Differences between Squamous and Glandular Ulcers in Horses

Differences between Squamous and Glandular Ulcers in Horses

What are the Differences between Squamous

and Glandular Ulcers in Horses?

Equine gastric ulcers can affect up to 93% of horses. Ulcers are painful lesions that form in the lining of the gastrointestinal tract that can result in impaired nutrient absorption, discomfort, digestive complications, and result in poor performance in your horse.

Traditionally, veterinarians and horse owners treated and managed all gastric ulcers the same way. However, their etiology and physiology differ depending on the region of the stomach in which they appear. STRUCTURE can aid in the healing of both types of ulcers, and help protect and prevent future ulcers for your horse.

Let’s talk about the two types of Gastric Ulcers, the differences, the causes, signs and treatments.

The first type of ulcers are Squamous Gastric Ulcers (ESGD) - these occur in the upper, unprotected portion of the stomach, which is not protected by mucus, this area is highly sensitive to damaging stomach acid.  Gastric ulcers are sores or lesions in the lining of the stomach. They are one of the most diagnosed health conditions in horses. Up to 80% of equine ulcers are generally found in the squamous or upper region of the stomach. 

Common Causes

  • Fasting or inconsistent feeding
  • High-Grain or High-Concentrate Diets
  • Intense exercise (acid splashes upward)
  • Stress (travel, competition, stall confinement)
  • Inconsistent Feeding Schedules
  • Limited Access to Hay or Pasture
  • Social Stress

Typical Signs

  • Girthiness
  • Feeding and appetite changes
  • Weight loss
  • Behaviour changes
  • Reduced performance
  • General discomfort

Then there is the second type of ulcers, Glandular Gastric Ulcers (EGGD) - these occur in the lower portion of the stomach, which normally has strong natural protection. Ulcers here are linked more to impaired mucosal defence than excess acid. Compared to squamous ulcers, much less is known about EGGUS and the pathophysiology of this disease. The glandular region comprises the bottom two-thirds of the stomach. This region is where acid secretion takes place.

Common Causes

  • Stress and elevated cortisol
  • NSAID overuse
  • Compromised blood flow to the stomach lining
  • Compromised Mucosal Defence
  • High-Intensity Training
  • Bacterial or Microbial Factors
  • Management and Environmental Stress
  • Chronic inflammation

Typical Signs

  • Similar to ESGD, but often more subtle
  • Poor response to standard ulcer treatments
  • Reluctance to go forward under saddle

Key Differences at a Glance

Equine ulcers are extremely common, with the prevalence being much higher for ESGD compared to EGGD. This largely depends on lifestyle, diet, and environmental factors. It varies considerably between squamous and glandular ulcers.

The key Differences are that ESGD is caused by acid exposure and that EGGD is caused by impaired protection, stress, and inflammation.

Squamous ulcers (ESGD) seem to appear the highest in racing and performance horses. Specifically, Thoroughbred racehorses have the highest prevalence. Although there is limited research on the prevalence of EGGD, up to 65% of Thoroughbred racehorses may be affected by EGGD. 

Gastric ulceration is one of the most prevalent health conditions affecting horses. While the number of squamous region ulcers are up to 93% for some groups of the equine population, glandular ulcers are lower, affecting up to 65% of competing horses.

Risk Factors for ESGD and EGGD

Current research on risk factors for equine ulcers tends to focus on EGUD as a whole, but new findings show there are clear differences between the risk profiles for ESGD and EGGD.

The risk of squamous ulcers is related to increased exposure to damaging acids along the stomach lining.

The development of glandular ulcers involves impaired defense mechanisms such that the protective barrier of the stomach is weakened.

Risk Factors for Squamous Ulcers

Common risk factors for ESGD include:

  • High-intensity training
  • High grain or concentrate diets

·         Fasting or long periods without forage

·         Limited turnout

  • Changes to the social environment
  • Lack of routine
  • Travel and competition

Risk Factors for Glandular Ulcers

Risk factors for EGGD include factors that weaken or lessen the integrity of the protective functions in the glandular region.

  • Overuse of non-steroidal anti-inflammatory drugs (NSAIDs)
  • Limited turnout
  • Short, intense exercise
  • Breed (example - Warmblood)
  • Possible microbial factors
  • Low hay intake
  • High unprocessed grain intake
  • Feeding an incomplete or unbalanced diet

 

Diet, feeding regimens, and excessive exercise create greater risks for squamous ulcers, while stress and NSAID use are more likely to contribute to glandular ulcers.

Diagnosing Gastric Ulcers

A veterinarian can perform a gastroscopic exam for a clear diagnosis.  This is a routine procedure, under sedation and after fasting, through your horse’s nostril, down the esophagus, and into their stomach. This allows your vet to assess the number and severity of ulcers present, and determine which area is affected.

Gastroscopy is the only definitive way to diagnose gastric ulcers, and due to the high prevalence of ulcers.

Grading Squamous Ulcers

At present, there is only a standardized grading system available for squamous ulcers.

Glandular ulcers should be accompanied by a detailed description, number of lesions, their distribution and appearance, as well as subjectivity of their severity degree.

GRADE

SQUAMOUS Ulcers

0

Epithelium is intact. No appearance of hyperkeratosis (thickening of the mucosa).

1

Mucosa is intact. Areas of hyperkeratosis.

2

Small, single, or multifocal superficial lesions (less than 5)

3

Large, single deep, or multifocal superficial lesions (greater than 5)

4

Extensive lesions. Areas of apparent deep ulceration.

 

Signs and Symptoms of ESGD and EGGD

Even though there are many differences between ESGD and EGGD, the signs and symptoms can be relatively the same. However, it is important to note that all horses may present symptoms differently when it comes to gastric ulcers – some may be more stoic while others may express their discomfort more outwardly.

Horses exhibiting any of the following signs and / or symptoms you should contact your veterinarian:

  • Poor appetite or picky eating
  • Chronic diarrhea
  • Weight loss and  /or poor body condition, including hair and / or coat condition
  • Stretching to urinate
  • Increased aggression or irritability
  • Poor performance or behavior changes under saddle
  • Recurrent colic
  • Behavioural changes (and example is anxiety)
  • Sensitivity in the girth area (girthiness)
  • Cribbing, teeth grinding, and other stereotypical behaviours
  • Excessive salivation
  • Excessive recumbency (lying down)

Treatment of ESGD and EGGD

After a diagnosis, your veterinarian will develop the best treatment plan for your horse. Including changes in your horse’s feeding and management.

Lifestyle Strategies

Simple lifestyle changes in your horse’s daily routine can naturally aid and reduce their ulcer risk.

  • Avoid intermittent feeding
  • Provide constant access to water
  • Increase turnout
  • Reduce grain consumption
  • Increase haylage and hay quality
  • Minimize NSAID use
  • Provide your horse with a suitable social group

Feeding Strategies

Protein-rich alfalfa hay is one of the hays that has shown to reduce ulcer risk, supplemental oils to reduce grain consumption may also decrease risk factors for ulcers and several gut problems.  In addition to adding 1 – 2 ounces of salt per day to your horse’s ration, which encourages water intake, promoting the transit of food through the gastrointestinal tract.

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