Understanding Equine Ulcers: What Are Your Treatment and Prevention Options?

Understanding the options for treatment and prevention of equine ulcers can allow horse owners to better care for their horses. There are many ways that horse owners can help their horses avoid gastric ulcers and also differences in how you can treat ulcers.

In part one of this two-part series of The Equine Connection Podcast, Dr. Rambo discussed the basics of equine ulcers. In part two of this two-part series, we talked about different treatments and ways that horse owners can help prevent gastric ulcers in their horses. 

How To Treat Equine Ulcers

The best treatment for ulcers will depend on the location in the stomach wherethat your horse has ulcers. The following provides a brief review of some of the common drugs you may have heard about for the treatment of ulcers in horses. This is for educational purposes and does not replace the need to discuss your specific horse’s case with your veterinarian. 


Most U.S. horse owners are familiar with GastroGard®, which is the FDA-approved form of omeprazole that is used in horses for the treatment of Equine Squamous Gastric Disease. Other parts of the world have other preparations, but omeprazole has been the basis of treatment in equine ulcers for years.

Omeprazole is a protein pump inhibitor. It shuts down some of the acid secretion that happens in the stomach, which allows the pH of the stomach to be less acidic. The goal of acid reduction is to get the stomach pH above 4 for at least 16 hours a day. This allows for the healing of that squamous (upper portion) of the stomach. From part 1 of this article and podcast series, you might remember that the upper part of the stomach isn’t protected against the acid that is secreted in the lower portion of the stomach.


Another drug your veterinarian might use is ranitidine, a histamine-2 blocker that decreases the amount of acid created by the stomach. In other words, it works by binding histamine receptors instead of proton pumps in the stomach. 

Ulcers in the lower portion of the stomach (glandular portion) have a slightly different protocol for treatment. Drugs designed to increase the pH in the stomach are less effective in addressing glandular ulcers as compared to squamous ulcers because ulcers in the glandular part of the stomach are not simply a function of acidity.  


Sucralfate, which is a coating agent, is often combined with a protocol to increase pH. It makes a protective barrier over the ulcerated area to help protect it from further injury and allow it to heal. Sucralfate actually works throughout the GI tract, but that makes it harder for many things to be absorbed, so it isn’t without some complications. 

Ongoing research is being conducted to determine the best combination of therapies to address glandular ulcers. 

Ideally, your veterinarian would use a gastroscope to look into the stomach and create a treatment protocol for the issues found. Then, come back and scope the horse again to ensure the treatment(s) are working.

Equine Ulcer Prevention Tips

Decreasing Stressors That Can Contribute to Ulcer Risk

Where you can help in preventing and alleviating some of the issues of stomach ulcers is through the management of the horse and its environment. For example, if you are going to put your horse in a trailer and drive it somewhere, that is a known stressor associated with the development of equine ulcers. 

If you know your horse is prone to ulcers or has been previously diagnosed with ulcers, there are supplements that might support the horse’s GI tract to help avoid the development of ulcers. While supplements are part of a holistic plan for the prevention of ulcers, you can’t “supplement” your way out of bad management. And bad management might mean just a specific situation for the individual horse, not that you are managing all of your horses poorly.

Unfortunately, you can’t put the “perfect supplement” in front of a horse and never have a gastric issue. It doesn’t work that way.

Equine Supplements for Digestive Health

Some supplement ingredients horse owners might want to use include gastric buffers. These products are known to increase pH (make the stomach less acidic). This makes buffers a helpful component of ulcer prevention. You might utilize these ingredients for times when stress can contribute to equine ulcers. That could be before transportation, before exercise, and so on.

Calcium Carbonate and Magnesium Oxide

Early buffers included ingredients such as calcium carbonate and magnesiummagnexium oxide. They increase pH, but only for short periods of time. Alfalfa is high in calcium carbonate, which is why many owners want to feed alfalfa to horses that are prone to stomach ulcers in the squamous (upper portion) of the stomach.

Marine-Derived Calciums

Recently, researchers have been focused on seaweed and marine-derived calciums. The seaweed-derived calcium is very porous, which means there are many more binding sites for the protons in acids. That makes it a more effective buffer.

The seaweed-derived calciums offer about four hours of buffering as compared to a maximum of two hours with calcium carbonate. However, remember that the goal is to get the stomach to a 4 pH for at least 16 hours a day. Even using the seaweed-derived calcium, an owner would have to feed it multiple times a day. So, you obviously can’t get the same level of acid control you can with a drug, making these supplements geared towards prevention, instead of treatment.

Aloe Vera, Lecithin, and Glutamine

To support the glandular portion of the stomach, some previously tried ingredients include aloe vera and lecithin (a type of fat). There has also been research into an amino acid called glutamine. In most cases, a horse’s body can make enough glutamine to supply its needs. However, in times of stress, horses will use up more glutamine than normal, so the internal production of that amino acid might not be able to keep up withto the demand. Just a note, glutamine is used throughout the GI tract. And if a horse gets too much glutamine, its body will turn it into carbons, and it will be used up for energy, or they will urinate the rest out. However, it’s good to know that if something goes awry in places other than the stomach in the GI tract, glutamine can be used by the horse.

