Ulcers have become one of the most cited explanations for changes in equine behaviour, appetite, and performance in the modern sport horse. Image by KER.
Ulcers are not a one-size-fits-all diagnosis or solution; Dr Peter Huntington of Kentucky Equine Research highlights the need for tailored, long-term equine gut health management beyond acid suppression.
Ulcers have become one of the most cited explanations for changes in equine behaviour, appetite, and performance in the modern sport horse. A horse that becomes girthy, resistant under saddle, sensitive to leg aids, or inconsistent in form is frequently labelled as “ulcery” before a fuller picture is considered. While awareness of gastric health has undoubtedly improved, the conversation itself has, in many cases, become overly simplified.
According to respected veterinarian and Director of Nutrition at Kentucky Equine Research (KER), Dr Peter Huntington, the awareness of ulcers is a positive step forward in equine management — however they are often misunderstood.
“We’ve probably always had ulcers in horses,” Dr Huntington explains. “We’re just much better at identifying them now. However, in some cases, we’re also overtreating the horse when the situation doesn’t necessarily warrant aggressive intervention.”
To move forward, owners and riders must shift away from viewing ulcers as a one-size-fits-all diagnosis and instead understand the complexity of the equine digestive system – particularly the critical and often overlooked role of the hindgut.
UNDERSTANDING THE EQUINE GI SYSTEM
The equine digestive tract is designed for near-constant forage intake. Horses evolved to graze for up to 16 hours per day, producing saliva that naturally buffers stomach acid and supports healthy digestion. Modern management, however, rarely mirrors this natural rhythm.
The equine digestive tract is designed for near-constant forage intake. Image by KER.
Restricted forage access, high-concentrate diets, intermittent feeding schedules, stabling, travel, competition stress and intensive exercise all place pressure on the gastrointestinal system. The result is a population that are far more vulnerable to digestive disturbances than their feral counterparts.
Ulcers themselves fall into two main categories:
- Squamous ulcers – which occur in the upper portion of the stomach.
- Glandular ulcers – found deeper in the stomach near the pylorus (where food exits into the small intestine).
While both are diagnosable via gastroscopy, their causes, response to treatment and long-term management can differ significantly.
“In sport horses we tend to see more glandular disease [an inflammatory condition that is located in the part of the stomach that is closest to the pylorus and in some cases continuing into the small intestine],” Dr Huntington shares. “That’s important because glandular ulcers don’t typically respond well to acid prevention alone.”
NOT ALL ULCERS ARE EQUAL
Mild ulceration is surprisingly common – even in horses that appear healthy, perform well, and maintain good body composition.
“Grade one ulcers may not be the end of the world,” Dr Huntington explains. “A lot of horses will show some level of ulceration and yet function perfectly well in every other respect.”
The concern arises when ulcers become more severe, persistent, or are associated with behavioural changes, appetite suppression, weight loss, or reduced performance. At this point, intervention becomes necessary – but the type of intervention matters.
ACID SUPPRESSION VS STOMACH PROTECTION
Protein Pump Inhibitors (PPIs) such as omeprazole have revolutionised ulcer treatment, particularly for squamous ulcers. By suppressing acid production, they allow the ulcerated tissue to heal.
However, Dr Huntington cautions against the routine or prolonged use of acid suppressants without a broader management plan.
“We probably overuse acid suppression in some horses,” he says. “It’s very effective but not something you can – or should – rely on indefinitely.”
There are several reasons for this:
- Acid plays a vital role in digestion, particularly protein breakdown.
- Long-term suppression may carry implications for bone metabolism.
- Ulcers frequently recur once treatment stops if underlying risk factors remain unchanged.
- PPIs do nothing to support hindgut health.
This is where the protective and buffering strategies, rather than outright acid suppression, become increasingly valuable.
THE FORGOTTEN HALF: WHY HINDGUT HEALTH MATTERS
While gastric ulcers dominate discussion, Dr Huntington believes that hindgut health may be even more critical – and far more undiagnosed.
“You can’t diagnose hindgut disturbances as accurately,” he explains. “But they can have a huge impact on overall health, performance, and behaviour.”
The hindgut houses a vast microbial population responsible for fermenting fibre and extracting energy from forage. Disruption to this environment – through starch overload, stress, antibiotics or dietary imbalances – can lead to reduced nutrient absorption, inflammation, loose manure, and subtle but significant changes in temperament and performance.
Importantly, hindgut issues are not the same as gastric ulcers, and signs such as sloppy manure or poor condition should not automatically be attributed to stomach ulcers alone.
