Clinical approach to the EGGD case (2026)
For veterinary use only
By Dr Gayle Hallowell
MA VetMB CertVA DipACVIM PhD DipACVECC PFHEA FRCVS
July 2026
Equine glandular gastric disease (EGGD) remains one of the more frustrating gastric syndromes seen in practice because clinical signs are often non-specific, lesion significance can be difficult to judge from history alone, and treatment response is less predictable than with squamous disease. A practical approach starts with confirming the diagnosis by gastroscopy, then building a treatment and management plan that addresses the glandular lesions and the wider clinical picture.
When a horse presents with poor performance, behavioural change including resentment to girthing, intermittent colic and perhaps reduced appetite, gastric disease often moves quickly up the differential list. The challenge, of course, is that these signs are not specific, and they do not reliably distinguish equine glandular gastric disease from equine squamous gastric disease or from other painful or inflammatory conditions. That is why the most useful starting point for the suspected EGGD case is to think in terms of defined syndromes rather than a generic “ulcer” diagnosis.
When should EGGD be suspected?
Current understanding supports treating ESGD and EGGD as distinct syndromes, because the pathophysiology is different and the treatment response may differ too. ESGD is primarily associated with acid exposure of the squamous mucosa, whereas EGGD appears to reflect impairment of glandular mucosal defence and repair. In practice, that matters because the glandular case is often the one that feels less tidy: the history may be mixed, the response to empirical therapy may be incomplete, and the expected risk factors may not fully explain the presentation.
It is also increasingly useful to approach EGGD as part of a whole-horse problem rather than a stomach-only problem. In the horse with persistent or recurrent glandular lesions, co-morbidities such as dental disease, lameness-related pain and inflammatory bowel disease are worth considering as potential contributors to lesion development, ongoing clinical signs or delayed healing. For the clinician, this means asking not only “does this horse have EGGD?” but also “what else may be driving pain, stress, inflammation or treatment failure in this case?”
What is the best first step?
If EGGD is a genuine differential, diagnosis is by gastroscopy. It allows direct visualisation of the stomach, differentiation between squamous and glandular disease, and more rational treatment planning than empirical acid suppression alone. In recurrent, incomplete-responders or poor-performance cases, scoping early is often more efficient than treating presumptively, particularly when owners are trying to decide whether gastric disease is likely to be central to the case or incidental to it.
This is also the point at which the wider case review becomes important. Once glandular disease has been identified, the next question is not simply which drug to use, but whether there are other clinical factors likely to impair healing. A horse with unresolved lameness, chronic dental discomfort or suspected inflammatory bowel disease may not respond as well one with isolated gastric pathology, even when the treatment choice is appropriate.
Which treatments should be considered?
When glandular disease is diagnosed, the clinical conversation becomes more nuanced than it would be for straightforward ESGD, because EGGD cases may need a longer course, closer monitoring and a more flexible plan if the response is only partial. Effective treatment options include oral omeprazole or esomeprazole and sucralfate, long-acting injectable omeprazole and misoprostol. As this is a syndrome, one of these treatment options may be more effective than others, but we currently don’t have data to be able to identify which one that will be. Efficacy varies between studies and this likely reflects different lesions being treated in different clinical circumstances.
When should signs start to improve?
One of the most useful practical discussions to have with owners is about timing. If gastric pain is contributing to the presenting signs, it is reasonable to expect some clinical improvement within around 7 to 10 days of starting therapy. That improvement may be seen in appetite, demeanour, ridden behaviour, comfort when being girthed or a reduction in low-grade abdominal pain.
Importantly, early improvement should not be confused with lesion resolution. Clinical progress in the first week or so can help support the view that gastric disease is relevant to the case, but it does not remove the need for an adequate treatment course, appropriate follow-up and a critical review of any co-morbidities if progress stalls. Equally, if there is no meaningful improvement, it is worth reconsidering lesion significance, treatment choice, compliance, dosing and the possibility that the stomach is only one part of the problem.
The key clinical message is that EGGD cases are that medication is only part of its management. The best outcomes usually come from confirming the diagnosis, selecting a rational primary treatment plan, expecting some early change if the lesions are clinically relevant, and investigating the wider horse when healing is delayed or incomplete. If underlying disease or other risk factors are not addressed, clinical disease will return.
