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Background Equine gastric ulcer syndrome (EGUS) adversely affects the health, welfare, and performance of sports horses, requiring gastroscopy for definitive diagnosis. Owners frequently consider girth aversion as highly suggestive of EGUS. Objectives To evaluate whether owner‐reported clinical signs or fecal occult blood tests (FOBTs) can help identify horses needing gastroscopy for EGUS diagnosis or monitoring treatment, thereby reducing unnecessary procedures in unaffected horses. Animals Eighty competition dressage horses referred by veterinarians for EGUS evaluation. Methods Case–control study including questionnaire, clinical examination, gastroscopy, and FOBT. Based on gastroscopic findings, horses were classified as cases (presenting equine squamous gastric disease, equine glandular gastric disease, or both) or controls (no lesions). Nineteen horses underwent a follow‐up examination after EGUS treatment. Predictive values of clinical signs and fecal hemoglobin were assessed using the Wilson–Brown method, and group differences were analyzed using Mann–Whitney and Fisher's exact tests. Results Fifty‐five horses (69%) had EGUS. The most commonly reported clinical signs in this cohort included girth aversion (78%), poor performance (33%), and weight loss (30%), with no differences between groups (p = 0.44–0.99). Neither clinical signs nor FOBT had sufficient sensitivity or specificity for EGUS screening. Among the 19 horses reevaluated after treatment, resolution of clinical signs did not reliably predict mucosal healing, with poor agreement between owner‐reported clinical response and gastroscopic outcome. Conclusions and Clinical Importance In competition dressage horses, owner‐reported clinical signs and FOBT results are unreliable predictors of EGUS or treatment outcomes. Gastroscopy remains essential for accurately diagnosing and monitoring EGUS in sports horses.

Background The relationships among gastric lymphoid follicular hyperplasia (GLFH), Helicobacter‐like organisms (HLOs), and clinical signs have not been established in dogs. Objectives To evaluate the epidemiologic, clinical, endoscopic, and histopathologic findings associated with GLFH in dogs, and determine the association of GLFH with HLOs and the French Bulldog (FB) breed. Animals Two hundred eighty‐eight dogs that underwent gastroscopy between 2013 and 2016. Methods Retrospective, cross‐sectional study. Gastric biopsy samples were reviewed and scored for inflammation and HLOs. Dogs were divided into 3 groups: group 1 (63 FBs), group 2 (45 non‐FB brachycephalic dogs), and group 3 (180 nonbrachycephalic dogs). Variables were evaluated for their association with GLFH. Results Univariate analysis determined that intact males, young age, vomiting, gastroscopic findings (discoloration, hemorrhage, and ulcers), and histopathologic findings (gastric lamina propria lymphocytic infiltration and HLO score) were associated with GLFH (P ≤ .03). In the multivariate analysis, GLFH was associated with the HLO score (odds ratio [OR] > 5 for HLO scores 1‐2 and >15 for HLO score of 3; P < .001), with vomiting (OR > 4; P = .01) but not with FB breed (P = .76) and age (P = .1). The HLO score was associated with younger age (P < .001). Conclusion and Clinical Importance The HLO score was associated with a high GLFH score. Vomiting was associated with GLFH. Helicobacter‐like organisms are highly prevalent in young dogs and GLFH is indirectly associated with this factor. Clinical relevance of the identification of GLFH and HLO remains to be determined.

Background Current methods to measure intragastric pH in horses have limitations. A wireless capsule has been designed for continuous esophageal pH monitoring in humans. Objectives To (1) determine the feasibility and describe the methodology of measuring intragastric pH wirelessly in horses; and (2) determine attachment duration of the capsules. Animals Eleven healthy adult horses. Methods Capsules were attached to squamous and glandular gastric mucosa under gastroscopic guidance, using suture loops and 1 to 4 hemostasis clips. pH was continuously recorded using a wireless recorder in both fed and fasted states. Gastroscopy was performed daily to assess capsule attachment and any mucosal damage. Data were analyzed using commercially available software. Values are reported as median (interquartile range). Results Capsules were successfully placed and data obtained in squamous (n = 11) and glandular (n = 7) regions. The overall duration of squamous capsule attachment was 27 hours (15‐32); 1 clip (n = 4) was 15 hours (11‐20), 2 clips (n = 2) was 20 hours (16‐23), 3 clips (n = 4) was 32 hours (30‐32), and 4 clips (n = 1) was 33 hours. The overall duration of glandular capsule attachment was 10 hours (8‐21); 1 clip (n = 2) was 11 hours (10‐13), 2 clips (n = 2) was 19 hours (14‐23), 3 clips (n = 2) was 7 hours (7‐8), and 4 clips (n = 1) was 158 hours. There was no substantial damage to the gastric mucosa as a consequence of attachment. Conclusions and Clinical Importance This novel technique enables the wireless measurement of intragastric pH in horses at known locations under fed and fasted conditions, providing a viable alternative for continuous monitoring in both research and clinical scenarios.

