Esophageal Ulceration in Horses: Symptoms, Causes, and Recovery

Esophageal ulceration means the inner lining of the esophagus has been irritated, eroded, or injured. In horses, this most often develops after esophageal obstruction, also called choke, when feed or another material gets stuck and stretches or damages the tissue. The injury can range from mild inflammation to deeper ulceration that takes longer to heal.

This condition matters because the equine esophagus is delicate. When the lining is damaged, swallowing becomes painful and less coordinated. Some horses drool, cough, or have feed and saliva come back through the nostrils. If the injury is severe, scar tissue can form during healing and narrow the esophagus, creating a stricture that makes future swallowing problems more likely.

For many pet parents, the first clue is that a horse who recently had choke still is not eating comfortably. Others show subtle signs, like slow eating, repeated swallowing, or reluctance to take dry feed. While some cases heal well with supportive care, others need close follow-up with your vet because complications can develop days to weeks after the original injury.

The most common cause is choke, where feed becomes lodged in the esophagus. Pressure from the obstruction, repeated swallowing against the blockage, and irritation from saliva and feed can all injure the lining. Merck notes that circumferential ulceration can occur after esophageal obstruction and may set the stage for later stricture formation.

Ulceration can also happen after trauma to the esophagus. That may include rough passage of a stomach tube, irritation from retained foreign material, or damage associated with repeated attempts to clear an obstruction. In some horses, caustic medications or substances, severe reflux, or very dry, poorly chewed feed may contribute to inflammation and erosions.

Risk factors often overlap. Horses with dental disease may not chew feed well. Fast eaters, horses fed dry pellets or beet pulp without enough soaking, and horses with prior esophageal injury may be more likely to have another problem. Once the lining has been damaged, the healing tissue is more vulnerable, so careful feeding and follow-up matter during recovery.

Your vet will start with a physical exam and a careful history, especially any recent choke episode, nasal discharge with feed, coughing, or pain during eating. In some horses, the diagnosis is strongly suspected based on signs alone, but confirming the extent of injury usually takes imaging or endoscopy.

Endoscopy is often the most useful test because it lets your vet directly look at the esophageal lining. This can show redness, erosions, deeper ulcers, retained feed, or narrowing from scar tissue. It also helps monitor healing after an obstruction. In more complicated cases, your vet may recommend contrast radiographs to look for a stricture, poor motility, or, more rarely, a perforation.

Additional testing depends on the horse's condition. If there is fever, coughing, or abnormal lung sounds, your vet may check for aspiration pneumonia. Bloodwork may help assess dehydration or inflammation, but it does not diagnose the ulcer itself. The goal is not only to identify the ulceration, but also to find any complication that changes the recovery plan.

Prevention starts with lowering the risk of choke, since that is the most common path to esophageal ulceration. Feed management matters. Horses that bolt their feed may do better with slower feeding strategies, smaller meals, and adequate water access. Dry pellets, cubes, or beet pulp may need soaking for horses with a history of swallowing problems, poor dentition, or prior choke.

Routine dental care is also important. Horses that do not chew well are more likely to swallow large, poorly moistened feed material. If your horse has had a previous esophageal injury, ask your vet whether temporary diet changes are wise during recovery, even after the emergency seems over.

Careful handling during and after a choke episode can reduce further trauma. Follow your vet's feeding instructions closely, including how long to use soaked feed before returning to normal forage. Recheck visits matter because some complications, especially strictures, develop as the tissue heals rather than at the moment of injury.

If your horse has repeated swallowing trouble, coughing with feed, or recurrent choke, do not assume it is a one-time event. Early evaluation gives your vet more options and may help prevent a mild injury from becoming a long-term esophageal problem.