Probiotics are another way to support the horse’s digestive system (check out the article on How Prebiotics & Probiotics Help Your Horse). Probiotics are live microorganisms that have a positive effect on the microbial population in the GI tract. For horses, a target area for probiotics is the hindgut of the horse, where fiber is broken down. 

Feeding the Ulcer-Prone Horse

The quantity and quality of forage we provide to our horses is the most important part of their diet. Forage availability is important to prevent squamous disease in the upper portion of the stomach. 

Horses in the wild will graze 20 hours a day. But there are some “easy keeping” domestic horses that will become obese if forage/hay is given unrestricted. Obesity also has negative health consequences for horses, with the potential to disrupt the balance of the GI tract.

Horses should receive a minimum of 1.5% of their body weight in good-quality forage each day. However, good-quality forage doesn’t necessarily mean dairy cow-quality alfalfa hay. If your horse is fat, that isn’t the right forage choice.

A good-quality grass hay that is low in sugar and fed in multiple small meals each day can help obese horses maintain body weight while keeping long-stem forage in their gut. Owners can also use slow-feed nets to extend the amount of time a horse is eating hay (“grazing”). One of the keys to having horses “graze” on forage over a long period of time is that as horses chew, they create saliva. Saliva naturally helps buffer the stomach. Just the presence of forage in the stomach can buffer the acid. 

Timing of forage feeding is also important. Think about when you exercise a horse. If the horse has forage in its stomach, the acid is less likely to “splash up” on the squamous (top portion) of the stomach, which can help decrease the risk of squamous ulcers. So, if you have an overweight horse that you are exercising, it is good to time feeding of forage so they still have some in their stomach during the exercise period. 

On the other end of the spectrum, if you have a horse that needs more calories than can be obtained from just forage, look for horse feeds that are lower in sugar and starches and use good-quality fiber and fat sources, which can increase calories and still keep the meal size small. 

The maximum meal size for a 1,000- to 1,200-pound horse should be about five pounds of horse feed, per meal. If you are giving something like alfalfa pellets in addition to your horse feed, don’t exceed the five-pound limit in a given meal. 

We recommend you listen to part two on equine ulcers to learn even more and get additional tips from Dr. Nicole Rambo. And if you missed it, be sure to listen to part one.


Equine Glandular Gastric Disease: Prevalence, Impact and Management Strategies, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642651/#:~:text=Sucralfate%20is%20frequently%20used%20in,with%20EGGD%20Grade%20%E2%89%A52.

Related Products

Constant Comfort® Pellet

  • The Constant Comfort® gut health supplement system offers your horse 24/7 support and is comprised of two products: Constant Comfort® Plus and the Constant Comfort® Block. Constant Comfort® Plus is a top dress that should be fed at regular feedings and before times of stress. It provides your horse with Aloe Vera, Glutamine and Lecithin to help soothe their stomach and support their stomach lining, as well as Seaweed Derived Calcium to maintain proper stomach pH. It also contains Equi-Ferm XL®, a pre- and probiotic that supports hindgut health. We recommend using the Constant Comfort® Plus in conjunction with the Constant Comfort® Block.

Constant Comfort® Block

  • Your horse’s stomach secretes acid continuously, so they need support all day and night – not just at feeding times. The Constant Comfort® Block is designed to help soothe and support your horse’s stomach 24/7 when offered free-choice. It contains Seaweed Derived Calcium to maintain proper stomach pH, as well as Equi-Ferm XL®, a pre- and probiotic that supports hindgut pH, overall digestive health, and total diet digestibility. We recommend using the Constant Comfort® Block in conjunction with Constant Comfort® Plus.

Kalm ‘N EZ® Pellet

  • Kalm ‘N EZ® Pellet is higher in fat (8%), high in fiber (20%), very low in NSC (13.5%), and does not have any added iron. This feed is suitable for moderate to harder-keeping horses with sugar and starch sensitivities, including Insulin Resistance, PSSM Type 1, and other metabolic disorders. The low sugar and starch (NSC) levels also make it an excellent choice for hyperactive horses and horses with digestive tract sensitivities. Its high fiber level also makes Kalm ‘N EZ® Pellet a great option when hay quality is poor or hay replacement is necessary. This feed is formulated with pre- and probiotics to support your horse’s digestive health.

Senior Sport®

  • Senior Sport® was designed with the hard-keeping and hard-working horse in mind. This textured feed is high in fat (10%), high in fiber (18%), and low in NSC (16.5%), making it suitable for horses with sugar and starch sensitivities that also have higher calorie needs. Its high fiber level makes it a great option when hay quality is poor, or hay replacement is necessary. Senior Sport® is also formulated with pre- and probiotics to support your horse’s digestive health and does not contain any added iron.
Article By: Kimberly S. Brown
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