Background Grading of equine gastric ulcer syndrome (EGUS) is undertaken in clinical and research settings, but the reliability of EGUS grading systems is poorly understood. Hypothesis/Objectives Investigate interobserver and intraobserver reliability of an established ordinal grading system and a novel visual analog scale (VAS), and assess the influence of observer experience. Animals Sixty deidentified gastroscopy videos. Methods Six observers (3 specialists and 3 residents) graded videos using the EGUS Council (EGUC) system and VAS. Observers graded the videos three 3 for each system, using a cross‐over design with at least 1 week between each phase. The order of videos was randomized for each phase. Methods Interobserver and intraobserver reliability were estimated using Gwet's agreement coefficient with ordinal weights applied (AC2) for the EGUC system and the intraclass correlation coefficient (ICC) for the VAS. Results Using the EGUC system, interobserver reliability was substantial for squamous (AC2 = 0.69; 95% confidence interval [CI], 0.57‐0.80) and glandular mucosa (AC2 = 0.72; 95% CI, 0.70‐0.75), and intraobserver reliability was substantial for squamous (AC2 = 0.80; 95% CI, 0.71‐0.90) and glandular mucosa (AC2 = 0.80; 95% CI, 0.74‐0.86). Interobserver reliability using the VAS was moderate for squamous (ICC = 0.64; 95% CI, 0.31‐0.96) and poor for glandular mucosa (ICC = 0.35; 95% CI, 0.06‐0.64), and intraobserver reliability was moderate for squamous (ICC = 0.74; 95% CI, 0.62‐0.86) and glandular mucosa (ICC = 0.56; 95% CI, 0.39‐0.72). Conclusions and Clinical Importance The EGUC system had acceptable intraobserver and interobserver reliability and performed well regardless of observer experience. Familiarity and observer experience improved reliability of the VAS.

Background To date, risk factors for equine glandular gastric disease (EGGD) have not been described in Thoroughbred racehorses. Objectives To determine management factors associated with EGGD, identify clinical signs in affected horses, and compare these to equine squamous gastric disease (ESGD). Animals The study was carried out on 109 Thoroughbred racehorses from 8 training yards (3 in the United Kingdom and 5 in Australia). Methods Gastroscopic examination alongside a questionnaire regarding management, feeding, exercise, and health. Results Management factors and clinical signs were different for EGGD versus ESGD. Exercising ≥5 days per week was associated with a 10.4 times (95% CI [confidence interval]: 1.34‐26.9) increased risk of EGGD. Horses racing below expectation were 3.7 times (95% CI: 1.1‐16.7) more likely to have EGGD. Trainer was also identified as a risk factor for EGGD. Time in work ≤6 weeks was associated with a decreased risk of ESGD (odds ratio [OR] 0.3; 95% CI: 0.1‐0.99). Horses aggressive to humans were less likely to have ESGD (OR 0.12; 95% CI: 0.03‐0.54). Horses with stereotypies were more likely to have ESGD (OR 5.0; 95% CI: 1.6‐15.9). Conclusions and Clinical Importance The findings of our study further support the notion that EGGD should be considered as a distinct disease entity to ESGD. Exercising ≤4 days per week could reduce the risk of EGGD. Horses with EGGD are more likely to perform below expectation and, as such, EGGD might be performance limiting in some affected individuals. Stress minimization could reduce the risk of EGGD.

