Girth aversion or girthiness is a nonspecific clinical sign anecdotally associated with multiple conditions in the horse (behavioral problems, gastric ulcers, back pain); however, studies have not been conducted to definitively correlate this clinical sign to specific pathologies. This retrospective study aims to describe the clinical signs and final diagnoses of 37 horses evaluated at the University of California, Davis with a presenting complaint of girthiness. Medical records of all horses presented to the veterinary hospital between 2004 and 2016 for girthiness were reviewed. Twelve horses were diagnosed with gastric ulceration, 10 with various orthopedic problems, 3 with ill-fitting saddles, 1 with reproductive tract neoplasia, and 10 with various diseases including liver abscessation, vena cava aneurism, sternum pain, and urinary tract infection. Identifying the exact cause of girthiness remains a challenge; however, gastric ulcers was a common finding; therefore, a clinical examination should be oriented to further investigate this condition because 92% of gastroscoped horses in this study were diagnosed with gastric ulcers.