Equine Gastric Ulcers: Causes, Symptoms, Diagnosis & How To Treat Them Naturally

While Equine Gastric Ulcer Syndrome (EGUS) is more common in performance horses, around 35% (1 in every 3) of non-performance horses will suffer from an ulcer at some point in their life, with that increasing to 1 in 2 for foals. The good news though is that it’s not difficult to reduce your horse’s chances of getting an ulcer. On top of that, if your horse, unfortunately, does suffer from an ulcer, there’s a wide range of natural treatments that will help to treat it.

What causes ulcers in horses?

Before you can successfully treat an ulcer it’s important to understand what caused it in the first place, knowing what can cause ulcers will also help you to reduce your horse’s chances, if not eradicate them completely. A recent study showed that 93% of all racehorses suffered from ulcers, while 63% of performance horses were likely to have an ulcer at some point in their life, reducing to just 35% for ‘domestic’ horses. While these numbers may seem shocking at first it does give us an indication of what a possible cause might be. Most race and performance horses spend a lot of time stabled with little or no forage and a very controlled diet which is why their risk of suffering from ulcers is so high.

Knowing that a horse’s diet can change their susceptibility is only part of the matter, to fully recognize why it’s such a big factor you need to understand how a horse’s digestive system works. Unlike humans, who only produce stomach acid when eating (or under stress), horses are continually producing acid which is why they spend so long eating and grazing. As a horse grazes the forage slowly moves through his digestive tract and stomach, this process actually reduces the amount of acid that’s produced which is why grazing is vitally important for a horse’s wellbeing. The saliva that’s produced while chewing will also act as a barrier, protecting the sensitive stomach lining against acid.

Horses can suffer from ulcers if they don’t have regular, small meals.

Forage isn’t the only contributing factor when it comes to ulcers, just like humans stress can also be a factor, regardless of whether it’s environmental or physical stress. If a horse is excessively exercised this can increase the ulcer risk because as the horse moves acid is sploshing about in his stomach. The acid then splashes the upper region of the stomach which is more sensitive, over time an ulcer can start to develop.

Prolonged usage of NSAIDs (or non-steroidal anti-inflammatory drugs) can, over time, damage the lining of a horse’s stomach which increases the risk of ulcers. While I’m of course not saying that you should stop treating pain in your horse with NSAIDs, you should do it with caution, and always speak to your veterinarian first. Every horse is different and what is considered long-term in one horse is different from another so it’s important to speak to your veterinarian if your horse is taking NSAIDs and starts to show signs of stomach pain or discomfort.

How to prevent your horse from getting an ulcer

Forage is the most important factor in reducing your horse’s chances of getting an ulcer but it won’t 100% guarantee he won’t suffer from one. There are also other factors that need to be taken into consideration but if you follow these simple steps it’ll greatly reduce the chances.

Increased grazing – A horse’s stomach will continually produce acid regardless of whether or not he’s eating and if he’s spending a lot of time not eating the acid is just going to build up. If your horse is able to spend at least 16 to 18 hours a day grazing then this will help to neutralize the acid. This is because although the acid is being used to break down the forage, the saliva produced by chewing also helps to create a barrier in the lining of the stomach. To help your horse graze as much as possible don’t use hay feeders in the pasture but instead scatter it around. 

Being able to continuously graze will help to reduce a horse's chance of getting an ulcer

Regular water – Constant access to plenty of water is so important to every aspect of a horse’s life and the prevention of ulcers is no different. Water will help with your horse’s digestion but also to wash excess acid through.

Reduce grains – Horses do need a certain amount of grain in their diet but feeding too much can increase their risk of ulcers. This is because, while chewing grains, they produce far less saliva than when compared to hay and other forage. Grains also encourage the stomach to turn sugars and starches into fatty acids which are more likely to damage the stomach lining. Some horses need more calories than others but instead of boosting their intake with starchy, sugary foods opt for one that is higher in fat. Fatty calories are far better for horses than sugary ones (just as is the case with us).

Be consistent – Horses are highly intelligent animals and repetition can get boring for them so it’s important to keep them stimulated but too much change, or too greater change at once, can be very stressful for them. Just as is the case with us, stress leads to an increase in the production of acid which in turn will increase the risk of ulcers. If you need to change your horse’s routine do it gradually but also combine it with anti-stress measures too. Even something as simple as hanging a bit of dried lavender in his stall or rubbing lavender oil into his coat can help to keep him calm and reduce his stress levels.

Avoid NSAIDs as much as possible – It’s not always possible to avoid the use of some drugs but if you can, reduce their use as much as possible. It’s also a good idea to speak to your veterinarian about any steps you can take to minimize the effect these drugs can have on the lining of the stomach.

