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Gastroparesis &
GASTRIC RUPTURE In Friesian Horses

What is

Gastroparesis is a disease caused by a primary mechanical failure of the stomach muscles. This results in delayed emptying of the stomach contents, which can lead to primary gastric impaction and, in severe cases, primary gastric rupture. The prevalence of the disease in Friesian horses and the familial association suggest a genetic inheritance. The leading research theory is that gastroparesis is caused by a connective-tissue disease in Friesians.

Primary Gastric Impaction

Primary gastric impaction is caused by the persistent and progressive accumulation of feed material in the stomach. Resolving primary gastric impaction can be difficult, mainly if the impaction has gone undiagnosed for a significant amount of time. However, if the gastric impaction is due to gastroparesis and caught early enough, horses can be fasted for a period of time and then placed on a special diet to prevent future impaction.

Primary Gastric Rupture

When a primary gastric impaction is left untreated, it results in an abnormal expansion of the stomach, which can cause gastric rupture. Gastric rupture is almost always fatal, and the hallmark sign of it is intense and unbearable abdominal pain. This severe pain often causes an extremely violent reaction from the horse and is almost always unrelieved by the typical pain medications given for colic. If the horse is remarkably stoic, as Friesians are reported to be, it may not show signs of intense pain until it is too late for intervention. 

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Anatomy of the equine stomach


The equine stomach's capacity is relatively small compared to the size of a horse and holds only 2.5 gallons.

Excessive recumbency


General grumpiness


Recurrent mild colic

Symptoms of

Symptoms of gastroparesis closely mimic symptoms of equine gastric ulcers. It is critical that Friesians undergo a fasted gastroscopy to confirm suspicions of gastric ulcers in order to rule out gastroparesis.

  • Pawing

  • Coughing

  • Weight loss

  • Poor appetite

  • Teeth grinding

  • Poor Performance

  • Flehmen-like response

  • Excessive salivation

  • Behavioral changes

  • Poor coat condition

  • Poor body condition

  • General grumpiness

  • Recurrent or mild colic

  • Excessive recumbency

  • Stretching as if to urinate

  • Sensitivity in the girth area

  • Bucking, bolting, or rearing

  • Intermittent low-grade fever 

  • A generally unthrifty appearance

  • Less interest in either hay or grain

  • Cribbing or other stereotypic behaviors

  • Nervous or spooky under saddle or in harness

  • Reluctance to finish meals or being a “picky eater”

  • Aggressiveness towards humans other horses, especially at feeding time

  • Loss of muscle over the top line, neck, or hindquarters. Prominent ribs. 

  • Displaying unreliable behavior between one exercise session and the next

Diagnosing Gastroparesis

Gastroparesis is typically diagnosed by performing a fasted gastroscopy commonly referred to as a "scope".



An esophagoscopy is an examination of the stomach using a thin, tube-like scope with a light and a camera. A fasted gastroscopy allows the veterinarian to visualize the stomach and look for poor motility and complications such as ulcers or feed impaction. 

It is very important that the horse is fasted for a minimum of 12 hours to ensure the stomach has the opportunity to empty completely.


Primary gastric impaction


Endoscopic view of a gastric impaction that has backed up into the esophagus


Food Trials & Diet Management

A food trial involves choosing the smallest number possible of food items, such as hay or grass, and feeding that diet exclusively for 1-2 weeks, and then performing a follow-up fasted gastroscopy to ensure the stomach is emptying. It can take several rounds of food trials followed by fasted gastroscopy to arrive at a safe diet. If the disease progresses, follow-up food trials will likely be needed to adjust the horse's diet.

Unfortunately, there is no cure or clinically proven treatment for gastroparesis. However, there are medications your veterinarian may prescribe in an attempt to increase your horse's gastric motility. No long-term studies have been done to detail the impact these medications may have on the disease or their success in horses with gastroparesis.

Horses with gastroparesis can be managed with a strict diet and management protocol, but the prognosis is guarded to poor. We assist owners all over the world with diet and management plans for horses with gastroparesis. Please reach out to us if you would like a consult.

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Community Support


For more information or community support, please join our Facebook support group, Equine Delayed Gastric Emptying (Gastroparesis)

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