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Equine Gastric Ulcer Syndrome (EGUS)

Up to 90% of performance horses have ulcers. Endoscopy is the only real diagnostic.

EGUS is one of the most common — and most under-diagnosed — conditions in equine medicine. The signs are non-specific. The supplement market is enormous. The actual gold standard is straightforward: scope, treat with omeprazole, manage the inputs that caused the problem in the first place. Mineral testing fits as a peripheral input, not a substitute.

60–90%prevalence in performance horses
Endoscopythe only real diagnostic
Omeprazolethe proven treatment
01 — What It Is

The horse stomach has two distinct regions — and two distinct ulcer types

Equine Gastric Ulcer Syndrome (EGUS) is the umbrella term for ulceration of the stomach lining. The horse stomach is unusual: it has two anatomically and biologically different mucosal regions that react differently to acid, food, and stress. The ulcers in each region — ESGD and EGGD — have different causes, different risk factors, and different treatment timelines.

ESOPHAGUS food & saliva enter MARGO PLICATUS dividing line PYLORUS → small intestine SQUAMOUS MUCOSA non-glandular · upper third · ESGD ulcers GLANDULAR MUCOSA acid-producing · lower two-thirds · EGGD ulcers = common ulcer locations
ESGD
Equine Squamous Gastric Disease

Ulcers in the upper, non-glandular region — often from acid splash during exercise on an empty stomach. Most common type. Usually heals well with 28-day omeprazole + management.

EGGD
Equine Glandular Gastric Disease

Ulcers in the lower, acid-producing region — often associated with chronic stress, NSAID use, intensive training. Slower to heal; often requires sucralfate alongside longer omeprazole treatment.

02 — The Causes

What causes ulcers — and the smart workup order

Ulcers in horses are largely a management disease. The horse stomach evolved to graze 16+ hours a day, producing acid continuously. Modern management — meals, stalls, training, transport, NSAIDs — pulls horses away from that continuous-grazing model. The further away, the higher the ulcer risk.

Risk factors — count how many apply to your horse

In training or competition — exercise increases ulcer risk substantially
Stalled most of the day — limited movement, limited continuous grazing
Meal-fed (vs. free-choice forage) — gaps between meals = unbuffered acid
High-grain / high-starch diet — increases stomach acid production
NSAID use (Bute, Banamine) — directly damages glandular mucosa
Frequent transport — chronic stress driver
Social isolation — herd animals stressed by isolation
Recent change of environment, owner, or routine

If 4 or more apply to your horse and you've seen any behavioral or physical signs from the hero list, gastroscopy is warranted. Statistically, the answer is likely yes.

The smart diagnostic order

First

Gastroscopy

The only diagnostic that confirms ulcers and grades them. Done by your vet — horse fasted overnight, scope passed through nose to stomach.

Second

Treat with omeprazole

Proven treatment. Typically 28 days for ESGD, longer for EGGD. Sucralfate often added for glandular ulcers.

Third

Management changes

Continuous forage, less grain, reduced stress, careful NSAID use. Without these, ulcers recur regardless of treatment.

Fourth

Mineral & nutrition support

Hair analysis to identify Mg status, iron (chronic GI bleed indicator), heavy-metal contributors. One peripheral input.

Critical Point

No blood test, fecal test, or hair test diagnoses ulcers. Endoscopy is the only answer.

Many supplements and tests are marketed for "ulcer assessment" or "ulcer management" without diagnostic proof. The literature is clear: gastroscopy is the only validated method to confirm and grade ulcers. Skipping the scope and treating empirically wastes time and money in roughly the same proportion as treating the wrong type of ulcer.

Get the mineral piece of the workup

$49.99 kit. ICP-MS analysis. Magnesium, iron, calcium, full heavy-metal panel.

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03 — What You Learn

What the test does — and explicitly does not — tell you

Hair mineral analysis is a peripheral input in an ulcer workup. It does not diagnose ulcers. What it can do is identify mineral status that supports stress management, flag iron status as a possible chronic-bleed indicator, and rule out heavy-metal exposure that may be adding inflammatory load.

TierWhat It MeasuresWhy It Matters For Ulcer Cases
Essential Minerals Magnesium, Calcium, Iron, Selenium, Sodium, Potassium, Phosphorus, Sulfur, Copper, Zinc, Manganese, Cobalt, Chromium, Boron, Molybdenum Mg supports stress regulation. Iron status may flag chronic GI bleed (low) or supplementation issues (high). Calcium status informs buffer support choices.
Mineral Ratios Calcium/Magnesium, Sodium/Potassium, Iron/Copper, Zinc/Copper, Calcium/Phosphorus, Sodium/Magnesium, Calcium/Potassium The Ca/Mg ratio is the calming/stress ratio. Fe/Cu reveals iron overload status. These influence the support program around — not instead of — ulcer treatment.
Toxic Heavy Metals Lead, Mercury, Arsenic, Cadmium, Aluminum, Antimony, Beryllium, Uranium Chronic exposure adds inflammatory load that may worsen GI mucosal vulnerability. Ruling exposure in or out removes a variable.

