Choke in Horses (Esophageal Obstruction)

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.

By understanding the causes, signs, and preventive measures for choke, you can help keep your horse happy, healthy, and safe.

Evidence-Based Reference

1. 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