Choke in Horses (Esophageal Obstruction)
- What is Choke in Horses?
- What Causes a Horse to Choke?
- Signs Your Horse May Be Choking
- What Should I Do if My Horse Is Choking?
- What Can I Expect After My Horse Chokes?
- What Can I Do to Prevent My Horse From Choking?
- Video on Choke in Horses
- Evidence-Based Reference
Updated January 27, 2025 | By: Liz Schatz, DVM
What is Choke in Horses?

Choke, also called esophageal obstruction, is a common emergency situation in which feedstuffs or foreign materials become lodged in the esophagus of a horse.
Anatomy
When a person chokes, it is a different situation anatomically than when a horse is choking. If a human is choking, there is an obstruction of the trachea (windpipe). If a horse is choking, there is an obstruction of the esophagus, a 4-5 foot long muscular tube that connects the mouth to the stomach. An obstruction can occur at any point along the horse’s esophagus and may contain differing amounts of feed material.
When horses breathe, the air travels through their nostrils and nasal passages, down their trachea and into their lungs, so they are still able to breathe normally during a choke episode.
What Causes a Horse to Choke?
There are many different scenarios that may lead to choke in a horse, including:
- Rapid ingestion of feed (also referred to as bolting their feed), which may happen with horses that’re low on the herd pecking order during feeding time in group turnout.
- Incomplete chewing of feed due to dental issues.
- Dehydration or insufficient water intake.
- Ingestion of foreign material, such as eating bedding.
- Eating during heavy sedation.
- Esophageal disorders, including megaesophagus (enlargement of the esophagus).
- Predisposition due to previous episodes of choke that result in scarring of the esophagus.
- Predisposition due to breed. Studies have shown that Friesians have a high prevalence of esophageal disease, specifically megaesophagus which may lead to choke [1]. There is anecdotal evidence that choke is more common in Miniature Horses than other breeds.
Although horses of any age can choke, senior horses seem to be more prone to this issue due to several factors, like dentition.
Signs Your Horse May Be Choking

Horses experiencing choke will exhibit many clinical signs, including:
- Hypersalivation (excessive saliva coming from the mouth).
- Repeated coughing.
- Gulping and attempting to swallow.
- Extension or stretching of the neck.
- Sweating and other signs of distress.
- Feed material coming out of the nostrils.
What Should I Do if My Horse Is Choking?
If you think your horse may be choking, remain calm and call your veterinarian right away. Horses can choke for quite some time, and some mild cases of choke may resolve on their own. However, it is always recommended that you call your veterinarian on an emergency basis so they can assess the situation and make appropriate recommendations. While you wait for the veterinarian to arrive, remove all their food and water and keep your horse as calm as possible.
Veterinary treatment of a horse with choke