Background Equine glandular gastric disease (EGGD) is common in domesticated horses and can be challenging to treat. Oral omeprazole (ORLO) is used widely but the clinical response is frequently poor. Objectives To compare rates of EGGD healing and improvement between ORLO and a long‐acting injectable omeprazole preparation (LAIO). Study design Retrospective clinical study. Methods The case records and gastroscopy images of horses presenting to masked for peer review over a 12‐month period were reviewed, with images blindly assessed by one of the authors. Treatment responses to 4 mg/kg LAIO administered every 7 days for 2 and 4 weeks were compared with ORLO 4 mg/kg PO q24hrs for 4 weeks. Data were compared using a Mann‐Whitney U test with post‐hoc Dunn's test, Chi‐squared test and a Fisher's exact test. Results Thirty‐three horses that received LAIO and 12 that received ORLO were identified. Nine horses in the LAIO had received other treatments previously. The groups were comparable in signalment and EGGD lesion severity. Long‐acting injectable omeprazole was found to be non‐inferior to ORLO. LAIO was associated with better healing rates than ORLO at 4 weeks (LAIO‐80%; ORLO‐42%; p = 0.02), and reduction in lesion severity at 2 and 4 weeks in the LAIO group but not in the ORLO group at 4 weeks. Eighteen percent of horses in the LAIO group and 50% in the ORLO group did not heal at 4 weeks. There was no association between rate of healing or improvement and resolution or improvement of clinical signs. Six localised and self‐limiting injection site reactions were identified in 4 horses treated with LAIO (6.7%). Main limitations Retrospective design, small numbers and the use of other treatments prior to use of LAIO. Conclusions LAIO was found to be non‐inferior to oral omeprazole for EGGD. Larger blinded randomised clinical trials are justified. Equine glandular gastric disease (EGGD) is common in domesticated horses and can be challenging to treat. Long‐acting injectable omeprazole was found to be non‐inferior to ORLO. LAIO was associated with better healing rates than ORLO at 4 weeks (LAIO‐80%; ORLO‐42%; p = 0.02), and reduction in lesion severity at 2 and 4 weeks in the LAIO group but not in the ORLO group at 4 weeks.

Background Equine squamous gastric disease (ESGD) is a highly prevalent disease in horses, particularly in elite athletes. Some horses respond slowly, or fail to respond, to the licensed treatment, oral omeprazole (ORLO). Objectives To compare rates of ESGD healing and improvement between ORLO and a long‐acting injectable omeprazole preparation (LAIO). Study design Retrospective clinical study. Methods The case records and gastroscopy images of horses presenting to Rainbow Equine Hospital over a 12‐month period were reviewed, with images being reviewed blind by one of the authors (David Rendle). Treatment responses were compared between horses that received 2 or 4 injections of 4 mg/kg LAIO at weekly intervals, and horses that received ORLO at 4 mg/kg PO SID for 4 weeks. Data were compared using a Mann–Whitney test with post hoc Dunn's test, chi‐squared test or Fisher's exact test. Results Fifty‐six horses met the inclusion criteria: 29 received LAIO and 27 received ORLO. Treatment groups were comparable in terms of signalment and ESGD lesions. There was a difference in rate of healing when LAIO and ORLO treatment groups were compared at 28 days (LAIO‐97%; ORLO‐67%; p = .005; OR = 14(1.8–158)), but no difference between LAIO at 14 days and ORLO at 28 days (LAIO‐86%; ORLO‐67%; p = .12; OR = 3.1 (0.9–10)). Five localised and self‐limiting injection site reactions were identified in 3 horses out of 98 injections (5.1%). Main limitations The study was limited by its retrospective nature, absence of randomisation and limited numbers. Conclusions Four weeks of treatment with LAIO resulted in better rates of ESGD healing than 4 weeks of ORLO. Larger more robust studies of LAIO are warranted. A retrospective clinical study comparing rates of ESGD healing and improvement between oral omeprazole and a long‐acting injectable omeprazole preparation in 56 horses. Ninety‐seven per cent of horses treated with long‐acting injectable omeprazole healed within 28 days compared with 67% of horses treated with oral omeprazole. In conclusion, 4 weeks of treatment with long‐acting injectable omeprazole resulted in better rates of ESGD healing than 4 weeks of oral omeprazole.

