What is Equine Gastric Ulcer Syndrome?

Gastric Ulcers, otherwise known as Equine Gastric Ulcer Syndrome (EGUS), are lesions in the horse’s stomach. They are most commonly caused when gastric acid, produced in the lower glandular part of the stomach and a vital part of the digestive system (as it acts to break down the food material at the start of digestion), comes into contact with the lining of the upper squamous part of the stomach for too long a period.

Present in as many as 90% of racehorses, 70% of competition horses, and 30% of horses at grass, EGUS is a widespread condition. There are a range of signs and symptoms, seen frequently by our Claims Team, including:

• Change of attitude
• Change of behaviour (when ridden and in the stable)
• Weight loss
• Dullness
• Resistance to girthing
• Poor appetite
• Colic signs

What causes EGUS?

Gastric Ulcers can be brought on as a result of a horse experiencing:

• Periods of time without food
• Periods of starvation
• High grain/low forage diets
• Stress
• Certain medications

As we have domesticated horses, we have typically altered their diet so that they have more energy for work, which inevitably means more hard feed (grains to provide carbohydrates) and less forage. We have changed their exercise patterns from a steady, day long amble to short periods of intensive activity and long periods of standing in a stable. When the horse is worked on an empty or near empty stomach the acid is splashed upwards and eventually will erode the stomach lining.

Stress during periods of competition and travelling can cause reduction in appetite which can compound the problem, and stress itself can indirectly increase acid formation.

How to prevent EGUS

Most effective ways of preventing gastric ulcers in horses relate to their management and their feed. Improvements that can be made to these practices include:

• Increasing forage intake
• Increasing time spent turned out (and consequently, access to grazing)
• Feeding a scoop of chaff 30 minutes before riding. This will help to soak up any excess stomach acid, reducing the risk of this splashing during exercise and causing ulcers.
• Splitting hard feeds into smaller meals fed more frequently (3 – 5 meals per day)

We’ve teamed up with Saracen Horse Feeds to offer some further detail when it comes to feeding for preventing EGUS:

Forage Intake

When feeding to reduce the risk of EGUS the first part of the diet to consider is the forage portion. This is not exclusive just to horses with EGUS or those with an increased risk of EGUS but should be the first and most important part of all horses’ diets.

If your horse’s calorie requirements allow, feeding forage on an ad-lib basis is the most ideal scenario, however if a calorie restricted diet is required, then absolutely no less than 1.5% of the horse’s ideal bodyweight needs to be provided in forage per 24-hour period.

Forage can take the form of hay, haylage, grazing and even chaff, high fibre cubes and sugar beet. The last three are particularly helpful, when trying to manage a horse with dental issues as these can be offered as a ‘forage replacer’ ration ensuring forage intakes are met.

Consider their hard feed

After looking at your horses’ forage intake, you can then consider their hard feed. Knowing how to read a feed label can come in handy when choosing the right feed for your horse but calling a nutritional helpline of a feed manufacture can also provide invaluable information in relation to your horses’ diet. Reducing the starch and sugar content of your horses feed is the next step and this can easily be done by reducing or removing the cereal component of the diet. Cereals provide a high level of starch, and this is not to say that starch or cereals are a bad thing, but for horses with ulcers, these should be avoided where possible.

When looking at a feed label (the white tag stitched into the bag) you want to look for fibre ingredients to be at the start of the ingredients (composition) list. Ingredients lists go in descending order of inclusion, so the first ingredient is the one included in the highest quantity. Looking for ingredients like dried (sugar) beet pulp, lucerne, soya hulls, oatfeed, wheatfeed and high temperature dried grass will indicate that the feed has a high fibre level. This can be confirmed by the Crude Fibre percentage which will also be listed on the label. Try to avoid feeds that contain ingredients such as wheat, oats, barley, or maize especially if they are within the first four ingredients listed. Starch and sugar are not legally required to be included in the feed label so knowing what to look out for can be beneficial when choosing a feed.

The BETA EGUS approval mark can also help you to make an informed choice as this accreditation is only awarded to feeds that meet a strict criterion which makes the feed suitable for horses with an increased risk of ulcers.

When feeding to reduce the risk of ulcers, it is recommended to keep starch and sugar levels below 1g/KG body weight per meal and 2g/KG body weight per day. For a 500KG horse this equates to 500g of starch and sugar per meal and 1000g (1KG) of starch and sugar per day.

Looking at feed manufacturers websites or calling their helplines can provide further information on things like starch and sugar content and there is a good equation for working out how much your horses diet provides.

(Quantity of feed fed / 100) X combined starch and sugar percentage of chosen feed

For example, 1KG of Re-Leve has a combined starch and sugar content of 14% so the equation would be:

1000g (1KG)/ 100 = 10

10 x 14 = 140.

1KG of RE-LEVE® provides 140g of starch and sugar making it a suitable meal for a 500kg horse. If the daily feeding rate is 2KG, just double the 140g which gives 280g meaning that this feed is still suitable to be fed at the recommended intake on a daily basis to a 500kg horse.

What insurance is there for EGUS?

As with all conditions, as long as the horse has not had any issues with ulcers previously, EGUS can be claimed for under the veterinary fee section of your horse insurance policy. Depending on the age and value of your horse, plus the activities you use him for, there are up to 8 different vet fee insurance options that cover gastric ulcers. With a range of incident limits and excess options available, there’s a policy to suit you and your horse.

