemental article to this one all about this subject of riding your horse when it is dealing with an ulcer

As your horse ages, you may also find that horses not only get ulcers but they can also get arthritis. Previcox and Equioxx have been known to help.

Final Note

Over the years and through some research I have learned a lot about this subject.  This article is not intended to be an all-encompassing post on the subject, but I hope to shed some light on the issue and answer some questions.  Most notably I am going to highlight natural treatments and remedies that are available for the treatment of ulcers.  I am certainly not a vet or trying to play one on the internet, so please consult your vet.

The information provided here is for informational purposes only.  It is not intended as a substitute for advice from a veterinarian or other health care professional.  It should not be used for diagnosis or treatment of any health problem or for prescription of any medication or other treatment. A health care professional should be consulted before starting any diet or supplementation program.  Also before administering any medication, alternative, herbal blends et al or if your horse has a health problem. Do not discontinue any other medical treatments without first consulting your health care professional.

Featured and supplemental articles on horse ulcers.

omeprazole for horses

Omeprazole For Horses

Omeprazole is an effective treatment for horse ulcers, or equine gastric ulcers known as equine…
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