25 years of gastric research - what do we know now that we didn’t at the turn of the century?

The first fundamental shift in our understanding is that gastric disease is a more accurate umbrella term than gastric ulcers. We now know there are two distinct diseases which affect different areas of the stomach: Equine Squamous Gastric Disease (ESGD) and Equine Glandular Gastric Disease (EGGD)

Less is known about the causes of EGGD but researchers describe it as an inflammatory disease rather than an ulcerative one which is why gastric ulcers is really an outdated term. This distinction is also the reason that whilst a grading system exists to define the severity of ESGD (Table 1), EGGD is not assessed in the same way. In fact, a recent study showed a grading system for EGGD had little value due to significant differences in grading by veterinary professionals (Pratt et al, 2022). 

It was really studies in the early 2000s that started to investigate causes of gastric ulcers. The early studies associated ulcers with horses in training so it was largely considered a problem of racehorses. Primary squamous gastric disease occurred in response to factors often considered inherent in intensive management that result in prolonged exposure to acid in an animal with an otherwise normal gastrointestinal tract. Now, researchers are starting to show that some relatively straightforward changes to dietary management can significantly reduce the risk of ESGD without compromising performance.