Treating horses for ulcers (1)

Horse Ulcers: Diagnosis, Treatment and Prevention. Full Guide


As a horse lover, you undoubtedly value the ability to ensure your horse is as healthy as possible. An important aspect of being able to do exactly that is to increase your awareness of horse ulcers. In this article, we will discuss the diagnosis, treatment, and prevention of horse ulcers so you can be confident your equine partner is healthy, happy, and ready to ride.

Identifying the signs of gastric ulcers, commonly referred to as stomach ulcers, is important. In this article, you will learn how to identify, treat and prevent horse ulcers from occurring.

What Are Horse Ulcers?

Horse gastric ulcers are sores that form in the lining of the stomach. Ninety percent of all horses will develop ulcers at some point in their life. Horses have four types of ulcers. Squamous ulcers occur in the upper part of the stomach, close to the esophagus, and are referred to as Equine Gastric Ulcer Syndrome. Glandular ulcers are found in the lower part of the stomach and are referred to as Equine Glandular Gastric Disease. Pyloric ulcers are found in the opening of the stomach to the small intestines. 

But why are ulcers so prevalent in horses?

Compared to other large animals, the horse’s stomach is on the smaller side. In fact, because of the size of their stomach, experts recommend horses should eat smaller meals more often.

A horse’s stomach acts like two stomachs in one. The upper portion of the stomach is called the squamous. It does not produce any digestive acids and therefore does not have a protective lining. It is particularly vulnerable to ulcers. The lower portion of the stomach is known as the glandular. It produces digestive acid twenty-four seven and, as a result, has a protective lining.

Squamous ulcers occur during a horse’s movement when acid splashes up onto the upper portion of the stomach where there is no protective lining and causes irritation. In some cases, it produces an ulcer. Even though movement can result in ulcers developing, they are preventable.

Horse Stomaches get two types of ulcers (1)
Figure 2 The Equine Stomach with permission from Jean Abernethy

Factors That Contribute to Horse Ulcers

Several factors contribute to a horse getting ulcers. One of the biggest factors is going a long time in between feedings. This causes stomach acid to build up and increases the likelihood of ulcers. A diet heavy in grains will also contribute to a likelihood of ulcers. Heavy use of NSAIDS also contributes heavily to ulcers.

  • Too much time between meals – We discussed how the horse’s stomach produces acid around the clock and is small. Therefore a horse really should eat several small meals throughout the day (grazing).
  • Diets heavy with grains – Roughage should make up most of the horse’s diet. If grain or pelletized supplements are fed, they should be accompanied by hay.
  • Frequent use of anti-inflammatories (NSAIDS).

Although a couple of these factors may seem daunting to overcome, we will discuss ways of working with the horse’s stomach that will not encourage the development of gastric ulcers.

Signs Your Horse May Have Stomach Ulcers

There are several symptoms of ulcers in horses, including colic, behavioral changes, and signs of unhealthy skin and hair. In case you have never experienced a horse suffering colic, some of the symptoms are the horse not eating or drinking, standing with front legs and hind legs unusually far apart as if stretching the stomach, laying down and getting up repeatedly as if uncomfortable and looking back at its side while standing. Now, here are the signs your horse may have stomach ulcers.

  • Recurring mild colic: Usually diagnosed by a vet.
  • Poor condition.
  • Ribs showing.
  • Hair appears dull and unhealthy.
  • Lackluster performance.
  • Not wanting to train.
  • Behavioral changes.
  • Not eating.

If you see one or more of these signs appearing in your horse, it is time to call a professional and get a thorough diagnosis. Some of these signs would occur much faster than others. For example, your horse may stop eating long before they begin to look like they are in poor condition.  

Likewise, a horse refusing to train or being very dull in its movement would occur before a dramatic drop in weight or change in body condition. These are early warning signs, and they are more subtle, requiring daily interaction and observation to notice.