What the test does NOT do

Be honest with yourself about the limits — they matter:

Where it does help

Important framing: Hair mineral analysis is a wellness and nutrition assessment tool. It does not diagnose ulcers, EGUS, ESGD, or EGGD. For a horse with suspected ulcers, gastroscopy by a veterinarian is the only validated diagnostic. Treatment requires omeprazole and management changes — supplements and mineral testing are supportive only.
04 — How It Works

The mineral test process — start to answers

Four steps. About a week of total elapsed time. Run in parallel with — never in place of — the gastroscopy your vet should perform.

1

Order your kit

Order the $49.99 hair & mineral analysis kit from Mane Metrics. Resealable bag, pre-labeled return envelope, plain instructions.

2 business days to arrive
2

Collect & ship

Snip about 1.5 inches of mane hair close to the crest. Total time at the barn: under 5 minutes. Drop the sealed envelope in any mailbox.

~5 minutes
3

Lab analysis

Partner laboratory runs ICP-MS analysis across 42+ elements — including the calming-mineral panel and the heavy-metal panel.

5–7 days at the lab
4

Get your answers

Email-delivered report with color-coded findings, plus a follow-up phone consultation focused on the mineral picture and what to bring to your vet.

Email + voice debrief

Note for ulcer workups

List "ulcers suspected" or "EGUS workup" as your main concern at checkout. The lab interpretation focuses on magnesium, the Ca/Mg ratio, iron status, and heavy metals when they know that's the investigation. Bring your gastroscopy results (when available), current diet, work program, and any medications to the follow-up consultation.

05 — Timeline

The full ulcer workup timeline — vet, treatment, mineral, parallel

The mineral test is one of three things you should be doing at the same time. Run them in parallel — the gastroscopy is urgent if signs warrant.

WhenWhat's happeningWhat you do
Day 0Decide on a real workupSchedule gastroscopy with your vet. Order mineral kit. Note current diet, meds, and signs.
Day 1–2Mineral kit shipsWatch your mailbox.
Day 2–3Collect mane sample~1.5 inches of mane near the crest. Seal and mail.
Within 1–2 weeksGastroscopy performedVet visit. Horse fasted overnight. Scope confirms or rules out ulcers, grades severity 0-4, identifies ESGD vs EGGD.
Day 9–12Mineral panel results deliveredRead the report. Schedule the voice debrief.
Day 14+Treatment starts (if ulcers confirmed)Omeprazole 28 days for ESGD; longer for EGGD often with sucralfate. Begin management changes immediately.
Week 4–6Re-scope to verify healingConfirms treatment success or identifies need for extension.
OngoingMaintenance managementContinuous forage, low-grain diet, stress reduction, careful NSAID use. The hardest part — and the most important.

The honest truth: ulcers recur in horses whose management hasn't changed. A 28-day omeprazole course does nothing if the horse goes back to four hours of empty stomach between meals, no turnout, and stressful training. The medication treats today's ulcers. The management decides whether tomorrow's appear.

I'm ready to learn what is really happening to my horse

Order the kit now. We'll handle the rest. Questions? Call (972) 284-1878.

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06 — The Research

What the science says about EGUS

EGUS is one of the better-studied conditions in equine medicine. The diagnosis pathway, treatment protocols, and management strategies all have substantial peer-reviewed support. Here are the references worth knowing.