Don’t exercise on an empty stomach – If you’re exercising your horse on an empty stomach then the excess acid will be left to splosh around in his stomach, this will result in the more sensitive upper areas of the stomach being damaged by the acid. While you don’t need to give your horse a full meal before exercising just make sure his stomach isn’t completely empty.

Reduce stress – Stress is a contributing factor when it comes to ulcers which is one of the many reasons why you need to do everything you can to minimize your horse’s stress levels. If you can, turn him out with other horses and give him toys to play with. If your horse needs to be stabled away from other horses for any period of time then think about installing a plastic ‘horse safe’ mirror in his stall to stop him from feeling isolated.

What are the symptoms of an ulcer?

Every horse is different and will display different symptoms but the common things to look out for are:

  • Poor appetite
  • Fussy eating habits
  • Low-grade colic
  • Pain in the back or girth area
  • Lack of interest
  • Loss of weight
  • Loose droppings
  • Restless nature
  • Reduced condition
  • Changes in attitude
  • Reduction in performance
  • Lying down more than normal

Some horses will continue to eat the same amount of food but will change the way they eat. Instead of eating all of their feed in one go, they’ll eat a little bit of it then walk away and come back to it later. This is because they’re in pain when they eat but are still hungry.

In more serious cases horses have been known to grind their teeth due to the pain and lie on their backs. It’s more common in foals, but it’s thought that they lie on their backs as that position offers some relief from the pain. If your horse is producing brown gastric fluid then it’s possible that he may have a bleeding ulcer and veterinarian assistance is crucial.

Diagnosing ulcers in horses

If you suspect your horse is suffering from an ulcer you need to speak to your veterinarian about it but the only definitive way of diagnosing an ulcer is a gastroscopy (also known as a gastric endoscopy). This is where an endoscope is placed down the horse’s throat, through their esophagus, stomach, and into the opening of their intestine. If it’s suspected that the ulcer is in the lower region of the stomach then the endoscope may be placed through the rectum, along the intestine, and into the stomach. Both of these methods are usually done under sedation so that the horse is calm and not stressed at all.

While a gastroscopy is the only completely reliable way of diagnosing an ulcer your veterinarian will be able to assess your horse to see the likelihood of his symptoms being the result of an ulcer. He can also perform a number of tests (such as a fecal blood test, ultrasound, or manure pH test) to help with his diagnosis. 

Are there different types of ulcers?

There are three different types of ulcers that a horse can suffer from depending on its whereabouts in their stomach the ulcer is.

  • Equine Squamous Gastric Ulcer Syndrome (ESGUS) – Also known as a squamous ulcer, its more commonly associated with a lack of forage and access to water as well as a change in housing and lack of contact with other horses. It affects the area that covers the top third region of the horse’s stomach known as the squamous.
  • Equine Glandular Gastric Ulcer Syndrome (EGGUS) – The lower two-thirds of the stomach, and in particular the end of the stomach known as the antrum, are affected by EGGUS (or glandular ulcers). Theses ulcers are more commonly linked to prolonged use of drugs such as NSAIDs as well as bacteria infections.
  • Colonic ulcer – Sometimes referred to as right dorsal colitis (RDC), colonic ulcers form in the large intestine. They’re not as common as the other types of ulcer but are similar in cause to EGGUS.

How do you treat an ulcer naturally?

Your veterinarian may prescribe some sort of acid suppressant drug such as omeprazole and while that does work it’s by no means a natural remedy. Thankfully there are a number of different natural alternatives to prescribed medication though. Along with treating the ulcer a lot of the alternatives below are also very good natural antacids for horses.

  • Aloe Vera – This is one of those miracle plants that has a hundred and one medical and health uses (okay so that’s a bit of an exaggeration but you know what I mean) and one of those benefits is in reducing the amount of stomach acid. On top of reducing the amount of acid, studies have shown that it can help to heal an ulcer just as well as omeprazole can.
Aloe Vera can help to treat ulcers in horses
  • Fenugreek – Just like Aloe Vera, fenugreek is great for excess acid. It’s also great for soothing any form of gastrointestinal inflammation because of its ability to coat the lining of the stomach and intestine. It’s a very good alternative to omeprazole.
  • Slippery Elm – Also known as the red elm, it’s a member of the elm family. The inner bark of the tree has a wide range of medical benefits and is a very good natural remedy for the prevention and treatment of ulcers. It can act as a barrier against excess acid by stimulating the production of mucus.
  • Ginger – Ginger can help to keep the entire digestive system healthy but can also help to reduce the levels of the H. Pylori bacteria which is known to be a cause of some ulcers. Ginger can also help to reduce the risk of ulcers caused by NSAIDs.
  • Mint – Both peppermint and spearmint contain an anti-inflammatory agent known as rosmarinic acid. This agent is known for its ability to soothe and calm inflammation but also for its capacity to be able to repair cell damage which can help to heal an ulcer. 
  • Lemon balm – This is often used also an alternative to mint because it contains the same anti-inflammatory agent. 
  • Chamomile – This has been a popular natural treatment in the prevention of ulcers for a long time because of its ability to reduce anxiety as well as to soothe intestinal inflammation and spasms, recent studies have shown that it can do a lot more than just that though. The studies found that chamomile extracts have anti-ulcer properties that can not only help to heal ulcers but can also prevent them from occurring (or returning) in the first place.