Background Wei Le San (WLS) is a Chinese herbal formula comprised of 9 herbs selected for their putative anti‐inflammatory effects. Objectives To evaluate the effects of WLS administration in horses with nonglandular gastric ulcers. Animals Ten mixed breed mares (aged 7‐21 years, 401‐567 kg body weight). Methods Experimental design was a blinded, prospective, 2‐period crossover study. All horses received a placebo (25 mL dextrose‐based syrup; n = 10) and the treatment (WLS, 5 g in 25 mL dextrose‐based syrup; n = 10), administered twice daily. Horses underwent a 1‐week, alternating feed‐deprivation period to induce or worsen existing ulcers; treatment began on day 7. Gastroscopic examination was performed on d0, d6, and d35, with gastric fluid pH obtained on d6 and d35. Gastric ulcer scores assigned by 3 masked observers were averaged for each examination. Results Ulcer number scores for horses treated with WLS (median = 0; range, 0‐4) was not different from the untreated controls (median = 0.5; range, 0‐4; P = .81) by the end of the treatment period. Ulcer severity score for treated horses (median = 0; range, 0‐1) was also unchanged compared to the control group (median = 0.5; range, 0‐1; P = .85). Gastric pH was not altered by either treatment, with a median of 2.1 (range, 1.9‐4.1) for the horses treated with WLS and 2.8 (range, 1.6‐7.2) in the untreated controls (P = .46). Conclusions and Clinical Importance The experimental model used to induce gastric ulceration was unable to discern a difference between the herbal supplement and the placebo in normal horses.

BACKGROUND : Equine gastric ulcer syndrome (EGUS) is common in adult horses, particularly those involved in performance disciplines. Currently, detection of EGUS by gastroscopy is the only reliable ante mortem method for definitive diagnosis; however it is unsuitable as a screening test because it is expensive, time consuming, and is not readily available to most veterinarians. Sucrose permeability testing represents a simple, economical alternative to gastroscopy for screening purposes, and the feasibility of this approach in the horse has been previously reported. The aim of this study was to determine the diagnostic accuracy of blood sucrose as a screening test for EGUS in a large group of adult horses with and without naturally occurring gastric disease. RESULTS : One hundred and one adult horses with or without naturally occurring gastric ulceration were studied. The diagnostic accuracy of blood sucrose for diagnosis of gastric lesions (GL), glandular lesions (GDL), squamous lesions (SQL), and clinically significant lesions (CSL) at 45 and 90 min after administration of 1 g/kg of sucrose via nasogastric intubation was assessed using receiver operator characteristics (ROC) curves and calculating the area under the curve (AUC). For each lesion type, sucrose concentration in blood was compared to gastroscopy, as the gold standard, and sensitivities (Se) and specificities (Sp) were calculated across a range of sucrose concentrations. Ulcer grading was performed blindly by one observer; and the results were validated by comparing them with that of two other observers, and calculating the level of agreement. Cut-off values were selected manually to optimize Se. The prevalence of GL, GDL, SQL, and CSL was 83, 70, 53 and 58% respectively. At the selected cut-offs, Se ranged from 51 to 79% and Sp ranged from 43 to 72%, depending upon the lesion type and time of sampling. CONCLUSIONS : Blood sucrose is neither a sensitive or specific test for detecting EGUS in this population of adult horses with naturally occurring gastric ulceration. Further studies aimed at evaluating the performance characteristics of the test in different study populations are warranted. Given the limitations of endoscopy, due consideration should also be given to alternative methods for comparison of blood sucrose with a gold standard.

Background Feeding alfalfa hay is often recommended for its buffering components, like protein and calcium, to prevent lesions of the gastric mucosa in horses. Until now, there has been no information regarding the influence of alfalfa particle size on the gastric mucosa. The aim of this study was to investigate the effects of feeding two alfalfa preparations with different particle sizes (alfalfa chaff vs alfalfa pellets) in comparison with grass hay on the gastric mucosa in weanling horses. We hypothesized that feeding a high proportion of fine alfalfa particles would negatively impact gastric mucosa and that feeding long alfalfa chaff would improve gastric mucosal health in weanlings. Results Before weaning, the prevalence of gastric mucosa lesions (one or more lesions considering all locations in the stomach) was 84.3 %; at 14 days after weaning, it was almost 100 %. Before and after weaning, most of the lesions were found at the greater curvature of the squamous mucosa and at the lesser curvature. After weaning, gastric mucosal lesions at the pylorus were significantly more severe in the group fed alfalfa chaff ( p  = 0.002). In the other regions, no differences related to the feeding regimes were observed. Conclusions Feeding alfalfa failed to improve gastric mucosal lesion scores in weanlings. Furthermore, foals fed alfalfa chaff had higher lesion scores at the pylorus. Alfalfa leaves contain a superior protein source and high amounts of calcium and magnesium, providing extra nutritional advantages in growing horses. At this time, either traditional grass hay rations or grass hay with alfalfa pellets can be recommended.