Gastric ulcers affect a striking share of performance and stabled horses, and the treatment protocol matters almost as much as the drug itself. The standard approach combines a 28-day course of the prescription medication omeprazole with diet and management changes that let the stomach lining actually heal. Here is the current veterinary consensus on which drug to use, how to give it, and what to change in the barn while the ulcer repairs.
What Is the Standard Medical Treatment?
Omeprazole is the cornerstone of equine ulcer therapy. It works by shutting down acid production in the stomach, which lets existing ulcers heal instead of being continually irritated.
Other medications play supporting roles, but none replace omeprazole as first-line therapy.
| Medication | Role in Treatment | Key Notes |
|---|---|---|
| Omeprazole | — | Once daily, 28 days for squamous ulcers; longer for glandular disease |
| Sucralfate | Adjunct, mainly for glandular or pyloric ulcers | Separate from omeprazole by at least 60 minutes |
| Misoprostol | Option for glandular ulcers in some protocols | Used when omeprazole alone is not enough |
| H2 antagonists (ranitidine, famotidine, cimetidine) | Older or additional acid reducers | Still mentioned in the literature, but omeprazole remains the drug of choice |
Antacids are not practical for horses because they require very high volumes and frequent dosing.
How Is Omeprazole Given Correctly?
Giving it with feed blunts absorption and can make the whole course less effective.
The usual course runs 28 days, though some cases need one to two months depending on ulcer type and severity. A recheck endoscopy after treatment is the standard way to confirm the ulcer has actually healed — improvement in symptoms alone is not a reliable signal to stop.
Glandular ulcers are a different animal. For equine glandular gastric disease (EGGD), omeprazole is often combined with sucralfate or misoprostol, and the treatment duration commonly stretches to 28–56 days. UC Davis’s equine gastric ulcer syndrome guide covers both ulcer types and the full dosing protocol.
What Diet and Management Changes Help Ulcers Heal?
Medication alone is not the whole treatment. Every major source pairs omeprazole with feeding and husbandry changes, because a horse’s stomach is designed to graze almost continuously. Long periods without forage let acid pool in the empty stomach and splash onto the sensitive upper lining, especially during exercise.
- Increase forage and avoid fasting. Free-choice hay, pasture turnout, and slow feeders keep the stomach buffered.
- Feed alfalfa hay. Alfalfa is a common component of ulcer management; feeding a small amount before exercise helps reduce acid splash.
- Feed hay before grain and before work. Grain is fed in smaller, more frequent meals, and concentrate intake is reduced overall.
- Reduce stress. Turnout, fresh water, and companionship all matter — stressed, stalled, and trailered horses are the highest-risk group.
Management changes carry most of the prevention weight, and owners who want to support healing with a targeted nutritional product can compare the best equine ulcer supplements tested this year.
FAQs
Why is a 28-day omeprazole course necessary?
Equine stomach ulcers take weeks to heal, not days. The 28-day course suppresses acid long enough for the damaged squamous lining to repair, and a recheck endoscopy confirms healing before the medication stops. Shorter courses often leave ulcers partially healed, which is why they quickly return.
What is the difference between squamous and glandular ulcers?
Squamous ulcers (ESGD) form in the upper, non-glandular stomach and respond well to omeprazole alone. Glandular ulcers (EGGD) form in the lower acid-producing region and frequently need combination therapy with sucralfate or misoprostol, plus a longer treatment window of 28–56 days.
Can ulcers heal with diet changes alone?
No. Diet and management changes support healing and prevent recurrence, but an existing ulcer usually needs the acid suppression that only omeprazole provides. The standard protocol is medication plus feeding changes together, not one or the other.
References & Sources
- UC Davis Center for Equine Health. “Equine Gastric Ulcer Syndrome.” Documents the omeprazole dosing protocol, 28-day course, and alfalfa-based management guidance.
- Merck Veterinary Manual. “Gastric Ulcers in Horses.” Confirms omeprazole as the primary therapy and the need for management changes.
- PMC / NIH. “Equine Gastric Ulcer Syndrome: An Update.” Reviews squamous vs. glandular disease, sucralfate and misoprostol use, and the rebound acid window.
Mo Maruf
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