While it is obviously important to treat the ulcer you also need to understand and treat the cause of it too. Otherwise, the ulcer may have gone but because the cause hasn’t it’ll just come back in time.

Can an ulcer heal on its own?

In the vast majority of cases, an ulcer won’t heal on its own and your horse will need some sort of intervention, either medicinal or natural. That said a very small percentage (around 5 to 10%) of horses will recover completely on their own without any sort of treatment. While a small number of horses will recover on their own it’s better to presume they won’t rather than presume they will.

What should you feed a horse with an ulcer?

If your horse has suffered from an ulcer then when it comes to his feed it’s time to go back to basics and keep it simple. If you keep these points in mind you can’t go far wrong:

Horses that are prone to ulcers need to have plenty of grazing
  • Plenty of forage – Forage takes longer to chew than concentrates and as a result, produces a lot more saliva which will help to keep the levels of stomach acid under control.
  • Little and often – We’ve all heard it a million times before but feeding horses little and often is crucial for a healthy gut and digestive system, and therefore a happy horse.
  • Avoid too many cereals – Cereal concentrates don’t allow the horse to produce the amount of saliva they need which increases their risk of ulcers. That’s not to say you shouldn’t feed concentrates but try to find one that has a higher proportion of digestible fiber
  • Include alfalfa  – Studies have shown that the protein levels (along with the amount of calcium) in alfalfa make it one of the best sources of fiber when it comes to treating horses with ulcers.
  • Don’t exercise on an empty stomach – You don’t need to feed your horse a lot before exercise, a scoopful of chopped fiber is enough. This will ensure his stomach isn’t empty and therefore the acid won’t be left to slosh around.
  • Turn out – Turning your horse out as much as possible will not only give him a chance to graze but will also reduce his stress levels. This will help when treating ulcers because it’ll take away one of the triggers for them.

I hope you found this article helpful. If you did I’d be grateful if you could share it please as it would really help me.

Recommended products 

Over the years I have tried hundreds of different horsey products, from various blankets and halters to different treats. Some I’ve loved, others I’ve hated but I thought I’d share with you my top all-time favorite products, the ones I never leave the yard without. I’ve included links to the products (which are in no particular order) that I really think are great.

  • Horse Knots by Reference Ready – If you’re like me and enjoy pocket reference guides then you’ll love this knot tying guide. These handy cards can easily fit in your pocket or attach to the saddle for quick reference. They’re waterproof, durable and are color coded to make them easy to follow.
  • Mane ’n Tail Detangler – Even if you never show your horse you’ll need to detangle his tail from time to time (and possibly his mane too) which is always a challenging chore! I’ve found that if I run a little bit of detangler through my horse’s tails every few days it stops them from getting matted up and makes combing them easy, even if they’re coated in mud. I don’t know if I should admit to this or not but it also works wonders on my hair.
  • TAKEKIT Pro clippers – Over the years I’ve tried a lot of different clippers and while some were obviously better than others I found these to be by far the best. They are heavier than a lot of other clippers but for me, that’s a good thing, it makes them feel more sturdy and hardwearing. On top of that they have a range of speeds so are just as good for clipping your horse’s back as they are his face. I also like the fact that they come in a handy carry case but that’s not for everybody. The company that makes them is super good and incredibly helpful too, a real bonus these days. The only thing I wasn’t keen on was the fact that it doesn’t come with any oil, but that’s not a major problem as it’s not difficult to buy lubricant.
  • Shire’s ball feeder – There are so many boredom buster toys out there but I like to use these every day, regardless of whether or not my horses are bored. I find that it helps to encourage my horses to problem solve by rewarding them with treats (or pieces of fruit) but it also mimics their natural grazing behavior which helps to keep them calm and de-stressed.
  • Horse safe mirror – This is a strange one that many people are surprised about but I like to put horse safe mirrors in the trailers as well as in the quarantine stalls. It helps to prevent the feeling of isolation by giving the impression of other horses being around. Being herd animals horses can get extremely stressed when they feel that they’re on their own but with these stick-on mirrors, they believe that at least one other horse is with them.
  • Rectal thermometer – I know this isn’t glamourous at all but it’s vital for your horse’s well-being to be able to check their temperature and a rectal thermometer is the easiest way of doing this which is why I’ve added it to the list.

Shopping lists

I’ve also put together a few shopping lists of essential items that I’ve found helpful over the years. I’ve broken the lists down into different categories rather than put everything in one massive list 😉

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