MANAGEMENT MATTERS
Modern horse management is, in many ways, at odds with equine biology. Limited forage access, intense workloads, and high-performance expectations all contribute to digestive stress.
Two of the most significant protective factors are also the simplest:
- Time spent chewing – this increases saliva production and buffering.
- Consistent forage intake – which prevents acid pooling and splashing during exercise.
“One of the most practical strategies is feeding something before work,” Peter says. “Even a small amount of forage or a fibre-based feed 30 minutes before riding can make a meaningful difference.”
Saliva, fibre mats (a protective, floating layer of ingested forage such as hay, grass or chaff), and buffering agents help prevent acid from splashing onto the sensitive upper stomach lining during exercise — one of the key mechanisms behind squamous ulcer development.
As ulcer management has evolved, so too has interest in products that protect rather than suppress, and that support both gastric and hindgut health as part of a broader strategy.
WHERE SUCRALOX FITS IN
This is where Sucralox, developed by Kentucky Equine Research (KER), enters the conversation.
Unlike PPIs, Sucralox is designed to work alongside the horse’s natural digestive process, not override them.
“Sucralox isn’t about prolonged acid suppression,” Dr Huntington explains. “There are some antacid components, but they don’t eliminate acid completely — which is important, because acid still needs to be there for digestion.”
Instead, Sucralox operates via a dual-action process:
- Coating and protecting the stomach lining – helping shield ulcerated or vulnerable tissue.
- Buffering excess acid – reducing irritation without shutting down acid production entirely.
This makes it particularly useful in situations where long-term acid suppression is unwarranted.
One of Sucralox’s key benefits lies in its ease of use. Delivered in-feed, it avoids many of the compliance challenges associated with paste formulations that must be administered on an empty stomach.
“In reality, best-practice protocols aren’t always followed,” Dr Huntington says. “And if it’s difficult to administer, horse owners often won’t do it consistently.”
“One of Sucralox’s
key benefits lies in
its ease of use…”
Because Sucralox can be fed daily, it provides continuous gastric support, making it well suited to:
- Horses prone to recurrence once medication stops
- Maintenance programs following PPI treatment
- Horses in ongoing work for competition
- Situations where stress or management changes increase ulcer risk
Sucralox is easy to use and can be delivered in-feed. Image by KER.
A ROLE IN GLANDULAR DISEASE & THE HINDGUT
Glandular ulcers, which tend to be slower to heal and less responsive to PPIs alone, often require a more comprehensive approach.
“In glandular disease, acid suppression on its own doesn’t give great results,” Dr Huntington notes. “Combining it with a protective agent like Sucralox improves outcomes.”
While research into glandular disease continues to evolve, current evidence supports the use of combined strategies that protect tissue, reduce irritation, and support healing over time.
Another key feature of Sucralox is yeast metabolites, which help stabilise the hindgut microbiota.
“The microbial population in the hindgut is critical,” Dr Huntington explains. “It’s linked to digestion, immune function, behaviour — even the gut–brain axis.”
By supporting microbial balance, Sucralox addresses an area that acid-suppressing drugs simply can not, reinforcing its role as part of a whole-gut health program rather than a single-target solution.
MONITORING SUCCESS WITHOUT OVER-TREATING
Unlike medications designed for rapid ulcer resolution, products like Sucralox are best assessed through functional improvements, including:
- More consistent appetite
- Improved manure quality
- Reduced behavioural tension
- Better tolerance of work and travel
- Improved overall condition and performance
“For severe ulcers where you want rapid change, you may still start with a PPI,” Dr Huntington says. “But if you do nothing after that, the ulcers will likely come back.”
Sucralox offers a way to break that cycle, reducing reliance on repeated medication while supporting the digestive system long-term.
KER Sucralox. Image by KER.
A SMARTER WAY FORWARD
As ulcer awareness continues to grow, so too must our understanding of what truly supports equine gut health.
Ulcers are not a diagnosis in isolation. They are a symptom – of management, stress, feeding practices, and digestive imbalance. Addressing them effectively requires more than suppression; it requires protection, prevention, and respect for the horse’s natural physiology.
By supporting both the stomach and hindgut, and by fitting seamlessly into daily feeding routines, Sucralox represents a modern, evidence-based tool for owners seeking a sustainable approach to digestive health.
As Dr Huntington puts it, “You can’t suppress acid forever. At some point, you have to work with the system — not against it.”
This article was written in conjunction with Kentucky Equine Research. You can find out more about KER Sucralox here. EQ
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