What Associate Professor Ben Sykes says gastric health can tell us about a horse’s welfare
When a horse is diagnosed with gastric ulcers, it is natural to focus on the immediate question: how do we treat them?
But Associate Professor Ben Sykes believes that question should be followed quickly by another:
What might this horse’s stomach be telling us about the rest of its life?
“The horse’s stomach is a great window into the horse’s wellbeing,” he says.
It is an important way to think about ulcers. Not as a catch-all explanation for every behaviour or performance issue, and not as something to treat in isolation, but as a possible signpost that prompts us to step back and look at the horse as a whole.
Associate Professor Sykes is a world-renowned expert in Equine Gastric Ulcer Syndrome and veterinary internal medicine. With more than 27 years of clinical experience, he is board-certified in large animal internal medicine by both the American and European Colleges of Veterinary Internal Medicine.
His message is clear: good gastric health is closely tied to good welfare.
“It’s very, very hard to get good gastric health without good wellbeing, without that horse’s not just physical needs, but social and emotional needs being met.”
Not every uncomfortable horse has ulcers. Not every horse with ulcers looks unwell.
One reason ulcers can be difficult for owners is that they do not have one neat, definitive set of signs.
A horse may lose appetite or weight. Another may look fat, shiny and be a keen eater. A horse may become girthy, resistant under saddle, tail swish, pin its ears or change its way of going. But none of those behaviours automatically equals ulcers.
In fact, Associate Professor Sykes cautions strongly against treating behaviours such as girthiness as an ulcer diagnosis.
“Girthiness … is a non-specific pain-based behaviour. It is not a clinical sign of any specific disease.”
A horse with ulcers may show girthiness or other pain-related behaviour, but these are not specific signs of gastric disease. It may also be reacting to back pain, saddle fit, lameness, oral pain or another issue entirely. Sometimes, more than one issue is present at once.
That is why a horse who has changed in behaviour, comfort or performance deserves a broader investigation.
“Horses are great communicators. We have been terrible listeners.”
As riders, parents, coaches and horse owners, we can all recognise the temptation to label a horse as resistant, difficult or naughty. But Associate Professor Sykes asks us to look again.
“What we see as resistance … the horse is trying to communicate to us that it is not happy with the situation.”
That does not mean every behaviour is pain. Training, confidence, skill and context matter too. But it does mean pain needs to be considered thoughtfully, rather than dismissed or oversimplified.
Ulcers can be part of a bigger pain picture
One of the most useful points from the discussion is that a stomach scope should not become the end of the investigation.
“If someone brings a horse to me for gastroscopy and its primary presentation is behavioural undesirable behaviour … the first thing I will do is a lameness exam.”
The reason is simple. Lameness, back pain, saddle fit problems, dental discomfort and gastric disease can all contribute to pain-based behaviour. Focusing only on the stomach may mean missing the actual driver, or one of several drivers, of the horse’s discomfort.
Associate Professor Sykes describes treatment as a circuit breaker: an opportunity to heal the gastric disease, while also addressing the factors that may have contributed to it.
For riding horses, the long-term aim should be management that does not rely on ongoing medication, while recognising that veterinary treatment may be essential to break the cycle initially.
“We should be able to manage riding horses without pharmacology in the long run.”
That does not mean medication is unimportant. Veterinary diagnosis and treatment are essential when ulcers are present. It means treatment should be paired with a practical review of the horse’s lifestyle, workload, comfort and management.
“Free-choice hay” is not enough if the horse is not eating it
Forage is central to gastric health, but Associate Professor Sykes makes an important distinction: having hay available is not the same as consuming enough of it.
“You’ve got to measure the intake because you cannot assume because the horse has free-choice hay that it’s actually eating it.”
A horse may have hay in front of it all day and still not consume enough. That is why it is worth measuring what is offered and what is left, rather than assuming intake is adequate.
Associate Professor Sykes recalled scoping horses with haynets in front of them that still had empty stomachs.
“The answer was the horses weren’t eating the hay.”
This can be particularly relevant for horses transitioning from racing or other high-concentrate feeding systems. Eating forage is not simply a feed-management issue. It is also a behaviour, and some horses may need time and thoughtful management to re-establish a stronger forage habit.
The practical question is not simply, “Does my horse have hay?”
It is: “How much suitable forage is my horse actually eating?”
How we offer forage matters too
The discussion also challenged some familiar stable routines.
Horses are designed to eat with their heads down. Associate Professor Sykes discussed evidence that horses eating at ground level chew more, and that horses offered forage freely from the ground consume more than those fed from haynets.
“Horses with free hay on the ground consume 50% more, and that translates to a decreased risk in squamous disease.”
This is not an instruction to throw hay onto a dirty stable floor. Clean, safe and hygienic feeding systems remain essential. But it is a reminder to think beyond what is easiest or tidiest for people.
“What is good hay for horses?” Associate Professor Sykes asks.
“For me, a good hay for horses is a hay that is suitably hygienic and palatable that a horse can eat as much as it wants of without restriction and without excessive weight gain.”
That will look different for different horses. A newly off-the-track Thoroughbred, a native pony and an easy-keeping warmblood will not necessarily need the same forage.
But the principle remains: suitable forage should support normal eating behaviour, not simply meet a feeding schedule.
More time outside can matter
The conversation also highlighted how management systems can shape feeding behaviour.
“Horses outside eat 50% more than horses inside.”
Associate Professor Sykes noted that even relatively practical adjustments, such as walk-in, walk-out arrangements or providing multiple forage sites, may encourage more normal grazing and movement behaviour.
“If we give them multiple roughage sites, they increase their amount of grazing behaviour. They naturally mimic that normal grazing, walking around type behaviour.”
Not every horse owner has unlimited turnout, large paddocks or the ability to completely change their facilities. But welfare improvements do not need to be all-or-nothing.
“If we want to talk truly about horse welfare, we’ve got to shift our perspective from looking at it solely through our eyes and what we want, to what the horse’s perspective of this is.”
That may mean looking for practical changes that better meet the horse’s needs while still working within the realities of the property, schedule and resources available.
Friends, forage and freedom
For Associate Professor Sykes, the familiar three Fs provide a useful framework.
Friends. Forage. Freedom.
They are not a replacement for veterinary care, good saddle fit, correct training or attention to soundness. They are part of the foundations that support a horse’s physical, social and emotional wellbeing.
“When we see ulcers, we need to deal with them. But we need to step back, look at the whole horse, and … look at the whole horse’s environment founded on the three Fs.”
That may mean asking:
- Does this horse have safe and appropriate social contact?
- Is it eating enough suitable forage across the day and night?
- Can it eat in a more natural position?
- Does it have regular opportunity to move, graze and behave like a horse?
- Has pain elsewhere in the body been assessed?
- Is the horse comfortable in its saddle, workload and daily routine?
The bigger message
Ulcers matter. They can be painful, they require proper veterinary diagnosis and treatment, and they should never be dismissed. But they should not become a convenient explanation for everything a horse does.
The most valuable message from Associate Professor Sykes is not simply that ulcers are common, or that forage is important. It is that gastric health gives us an opportunity to look more closely at the horse’s whole experience.
When something changes in our horse, the goal is not to find the fastest label. It is to listen carefully, investigate properly and improve the things we can.
- Watch the full discussion with Associate Professor Ben Sykes:
https://youtu.be/unImckiUxeY?si=yjeqf_jAYLKzBYh6
This article is intended as general education only. Speak with your veterinarian about diagnosis, treatment and management for an individual horse.
