Issue Description Exocrine pancreatic insufficiency is the
inability to properly digest food due to a lack of digestive enzymes
made by the pancreas. This disease is found frequently in dogs. Other Names EPI
Causes Exocrine Pancreatic Insufficiency is more
prevalent in German Shepard dog (70%), English Setters (5%) and
Collies (rough coated) (20%). The main reason for this condition is
hereditary (autosomal recessive) and involves immune-mediated damage
of the pancreas. Due to this reason, there is possibility of
"pancreatic acinar atrophy" (PAA), where the pancreas simply is
wrinkled and useless. A lack of effective pancreatic exocrine
secretion in the small intestine leads to EPI.
Other probable causes for canine EPI are pancreatic neoplasia,
repeated acute or subacute pancreatitis, and chronic pancreatitis.
Symptoms Animals with exocrine pancreatic insufficiency
often show weight loss despite having a normal or increased appetite.
Many dogs with EPI will have excessive appetites, even for things they
normally would not eat, including their own feces. Diarrhea is often
present, but will vary in consistency and frequency. Grey colored,
oily appearing stools are the classic finding for EPI in young dogs.
Increased rumbling sounds are often heard from the abdomen, and many
affected animals will pass increased amounts of gas. Occasionally, a
long history of intermittent gastrointestinal signs like vomiting,
diarrhea, and reduced appetite will be present if EPI is due to
recurrent bouts of pancreatitis.
Diagnosis The key diagnostic test for exocrine pancreatic
insufficiency is called the serum trypsin-like immunoreactivity test,
or TLI. The affected animal's blood sample for this test should be
drawn after at least a twelve-hour fast. A low value on this test,
accompanied by symptoms consistent with EPI, virtually confirms the
Routine bloodwork and other laboratory tests may
help establish the diagnosis of concurrent diseases, but are generally
not helpful in diagnosing exocrine pancreatic insufficiency per se.
Mild liver enzyme changes, and low serum cholesterol levels may be
seen with EPI, but other significant test findings indicate clinical
processes other than, or in addition to, EPI.
Treatment The main treatment for exocrine pancreatic
insufficiency is the administration of enzyme replacements that are
given with each meal. If the diagnosis of EPI is correct, and if
sufficient enzyme supplement is provided, diarrhea will begin to
resolve in a few days, followed by gradual weight gain in most dogs.
It is very important to establish the diagnosis of EPI before starting
pancreatic enzyme replacement therapy. Enzyme replacement can be
expensive, and usually must be given for the rest of the patient's
life. Some animals with diarrhea and a provisional diagnosis of EPI
are treated with pancreatic enzyme replacements even when the
diagnosis of EPI has not been confirmed. These animals may have
resolution of their diarrhea for reasons other than enzyme
replacement. If their response to treatment is incorrectly interpreted
as confirming the existence of pancreatic insufficiency, they may be
kept on an expensive and potentially unnecessary treatment for a long
Once an appropriate dose is found that controls the
symptoms, the enzyme dose can be reduced until the lowest dose that
maintains control is identified. The powder form of enzymes is
generally more effective than tablets, although the latter are easier
Some animals do not respond appropriately to enzyme replacement alone.
These patients may benefit from medications that augment enzyme
replacement therapy. Certain drugs that block H-2 receptors in the
stomach may increase enzyme replacement effectiveness by preventing
breakdown of the enzymes in the stomach.
Some dogs seem to do better when they are fed a low fat, low fiber,
highly digestible diet, but most dogs do not need specific dietary
treatment for EPI. Oral vitamin E supplementation or intramuscular
injections of vitamin B-12 may be administered to restore serum
concentrations of these substances in dogs with EPI. Although such
deficiencies have been documented in EPI, it is not known if they are
significant. Rarely, dogs with these vitamin deficiencies that do not
respond to enzyme replacement alone will do better when these
deficiencies are corrected. Antibiotics may be helpful in some dogs if
excessive bacterial growth in the intestines has occurred.
Prognosis Treatment of exocrine pancreatic insufficiency
is usually necessary for life. Most dogs with EPI due to pancreatic
acinar atrophy respond well to enzyme replacement alone, and have a
good long-term prognosis. Although affected dogs do not always regain
the weight they lost, most of them develop normal stools and no longer
continue to lose weight. Animals requiring additional medications to
boost the effectiveness of enzyme therapy generally do well.
In cats and in older dogs with EPI due to chronic pancreatitis, the
outcome is much less predictable. If other conditions are present,
particularly diabetes mellitus, then the prognosis may depend more on
the ability to treat these complicating factors successfully.