Now that you know what to watch for, you can check daily for these more subtle signs of distress in your horse. Developing the ability to observe these subtle changes early on may prevent the more serious long-term effects and possibly save your horse’s life. When you are concerned about your horse’s health, be sure to seek a diagnosis by a veterinarian.

It is important to note:

Some horses have a high pain tolerance, and they are tough, so you may never know they suffer from ulcers. If your horse does not appear to be suffering from colic but is walking away from his feed after a few bites, there is a good chance that gastric ulcers are the culprit.

Preventing Gastric Ulcers in Your Horse

Nearly ninety percent of all horses will develop ulcers in their lifetime. That should sound an alarm for all horse lovers of the importance of awareness. It is critical to take the time to observe and analyze your horse’s feeding habits and overall body condition daily. This is key to helping your horse avoid the pain and discomfort of developing ulcers.

Probably one of the first steps to preventing ulcers is to form the habit of feeding a small portion of roughage to your horse at least thirty minutes before riding. Alfalfa has proven highly beneficial when used as a small ‘pre-ride portion. This roughage consists of absorbent stems and leaves, making alfalfa superior to grass hay for absorbing stomach acids.

This is not a recommendation of a straight alfalfa diet. But alfalfa used in this capacity can settle stomach acids and avoid their splashing and causing irritation to the upper stomach lining. It is a valuable step in the prevention of gastric ulcers. Here is the rundown on preventative measures to help your horse avoid developing gastric ulcers.

  • Feed a small portion of hay 30 minutes before riding (preferably alfalfa).
  • Feed small meals frequently or utilize pasture and ‘slow feeders.’
  • Reduce the use of grains (this is not referring to extruded, complete, pelleted feeds).
  • Limit stress whenever possible.
  • Minimize or completely avoid the use of NSAIDS (most common being Bute).
  • When stalled, make sure there is access to feed (utilize a ‘slow feeder’) and if possible, allow your horse to see and hear other horses to eliminate stress.
  • MOST IMPORTANT… Be observant! Look for the signs and be proactive, and if need be, consult a professional.

If You Suspect Ulcers in Your Horse

There are primarily three options for diagnosing gastric stomach ulcers in horses, gastric endoscopy, gastroscopy, and noninvasive diagnosis through observing the horse’s behavior and the response to therapy. 

Clearly, the first two options must be performed by a professional, a DVM (veterinarian). The third option, you may be able to diagnose and employ the proper therapy right away if you are astute and can read the signs of your horse’s distress well.

I am in no way advocating for the average equine owner to forego professional treatment of their horses when their horse needs medical attention. But, throughout the years, I have observed many equine professionals who, through experience, became capable of diagnosing and treating equine gastric ulcers.

The safest plan of action is to let your vet know that you suspect an equine gastric ulcer so they can quickly treat it.

Now let us take a closer look at how a vet will diagnose an ulcer.

Diagnosing Horse Ulcers

  • Endoscopy – An endoscopy is typically referring to the use of the endoscope to examine either the upper respiratory tract or the upper digestive tract, such as the esophagus. As related to horse ulcers, an endoscopy would only reveal the damage done by acid occurring in the esophagus and perhaps the very upper reaches of the stomach (see figure 2). But, by definition, once the endoscope passes into the stomach, you now have a gastroscopy.
  • Gastroscopy – The use of an endoscope to examine, retrieve samples, and diagnose gastric ulcers. In this procedure, the esophagus, stomach (both upper and lower portions), and the beginning of the hindgut are examined for damage due to ulcers.

The Placement of the Ulcer Indicates the Seriousness of the Issue

To examine a horse for ulcers, a vet will use an endoscope. The endoscope, 3 meters in length, is inserted into the nostril and passes through the epiglottis and stomach. The camera on the end of the instrument allows the vet to see the digestive tract and locate any ulcers clearly.

