Gastroduodenal disease in foals

Host:

Welcome to the Bova UK Podcast, where we discuss diseases from diagnosis through to management. These podcasts are intended for registered vets and veterinary nurses. If you’re listening as a pet owner, please consult your local veterinary surgeon if you have any concerns about your animal.

Today’s episode is all about gastroduodenal disease in foals. I’m joined by the wonderful Dr. Emily Floyd, Clinical Director at Rossdales Equine Hospital, who has a particular interest in equine neonatology. Welcome, Emily!

Dr. Emily Floyd:

Thank you very much – delighted to be here.

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Understanding the Disease

Host:

Let’s begin with how common gastric ulceration is in foals.

Dr. Emily Floyd:

Prevalence varies in the literature, but estimates suggest 20–50% of foals may have ulcers. We don’t scope foals nearly as often as adults, so we may be underestimating. Clinically significant cases are usually seen from 4 to 6 weeks of age, but even neonates a few days old have shown ulcers on post-mortem.

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Pathophysiology & Risk Factors

Host:

How does gastric physiology differ in foals compared to adults?

Dr. Emily Floyd:

Young foals (especially neonates) naturally have a higher gastric pH, around 4. This becomes more acidic over the first 1–2 weeks. Their mucosa is thinner, and their pH fluctuates with milk intake. As they age, their pH stabilises to adult-like levels.

Host:

What about prematurity—are premature foals more at risk?

Dr. Emily Floyd:

Yes. Premature foals often have impaired gastric function and an inability to acidify properly. So while acid isn’t necessarily the enemy in these cases, the lack of acid can be a sign of systemic compromise.

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Perfusion & Pathogenesis

Host:

How significant is gastric perfusion in these cases?

Dr. Emily Floyd:

Very significant. Poor perfusion is likely a major driver of gastroduodenal disease in foals. It’s not just about acid—if a foal is septic or hypoperfused, they’re at high risk of ulceration and GI dysfunction.

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Risk Factors & Clinical Signs

Host:

Could you run us through risk factors for squamous and glandular disease?

Dr. Emily Floyd:

In neonates:
Key risks: poor perfusion, inadequate milk intake
In older foals (2+ months):
Key risks: stress (e.g. weaning), concurrent GI disease (like diarrhoea), overuse of NSAIDs

Host:

And what are the common clinical signs?

Dr. Emily Floyd:

Often vague: mild ill-thrift, poor coat, dull demeanour. Classical signs like bruxism and salivation are only seen in advanced cases. Severe cases (e.g. duodenal disease or outflow obstruction) may show inappetence, colic, and reflux.

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Diagnostics

Host:

How do you typically diagnose?

Dr. Emily Floyd:

Gastroscopy remains the gold standard, even in foals. Sedation and fasting protocols differ by age, but it’s entirely feasible.

• <1 week: Fast for 2 hours
• 2–3 months: Fast 6 hours
• 6 months: 8–12 hours

Ultrasound can also be helpful—especially to visualise delayed gastric emptying and duodenal wall thickening.

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Treatment Strategies

Host:

What does treatment look like?

Dr. Emily Floyd:

It depends on age:

• Neonates (first week): Avoid acid suppressants. Prioritise perfusion and milk intake.
• Older foals: Oral omeprazole is safe and effective. Add sucralfate or misoprostol for glandular disease or if NSAIDs are involved.

Host:

Would you use injectable omeprazole or esomeprazole?

Dr. Emily Floyd:

Yes, especially in foals with delayed gastric emptying or when oral bioavailability is a concern. I’ve found injectable omeprazole clinically helpful.

Host:

And what about misoprostol?

Dr. Emily Floyd:

Useful in suspected glandular disease or NSAID-induced damage. Also has mucosal-protective effects.

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Surgical Cases & Treatment Failures

Host:

When might medical therapy fail?

Dr. Emily Floyd:

Two key situations:

• Duodenal strictures – may require bypass surgery (approx. 50% success rate)
• Poor responders to omeprazole – might need to trial injectables, misoprostol, or combination therapy
  Some foals still rupture despite prophylaxis, which is a frustrating reality.

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Prevention

Host:

How can vets help prevent gastric disease in foals?

Dr. Emily Floyd:

• Neonates: Focus on normal bonding, milk intake, and early disease recognition
• Older foals: Manage stress, avoid excess concentrates, minimise NSAID use
• High-risk foals (e.g. with diarrhoea or NSAIDs): Prophylactic omeprazole can be considered
  My preference for NSAIDs is meloxicam, as phenylbutazone is more ulcerogenic.

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Take-Home Messages

Host:

Could you summarise your key take-home points?

Dr. Emily Floyd:

• Don’t rush into acid suppression in neonates—focus on perfusion and milk intake
• Omeprazole is a safe and effective first-line for older foals
• Use ultrasound as a helpful non-invasive diagnostic tool
• Identify high-risk foals early and intervene accordingly
• Be cautious with NSAIDs; meloxicam is a safer option
• Recognise that not all cases respond to treatment—some may need surgery

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Host:

Fantastic insights, Emily. That’s been an incredibly useful discussion, especially as foaling season begins. Thank you so much for joining us.

Dr. Emily Floyd:

Thank you very much for having me!

Host (Outro):

These podcasts are aimed at registered vets and veterinary nurses. If you’re listening as a pet owner, please consult with your local veterinary surgeon if you have any concerns about your animal.