EPI (Exocrine Pancreatic Insufficiency) in dogs and cats

A lack of digestive enzymes leads to poor digestion of food. Enzymes are chemicals which break down molecules in our food, for example from proteins to their smaller building blocks called amino acids. These are key to allowing the body to use the food we eat in our bodies for growth and regeneration. Symptoms of EPI are only seen when more than 90% of the exocrine pancreatic function is lost.

What are the causes of EPI in dogs and cats?

EPI can be caused by several different processes and this will affect the age at which an individual pet is affected:

• Pancreatitis - a relatively common disease that causes destruction of the cells due to inflammation. Can occur in any age but more likely in middle aged to older animals

• Cancer - this causes destruction of the enzyme producing cells. More likely in middle aged to older animals

• Pancreatic Acinar Atrophy (PAA) - the number of cells producing the enzymes is reduced. Most common in young German Shepards, Eurasians and Rough Collies

• Pancreatic duct obstruction - obstruction of the connecting duct which delivers the enzymes from the pancreas into the gut. This causes build up of fluid in the pancreas and pressure on the cells, causing them to die

• Pancreatic aplasia or hypoplasia - a condition that pets can be born with (congenital) where the pancreas under develops, or doesn’t develop an exocrine part at all. Seen in young puppies, or genetic in certain breeds, including German Shepards, Labradors and St Bernards

Symptoms of EPI in dogs and cats

Symptoms of EPI are usually persistent, but sometimes can be intermittent. They include:

• Weight loss despite eating well and poor body condition

• Diarrhoea - often a large amount, smelly and greasy, sometimes pale in colour

• Poor coat condition

• Hunger (polyphagia) as they are not able to digest nutrients despite eating well

• Pica and coprophagia - eating faeces, sometimes their own faeces, and also items that are not considered edible such as stones

• Sometimes anorexia and vomiting are present but these are unusual

How is EPI diagnosed in dogs and cats?

If your dog has symptoms consistent with EPI, the easiest way to diagnose the condition is with a blood test, which tests for TLI (trypsin-like immunoreactivity), a marker for enzyme production.

Treatment of EPI in dogs and cats

Once the diagnosis has been reached then there are several steps in treating the disease:

• Supplementation of minerals and vitamins that may be deficient from ongoing malabsorption such as folate and cobalamin (vitamin B12). This is either in the form of injections or oral supplementation

• Addition of digestive enzymes to allow food to be properly broken down in the gut. These are either in a powder form, capsules or enteric coated (to protect the active agent from the stomach acid and protect the soft tissues of the gut from being damaged by the enzymes). Alternatively you could feed raw fresh pancreas but this isn’t convenient and it is hard to regulate the amount of enzymes they are receiving

• Low fat diets? Consult your vet to discuss dietary management options. Digestion still will not be 100% normal even with digestive enzyme supplementation, so dietary modification is required to help manage ongoing symptoms. If tolerated, you should try to feed a normal fat content. However, decreased fat content reduces fat soluble vitamins. Only if symptoms persist should you consider reducing the fat content. Another option is to keep the fat content the same but increase the amount of enzyme, or use an enteric coated product to make sure more of the enzyme reaches the gut where it is needed

• Treatment of concurrent illness - some dogs with EPI also have small intestinal dysbiosis or antibiotic responsive diarrhoea. These cases may need a course or life long use of treatment

Prognosis for EPI in dogs and cats

Though dogs and cats do not return to normal with management of EPI, they can be successfully treated so that they have a normal lifespan and quality of life. This is best done by regular health check ups, weight checks, and veterinary consultation to ensure treatment is suitable and symptoms are well managed.

When to see your vet?

• If your dog may have signs of EPI

• To discuss investigation and management of EPI