At KBIS, the 15 month claim period on Leisure and Competition policies, allows you longer to claim when you need it most.

Can you ride a horse with EGUS?

In line with your vet’s advice, yes you can ride a horse with gastric ulcers alongside a treatment plan.

What to feed if your horse has EGUS?

If your horse has EGUS, look for feeds that display the BETA EGUS approval mark as these will help you to pick a suitable feed. Feeds such as RE-LEVE MIX®, RE-LEVE CUBES® and COMPETITION FIT BALANCER all display this logo but any high fibre, low starch feed is suitable. It is still important to remember your horse’s calorie requirements when feeding for gastric ulcers so ensure that the feed you pick is suitable for the level of work your horse is doing. It is also important to consider their calorie requirements as picking the wrong feed could lead to obesity issues, or an imbalanced diet being fed. Just because a feed doesn’t display the BETA EGUS mark doesn’t mean it isn’t suitable to be fed to a horse with ulcers such feeds as SUPER FIBRE CUBES, SHAPE UP and ESSENTIAL BALANCER don’t carry the logo but are all cereal free feeds with a high fibre content and low starch level. This means that they are also suitable but are lower in calories when compared to RE-LEVE® so are better suited to good doers.

Again, its important to look at your horses’ forage intake, ideally ad-lib is the best way to feed but some horses with ulcers become fussy with their forage. In these cases, feeding a cafeteria style buffet can help to increase fibre intake whilst also extending eating times. Alternative forage sources such as chaff, dried grass, fibre cubes or grass nuts can be offered in buckets alongside the horse’s normal hay or haylage ration. This helps to encourage the horse to exhibit their natural browsing behaviours and helps to avoid forage related satiety.

Gastric supplements that offer a buffering action against the stomach acid can also help to support optimal pH in the stomach. Feeds that contain pre-biotics or live yeasts along with prebiotic or yeast supplements can help to support hindgut health.

There is some debate around feeding oil to horses with ulcers and what type of oil is best and its effectiveness. Saracen tend to recommend 40ml of corn oil twice a day to help prevent glandular ulceration through supporting the mucosal layer of the stomach.

Feeding a scoop of chaff 30 minutes before riding is also a great idea as this helps to absorb excess stomach acid which could splash onto the sensitive squamous region of the stomach, causing ulceration. Feeding an alfalfa chaff will provide extra benefits in the form of calcium which is a natural buffer to the stomach acid and the act of chewing encourages salvia production which further buffers stomach acid through the bicarbonate which is naturally found in saliva.

What to feed whilst your horse is recovering from EGUS?

Feeding your horse whilst they are recovering from EGUS is very similar to the way they should be fed to prevent EGUS and also whilst they are being treated for EGUS. If your horse has lost weight due to suffering from ulcers, a higher calorie diet may be required to help encourage weight gain and the use of a supplement such as Equi-Jewel could be beneficial. This will help to add a concentrated source of calories whilst ensuring meal sizes remain small.

Your horse may also have backed off their forage so employing a cafeteria style of feeding could help to encourage them to eat more forage. Maybe consider the way the forage is presented as well, if they are finding it hard work to eat from a hay net, could you feed from the floor? Equally, if they are eating their forage very quickly, could you find a way to slow down intake, increasing eating time such as using a hay net with smaller holes or a slow feeder so that there aren’t periods of time when no forage is available.

If your horse has become fussy with their hard feed prior to EGUS diagnosis or during treatment, this will likely resolve when they are feeling more comfortable. However, palatable feeds such as RE-COVERY MASH can be added to their feed to help encourage them to tuck in better. RE-COVERY MASH is also ideal for hiding medication and as a high fibre mash. It helps to support optimal hydration status which reduces the risk of ulcers as dehydration has been identified as a risk factor in the development of EGUS.

How to make a claim for EGUS?

The average claim paid by KBIS in 2021 for gastric ulcers was in excess of £2,000 for Leisure and Competition horses.

Gastric ulceration is a common condition suffered by horses and will need to be diagnosed by gastroscopy at grade 2 or above in order to meet Underwriters terms and a claim to be assessed and then paid. This enables premiums to remain lower, benefitting all policyholders.

The process of making a claim for gastric ulcers with KBIS is made simple:

1. Notify KBIS
2. Obtain a claim form (available to complete online or to download. Our team are also happy to post a copy out to you if required)
3. Collate all the necessary info – your claim form will specify what additional documents/information are required
4. Send everything in – sending everything in together also means your claim is assessed as promptly as possible

Feed Facts

• Oatfeed is a high fibre ingredient which not only supports hindgut health, but oatfeed is also a great source of beta glucans which has a protective effect on gut membranes.
• Corn oil may reduce gastric output if supplemented daily, helping to support a healthy stomach environment.
• Horses listening to talk shows / talking radio were found to have a higher prevalence of EGUS, suggesting that this may cause stress.
• Saliva contains bicarbonate which is a natural buffer to the stomach acid. Increasing saliva production by encouraging chewing (feeding lots of fibre) will help to prevent EGUS.
• Feeding a scoop of chaff 30 minutes before riding will help to soak up any excess stomach acid, reducing the risk of ulcers occurring.
• You can work out the starch and sugar provided by your horses feed by dividing the daily quantity of feed in grams (e.g., 2K = 2000g) by 100 and multiplying that by the combined sugar and starch content of their hard feed.