Of course, finding the ulcers is just the first step to determining the cause. This is where the ‘big picture’ has relevance. For example, if ulcers are discovered primarily in just the upper portion of the stomach, this would indicate that the issue is likely a feed management-related issue. 

In other words, an adjustment to the diet or the feed schedule and exercise may need to be altered. We will discuss this in greater detail later.

If ulcers are discovered in the lower portion of the stomach, this indicates a more serious condition because the bottom portion of the stomach has a lining designed to protect the stomach wall from the acidic digestive enzymes (see figure 2).

When ulcers are found in the lower stomach, this points to the possible over-use of NSAIDs or non-steroidal anti-inflammatory drugs. The treatment for this condition may vary slightly regarding oral dosing amounts and the duration of treatment.

Because horses cannot speak to us about their health, we must be fully engaged to ensure optimal health.

Treating Gastric Ulcers in Horses

There are several steps you can take to treat your horse’s ulcers. Most of these should be taken while consulting your vet.

1. Prescribe Omeprazole to Treat Ulcers

The main treatment for gastric ulcers is Omeprazole. Omeprazole is an acid reducer. Because the equine stomach produces acid around the clock, Omeprazole has significant benefits. In a serious case of gastric ulcers, Omeprazole is usually administered for at least thirty days.

Now here is where things get tricky. It is important to consult a veterinarian. If your horse is on a thirty-day regimen of Omeprazole, you do not want to stop administering the drug cold turkey. 

Why is this a problem? 

When the treatment with Omeprazole is stopped suddenly without tapering the dose off, it can result in the horse’s stomach going into overdrive, producing acid. This results in a much worse reoccurring case of gastric ulcers, not the desired outcome!

Secondly, extended use of Omeprazole can result in your horse suffering dramatic weight loss and loss of body condition. This occurs due to a lack of digestive acids to begin the digestive process so the horse can absorb the needed nutrients from his feed.

As you can see, there is a delicate balance here that needs to be achieved, and if you lack the necessary experience to strike that balance, you need to consult a vet.

2. Pain Medicine to Assist in Eating

If your horse is showing signs of pain, dosing with sucralfate may be indicated along with omeprazole. Sucralfate is a pain reducer and may be needed when the pain associated with eating is so intense that the horse quickly loses interest in his feed.

3. Turn Your Horse Out to Pasture More Frequently

Giving your horse more time on pasture will greatly help your horse. In addition to this important step in treatment, there are several more actionable steps we can take to hasten your horse’s healing. If at all possible, turn your horse out more frequently. Remember, the horse’s stomach is small and produces acid continually. Consuming small meals more frequently helps to regulate this. 

4. Stop or Drastically Reduce the Use of NSAIDs

If you extensively use NSAIDS on your horse, your vet will direct you to reduce their use or eliminate them drastically. That is because NSAIDs are well known to irritate the stomach lining.

5. Adjust Your Horse’s Eating & Exercise Schedule

Another important step is to adjust the time between meals. This aspect of treatment can pose a real challenge for a lot of equine enthusiasts. Many horse lovers work away from their horses, which makes feeding more frequently than twice a day difficult. Fortunately, today, there are a few feed accessories on the market that make it easier to provide frequent feedings to your horse. This is done by dramatically slowing down how quickly they can consume their feed.

6. Confirming Ulcer Healing in Your Horse

After thirty days of treatment, a gastroscopy should be performed to examine the progress of healing the ulcers. Once it is determined that the horse is cured of gastric ulcers, it is critical to prevent future ulcers.

Riding a Horse with Ulcers

A horse can be ridden while recovering from and receiving treatment for gastric ulcers. An exception to this would be that if your horse has been suffering from the illness for an extended period before diagnosis and is suffering considerably from bad health. If your horse is physically weakened, then riding is not recommended.

Riding horses with ulcers requires care (1)

Ride with less intensity. 

