Best Horse Ulcer Treatment: How to Heal and Prevent Gastric Ulcers in Horses

Gastric ulcers are one of the most common and painful conditions affecting horses today—especially those in training, competition, or high-stress environments. Whether you suspect your horse is suffering or you’re looking to prevent ulcers before they start, this guide will walk you through the best horse ulcer treatments available, including medications, nutrition, and long-term management practices.

What Are Gastric Ulcers in Horses?

Gastric ulcers—formally called Equine Gastric Ulcer Syndrome (EGUS)—occur when the stomach lining becomes eroded or damaged, usually due to excess acid. Up to 90% of performance horses are affected, and many leisure horses develop ulcers, too.

Horse Stomach Anatomy & Types of Ulcers

A horse’s stomach is divided into two regions:

  • Squamous (non-glandular): The upper portion, which doesn’t produce acid and is prone to exposure-related ulcers.

  • Glandular: The lower region, which naturally secretes acid and mucus. This area can also ulcerate, but often requires different treatment.

Understanding the location of ulcers is key because squamous and glandular ulcers have different causes and respond to different treatments.

What Causes Gastric Ulcers in Horses?

Horses are natural grazers. Their stomachs produce acid constantly, even when they’re not eating. Ulcers form when acid overwhelms the protective barriers in the stomach lining. Contributing factors include:

  • High-grain, low-forage diets

  • Infrequent feeding or long fasting periods

  • Intense exercise

  • Travel or stall confinement

  • Chronic stress

  • Overuse of NSAIDs (like Bute)

Symptoms of Equine Gastric Ulcer Syndrome (EGUS)

Ulcers can be hard to detect, but common signs include:

  • Poor appetite or picky eating

  • Weight loss or trouble maintaining condition

  • Dull coat

  • Resistance to girthing or saddling

  • Behavioral changes, irritability

  • Grinding teeth or yawning

  • Poor performance or unwillingness to work

Foals may show signs like diarrhea, teeth grinding, or lying on their backs.

How Are Gastric Ulcers Diagnosed?

The only definitive way to diagnose ulcers is through gastroscopy, a procedure where a veterinarian uses a small camera to examine the stomach lining. This helps identify the ulcer’s location and severity—critical for choosing the right treatment.

Best Medical Treatments for Horse Ulcers

Once diagnosed, treatment can begin. The most effective approach depends on the type of ulcer.

1. Omeprazole

  • Type: Proton Pump Inhibitor (PPI)

  • Best For: Squamous ulcers

  • Action: Reduces acid production in the stomach

  • Note: Use only FDA-approved equine omeprazole (e.g., Gastrogard®). Inconsistent or compounded versions may not be effective.

2. Misoprostol

  • Best For: Glandular ulcers

  • Action: Increases mucus production and blood flow to protect the stomach lining

3. Sucralfate

  • Best For: Both types (as a secondary treatment)

  • Action: Coats the stomach lining to protect from acid while healing

4. H2-Receptor Antagonists (e.g., ranitidine)

  • Less effective than omeprazole, but sometimes used in mild cases or as maintenance

Natural & Supportive Therapies

Aloe Vera

Some horse owners use aloe vera for its soothing and anti-inflammatory effects. While not a substitute for medical treatment, it may help support healing.

Visceral+ and Other Gut Supplements

Equine supplements like Visceral+, Succeed, or GastroEase aim to improve gut health and reduce inflammation. Look for products with prebiotics, licorice root, and marshmallow root.

Nutritional Management of Gastric Ulcers

Feeding plays a huge role in both healing and preventing ulcers.

Best Feeding Practices:

  • Feed frequent, small meals to reduce fasting

  • Prioritize high-fiber forage (hay, pasture)

  • Offer alfalfa hay, which buffers stomach acid

  • Avoid or limit starchy grains and sweet feeds

  • Provide forage before exercise to form a “hay mat” that protects the stomach lining

Sample Feeding Plan for a Horse Recovering From Ulcers:

Time Feed
AM Alfalfa hay + soaked beet pulp or mash
Noon Grass hay or pasture access
PM Alfalfa + low-starch pellet
Throughout Day Free-choice grass hay, salt block, and fresh water

Management Practices to Prevent Recurrence

Medication alone won’t prevent ulcers from returning. Combine it with thoughtful horse management:

  • Maximize turnout and grazing time

  • Keep feeding consistent

  • Minimize stress from transport, competition, or changes in environment

  • Use slow-feed hay nets to extend eating time

  • Monitor NSAID usage and consult your vet before long-term use

  • Train and exercise gradually to avoid stress spikes

Summary: Making the Best Ulcer Treatment Plan

The best treatment for horse ulcers depends on:

  • Accurate diagnosis (squamous vs. glandular)

  • Veterinary-prescribed medication like omeprazole or misoprostol

  • Nutritional support focused on forage and reduced grain

  • Management changes to reduce stress and fasting

Healing gastric ulcers is possible—and preventable—with the right plan in place.

If you suspect your horse has ulcers, don’t wait. A combination of medical, nutritional, and environmental changes can restore their comfort and performance.

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