Background: Gastric impaction is an uncommon and potentially fatal condition in equids and is defined as a persistent accumulation of dry, firm ingesta within the stomach. Left untreated these impactions can progress to gastric rupture. However, gastric impactions present with non‐specific clinical signs of varying severity, making diagnosis challenging. While often diagnosed at referral practices, diagnosis and medical management of gastric impactions is possible in first‐opinion equine practice. Aim of the article: This article discusses what is known about the aetiology of gastric impactions and the current diagnosis and treatment options.