It is important to note that stress can intensify the effects of stomach ulcers and inhibit their healing. Therefore, how you ride your horse while treating stomach ulcers is an important factor in their healing.

In other words, You should alter the intensity of your riding during the thirty-day treatment cycle. If you are preparing your horse for competition or working through foundational training, it is recommended to adjust your training program to eliminate as much stress from your riding sessions as possible. You should consider postponing your training during treatment and focus on just enough riding and movement to maintain conditioning.

Keep in my mind; a healthy horse will always perform better. So, slowing down to allow your horse to heal from gastric ulcers may speed up your efforts later, once your horse is back to 100%.

Frequently Asked Questions

Can stomach ulcers make my horse buck? Ulcers can bring about behavioral issues with horses. Occasionally, a horse will buck from the discomfort of ulcers. Still, unless a horse has shown a disposition to bucking previously, ulcers will not normally induce new bucking in a horse. Other behavioral problems usually manifest themselves first, such as resistance to training and a reluctance to being ridden.

Can I treat my horse’s stomach ulcers naturally? Horse stomach ulcers can be treated naturally. Common natural treatments include Aloe Vera, Mugwort, Slippery Elm, and Chamomile. Natural remedies vary greatly in their efficacy. The question should be, ‘Will my horse recover from gastric ulcers if treated naturally?’ In some cases, your horse may recover, but there is little scientific evidence as to which treatment is most effective. If you want to treat your horse naturally, it is still prudent to consult a veterinarian.


Your equine partners are unable to speak for themselves and dependent on us to look after their health. To be good stewards of these amazing animals, we need to be like a sponge and learn all we can about what makes them think and behave the way they do, what incredible creatures they are from a physical standpoint, and what they require to stay happy and healthy.

Having an equine partner always begins with a dream, but it should not end there. The reality of horse ownership is that it requires effort, sacrifice, and a lot of care! Sadly, sometimes, people acquire a horse based on unrealistic expectations and don’t realize the amount of time, money, and effort it takes to care for a horse properly. As a result, it is often the horse that suffers the burden.

A horse’s health and condition are often a reflection of the human caretaker. Horse ulcers are very prevalent (up to 90% affected) and go undetected for an extended period. This means that if we lack the necessary diligence in our care, our horse may be suffering in silence from a harrowing case of gastric ulcers.

So, bookmark this article for future reference and follow the highlighted tips on how to diagnose, treat and prevent gastric ulcers in horses and help keep your equine partner happy, healthy, and riding like a champ!

For More Information

Check out this informative article entitled ‘Equine Gastric Ulcer Syndrome’ from UC Davis/ School of Veterinarian Medicine/Center for Equine Health /By Amy Young 7/29/19

My Favorite Equine Resources For Horses and Donkeys

This list contains affiliate products. Affiliate products do not cost more but helps to support BestFarmAnimals and our goal to provide farm animal owners with accurate and helpful information.

Squeaky Chicken Toy is hilarious to watch and the horses love it! It’s not super tough so keep it away from dogs.

Dewormer with Ivermectin: I use this for my horses and my goats. Duvet makes a great dewormer. I switch between the Ivermectin one and one like this one so the worms don’t get immune to it.

Manna Pro Apple Flavored Nuggets are a delicious smelling treat that my horses go crazy over.

Equinity Amino Acid Supplement for Horses makes a big difference for any horse that’s struggling with arthritis, hoof issues, or just generally. It’s great for older horses who can’t absorb all the nutrients in their food as well!

Manna Pro Weight Accelerator helps older horses gain weight and stay healthier! This was especially helpful when one of my older horses lost weight over the winter and helped her regain her weight over the summer!

Farnam Fly Control goes on the horse or donkey and will keep the flies off your sweet pet. It makes horses way more comfortable and will keep sores from getting infected as well.

Wound Kote protects sores and wounds. It acts as an antiseptic and helps wounds heal faster. It works on both my horses and goats.

Scroll to Top