Veterinary Telehealth: Optimizing Your Practice for Patient Care

Expert Veterinary Insights on ESGD, EGGD, and Modern Treatment Approaches Dr. Camilla Jamieson always knew she wanted to be a horse vet. Growing up around horses, she started learning about equine medicine as a kid and her passion for a career in the field was reinforced when a few equine veterinarians took her under their wing. Today, she is an internationally trained equine internal medicine specialist and trusted leader in the field, gaining expertise from her work in demanding equine medical environments all across the globe. We’ve been lucky enough to partner with her for several educational webinars, and now we’ve sat down with her to talk one-on-one about the intricacies of Equine Gastric Ulcer Syndrome (EGUS) and why effective diagnosis and management require more than a one-size-fits-all approach. Watch her September webinar! What are some of the biggest misconceptions about Equine Gastric Ulcer Syndrome you see among horse owners and veterinary professionals? One of the biggest misconceptions is that we can diagnose and treat equine gastric ulcers based on clinical signs alone. Many horses are treated for ulcers because of behavioral changes or performance issues, but those signs can be caused by a wide range of conditions. Without a gastroscopic examination, it can be difficult to determine whether ulcers are truly the underlying problem. Another challenge is that all gastric ulcers are often treated as though they’re the same disease. They’re not. The stomach has two distinct regions, and ulcers in those areas can behave very differently. The glandular and squamous portions of the stomach often require different treatment protocols, treatment durations, and management strategies. When treatment is selected without identifying the type and location of the ulcer, there’s a risk of using the wrong therapy or not treating long enough to achieve meaningful healing.  I also encourage veterinarians and owners to think about equine gastric disease as a long-term management condition. In many horses, especially performance horses, it’s not a matter of treating once and never dealing with it again. Managing the underlying risk factors is often just as important as treating the active disease. How has vets’ understanding of EGUS changed since you started in the field, and how has that impacted diagnosis and treatment? Fifteen years ago, most discussions around EGUS centered on acid suppression and oral omeprazole therapy. Today, our understanding is much broader. We know much more about how stress affects gastric health, how feeding practices influence acid production, and how horses’ natural grazing behavior impacts the stomach environment.  That expanded understanding has changed how we approach equine gastric disease management. We now recognize that diet, forage availability, stress reduction, turnout, and overall management are critical components of successful long-term care. At the same time, veterinarians have more therapeutic options available, including different proton pump inhibitors and treatment approaches tailored to individual cases.  While the fundamentals of diagnosis remain the same, access to gastroscopy has improved significantly. More practitioners have access to endoscopy equipment, making definitive diagnosis of Equine Gastric Ulcer Syndrome more accessible than ever before.  How do treatment approaches differ between Equine Squamous Gastric Disease (ESGD) and Equine Glandular Gastric Disease (EGGD)? Understanding the difference between ESGD and EGGD directly impacts treatment selection, expected healing time, client communication, and long-term management.  For example, many squamous ulcers respond well to omeprazole and may improve within a few weeks. More severe glandular or pyloric lesions often require much longer treatment periods and significantly different expectations. In those cases, I prepare owners for the possibility of months of therapy rather than weeks.  A definitive diagnosis also helps build client confidence and compliance. When owners can see endoscopic images and understand exactly what is being treated, it becomes much easier to explain why a particular treatment plan is necessary, why healing takes time, and why follow-up evaluations may be required. You’ve had experience working with extended-release injectable omeprazole before its introduction in the United States. What first drew your attention to this treatment approach? I went to vet school in England, and the Bova product was already on the market then, so I was aware that it was available. I got hands-on experience with the injectable omeprazole and used it a lot when I worked in the Middle East for four years after my residency. Our medication supply was all Australian products, so we had the Bova products through our Australian supplier. I worked with large stud farms that managed large horse herds, and daily oral medication administration wasn’t always practical. Injectable therapy offered a convenient alternative because multiple horses could be treated on a weekly schedule rather than requiring daily dosing. That convenience factor stood out immediately. Instead of coordinating daily administration, treatments could often be incorporated into routine veterinary visits. While management practices and owner preferences vary considerably from one region to another, injectable therapy provided a valuable option in situations where consistent oral administration was challenging.  Based on the research and clinical cases you’ve seen, what types of horses seem to benefit most from injectable omeprazole therapy? I don’t think benefit is necessarily tied to breed or discipline. Instead, it’s often related to management and practicality. Some horses simply aren’t ideal candidates for daily oral medication because of feeding schedules, travel demands, owner availability, or difficulty maintaining fasting protocols.  Every case is different. Treatment decisions should be individualized based on the horse, the owner, and the management environment. One of the advantages veterinarians have today is a growing range of therapeutic options that can be matched to the specific needs of each patient. Injectable Omeprazole for Horses See all the benefits of our omeprazole and discover why over 200,000 doses have sold globally! Product Benefits & Advantages What does current research suggest about the role of injectable omeprazole in managing equine glandular gastric disease? One area that continues to generate interest is how different formulations can help address some of the challenges associated with oral therapy. For example, one of the limitations of traditional oral omeprazole is that efficacy can be influenced