To determine whether your horse is choking, your veterinarian will probably start by performing a physical examination to get a full clinical picture. Next, your horse will likely be sedated so the veterinarian can pass a nasogastric tube. This process involves a flexible plastic tube that goes into one of the horse’s nostrils, down the esophagus, and into the stomach. Passing the nasogastric tube will help the veterinarian determine if there is still an obstruction present and if so, where it is.
If the obstruction is still present, your veterinarian will attempt to flush the material down into the stomach by gently pumping water through the nasogastric tube. In many cases, this will resolve the obstruction. However, some cases of choke are more complicated. If the choke cannot be resolved fairly easily with esophageal lavage (flushing with water), further diagnostics may be needed, such as endoscopy, ultrasound, or radiographs. Severe cases of choke can even require surgical intervention, but this is rare.
What Can I Expect After My Horse Chokes?
After your veterinarian resolves the choke, they will likely prescribe short-term medications and recommend some temporary management changes. These changes may include:
- Withholding all food for a short period of time.
- Soaking grain and hay when food is gradually reintroduced.
- Monitoring the horse for future episodes, as some horses tend to have chronic issues with esophageal obstruction (these horses generally require permanent management changes).
Some horses will have complications after a choke episode, such as dehydration, esophageal trauma or scarring, stricture (narrowing of the esophagus), as well as aspiration pneumonia. Be sure to follow any aftercare instructions from your veterinarian to minimize these complications as much as possible.
Prognosis for choke in horses
Most horses who experience a single episode of choke without subsequent complications have a good prognosis. The prognosis is often poor for more complicated cases and cases that involve underlying anatomical issues, such as stricture.
What Can I Do to Prevent My Horse From Choking?
You may be wondering if there is anything you can do to prevent choke, especially if you have a horse that has had a previous choke episode. The good news is that there are several things that may help and are worthwhile to discuss with your veterinarian, including:
- Always ensuring plenty of clean, fresh water is available.
- Adjusting their feeding program, such as soaking hay and grain meals.
- Cutting or breaking any treats, like carrots and apples, into small pieces.
- Using slow feeder hay nets and feed pans to prevent them from bolting their feed.
- Feeding horses separately, if possible, to minimize stress during feeding time.
- Having your veterinarian perform regular oral examinations to identify and address dental issues.
Video on Choke in Horses
In this Ask the Vet video, Dr. Lydia Gray describes choke, its causes, and what strategies owners can use if they have a chronic choker.
SARAH: "I have an older horse-- 20 plus--" She's not going to go into specifics, just like I didn't want to before. You know, it's fine. It's not a mare. "and he has recently started choking. He is now considered a chronic choker. I have had to get him tubed twice by the vet--" that's a bummer-- "and now we have to soak his feed in half a bucket of water. We think it is due to him just getting too excited about his food--" which I can understand, we've all been there-- "my vet recommended soaking his food or taking him off grain. Grain is the only thing he chokes on. Do you have any other ways of dealing with it? And can you explain why it's easier for a horse to choke after they've done it once already?"
DR LYDIA GRAY: Let's back up a little bit and talk about what choke is.
SARAH: Yeah, because it sounds like he'd recently started choking, feels like-- well don't submit a question on the internet, choking sounds like an emergency. And so the difference between choke and choking is an important one.
DR LYDIA GRAY: And choking people and choking horses.
SARAH: Yeah.
DR LYDIA GRAY: Yeah. So, when you think about a person choking, you think airway and Heimlich maneuver, an emergency, and like two or three minutes right?
SARAH: Yeah, you're supposed to do this.
DR LYDIA GRAY: Yeah. The international symbol. It's a little bit different on horses, we're talking about choke in the esophagus. So, it's an esophageal obstruction. Still an emergency, but not like minutes. So, she did right in calling her vet and they put a nasogastric tube down and lavaged with water. Water helps everything, it turns out. So, it's unfortunate. It is common in the older horse. So, she said 20 plus. And horses tend to choke on grain when they eat too fast. Hay, if they don't have good teeth anymore and they can't chew it into smaller pieces and swallow it, they swallow big pieces and then it backs up. If they don't have enough water in their diet. So, there's a couple of reasons-- but it's hay, it's pasture, and it's a grain or that kind of feed stuff.
I brought a prop today.
SARAH: Oh, I was wondering what this was for.
DR LYDIA GRAY: She said her horse gets excited about eating, and mine does too. And so--
SARAH: Oh, Newman.
DR LYDIA GRAY: Yeah. What I did was-- I don't know if this-- I'm a little afraid to tilt it, and it's quite heavy. So this is some grain in here, and these are actually bocce balls, because they're heavy, they're round and smooth, and they make the horse slow down to eat the yummy grain. And he has to move these around a little bit. My horse has become very, very good. He can get every little pebble, he just knows to move these around. But he can't come in here with an open mouth and wolf it down, and that's when you run the risk of choke, because you wolf down too much at once, you don't wet it with saliva, and then the esophagus-- which, the tube from the mouth of the stomach-- gets backed up.
SARAH: Lots of tube talk today.
[LAUGHING]
DR LYDIA GRAY: Lots of tube talk. So, the vet did right. You give sedatives, maybe muscle relaxants, to let the esophagus open up and let it pass, and you lavage with water in the stomach tube. Sometimes you do have to go to surgery if it's bad. I was sorry to hear that he's done it more than once, and so now he's a chronic choker. And the reason you become sort of prone to this is-- especially if it lasts too long, you could have some damage to the issue of esophagus. You either create ulcers in the lining, or strictures. So there's a narrower place, and now, every time he eats, the food is going to back up right there. So that's a problem. And it's why choking is an emergency, because you want it resolved as quickly as possible so that you don't have ulcers and strictures and chronic choking. So, we got this. Soaking, wetting-- soaking better than wetting-- the hay. Pasture-- for some horses, becomes not a thing they can do anymore, because every time they eat grass--
SARAH: Especially if they're unsupervised out in the pasture, that's tough.
DR LYDIA GRAY: Maybe a muzzle, so it slows down the rate of intake. Could be helpful. I always like the small hole hay nets or the slow feed hay bags, because it slows down the rate of intake. Anything you can do to slow their eating and to soften their eating; to wet it, to encourage them to drink with the SmartSalt pellets-- those are all things that you can do to help the horse that chokes.
SARAH: OK. Well, Evelyn, we wish you luck with your senior.
DR LYDIA GRAY: Yeah.
By understanding the causes, signs, and preventive measures for choke, you can help keep your horse happy, healthy, and safe.
Evidence-Based Reference
- Komine, M et al. “Megaesophagus in Friesian horses associated with muscular hypertrophy of the caudal esophagus.” Veterinary pathology vol. 51,5 (2014): 979-85. doi:10.1177/0300985813511126