  1. Gastric Ulcers in Horses Merck Veterinary Manual. Comprehensive clinical reference covering ESGD and EGGD pathophysiology, diagnosis (gastroscopy as gold standard), treatment with omeprazole and sucralfate, and the management protocols that prevent recurrence.
  2. European College of Equine Internal Medicine — Consensus Statement on Equine Gastric Ulcer Syndrome — The current consensus document on EGUS classification, diagnosis, treatment, and management. The reference text for evidence-based ulcer care in 2026.
  3. GastroGard (omeprazole) Prescribing Information — Boehringer Ingelheim. The FDA-approved omeprazole product for equine ulcer treatment. Dosing, treatment duration, and re-scope recommendations.
  4. Kentucky Equine Research — Equine Gastric Ulcer Syndrome — Practitioner-focused review of EGUS prevalence, risk factors, current treatment standards, and the limited role of supplements in active disease.
  5. Evaluation of hair analysis for trace mineral status and exposure to toxic heavy metals in horses Animals (Basel), 2022. Open-access study supporting hair as a useful biological indicator for both essential mineral status and heavy-metal exposure — relevant inputs to a complete management plan.
  6. Brummer-Holder M., et al. Interrelationships Between Age and Trace Element Concentration in Horse Mane Hair and Whole Blood Journal of Equine Veterinary Science, 2020. Foundational paper supporting hair tissue as a stable substrate for mineral status assessment.
  7. Emerging insights into the impacts of heavy metals exposure on health, reproductive and productive performance of livestock Frontiers in Pharmacology, 2024. Documents inflammatory effects of chronic heavy metal exposure that can compound GI mucosal stress.
Honest framing: The science on EGUS diagnosis and treatment is well established. Gastroscopy is the validated diagnostic. Omeprazole is the validated treatment. Management is the validated prevention. Hair mineral analysis is a peripheral input that supports the stress and inflammatory side of management — never a substitute for vet diagnosis or pharmacological treatment.
07 — FAQ

Frequently asked questions about ulcers in horses

The questions horse owners and trainers ask most often before they finally schedule the scope.

How common are ulcers in horses?

Equine gastric ulcers are extraordinarily common. Published prevalence in racehorses is up to 90%. Performance horses (eventing, dressage, show jumping) commonly run 60-80% prevalence. Even pleasure horses see prevalence around 30-40%. If your horse is in any kind of work, lives in a stall, eats meals (rather than free-choice forage), or shows behavioral signs, ulcers are statistically likely and warrant a real workup.

What are the signs of ulcers in horses?

Common signs include girthiness when tacking up, irritability under saddle, decreased appetite or picky eating, weight loss or poor body condition, recurrent mild colic, dull coat, decreased performance, behavioral change, and increased cribbing or wood chewing. The signs are non-specific and overlap with many other conditions — which is why definitive diagnosis requires endoscopy, not symptom-watching.

How are ulcers in horses diagnosed?

The only definitive diagnostic for equine gastric ulcers is gastroscopy (endoscopy of the stomach). A flexible endoscope is passed through the nose into the stomach to visualize the lining directly. The horse must be fasted overnight. Both the squamous (upper) and glandular (lower) regions are examined and any ulcers are graded 0-4. No blood test, no fecal test, and no hair test diagnoses ulcers. Endoscopy is the only answer.

What is the difference between ESGD and EGGD?

ESGD (Equine Squamous Gastric Disease) is ulceration of the upper, non-glandular portion of the stomach — the most common type, often related to splash from acidic stomach contents during exercise on an empty stomach. EGGD (Equine Glandular Gastric Disease) is ulceration of the lower, acid-producing portion of the stomach — slower to heal, often associated with stress, NSAID use, and intensive training. The two types respond differently to treatment, which is why endoscopic diagnosis matters.

What is the treatment for ulcers in horses?

Omeprazole (commercially GastroGard) is the proven first-line treatment for equine gastric ulcers, typically dosed once daily for 28 days for ESGD and longer for EGGD. Sucralfate is often added for EGGD cases. Management changes are essential alongside medication: continuous forage access, reduced stress, careful NSAID use, and elimination of high-grain meals. Supplements (calcium-based buffers, gut support products) are supportive at best — they do not replace omeprazole for active ulcers.

Can a hair mineral analysis diagnose ulcers in horses?

No. Hair mineral analysis cannot diagnose ulcers, EGUS, ESGD, or EGGD. Those diagnoses require gastroscopy by your veterinarian. What hair analysis can do is measure mineral status (magnesium for stress support, iron for chronic GI bleed indicators, calcium for buffer balance) and rule out heavy-metal exposure that may be adding inflammatory load. The honest framing: hair analysis is a peripheral input alongside the endoscopy + omeprazole + management protocol — never a substitute for it.

How can I prevent ulcers in my horse?

Preventive management is well established: provide continuous access to forage (the horse stomach produces acid 24/7 and needs forage to buffer it), eliminate or minimize grain meals (use lower-starch alternatives), reduce training and transport stress, use NSAIDs only when necessary and at appropriate doses, ensure adequate water access, allow turnout and social contact, and feed a small forage meal before exercise. None of these guarantee ulcer prevention but they substantially reduce risk.

How quickly can a hair test reveal mineral status in a horse with suspected ulcers?

Approximately 9-12 calendar days from order to results: 2 days for kit shipping, 5 minutes to collect, 5-7 days at the lab. You receive an emailed report plus a follow-up phone consultation. The mineral test runs in parallel with — never in place of — the gastroscopy your vet should perform if ulcers are suspected.

Other guides in the Mane Metrics network

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