Exocrine Pancreatic Insufficiency (EPI) in Dogs and Cats
The pancreas is an organ that has many functions, including producing enzymes to help digest food from what is called the ‘exocrine’ portion of the pancreas (there is also an ‘endocrine’ portion). EPI is a syndrome where the pancreas does not produce or secrete enough of these enzymes. This decreases the body’s ability to digest food, and in turn, reduces the amount of nutrition able to be absorbed.
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Causes of Exocrine Pancreatic Insufficiency in Pets
1. The most common cause of EPI in German Shepherds, Rough Collies, and Eurasian breeds is atrophy of the acinar cells of the pancreas
- Seen in young dogs
2. Chronic pancreatitis can lead to EPI in other dog breeds and cats
- Animals with EPI due to chronic pancreatitis may also have diabetes mellitus, as insulin is also made by the pancreas
- The average age of occurrence is middle-to-elderly dogs and cats
3. Much less commonly, in both dogs and cats, masses/tumors of the pancreas or outside of the pancreas that obstruct the pancreatic duct can lead to EPI
Clinical Signs of EPI in Dogs and Cats
- Polyphagia (consuming food in excess/increased appetite)
- Weight loss (even while eating anything and everything in sight) and vitamin deficiency
- Large amounts of stool, usually loose and foul-smelling
- Steatorrhea: excess amounts of fat in the stool due to not being properly absorbed by the intestines. This causes stool to appear pale tan in color (instead of a darker brown)
- Vomiting and anorexia (not eating) may be caused by other conditions as a consequence of EPI
Diagnosing EPI in Dogs and Cats
A blood serum TLI test (trypsin-like immunoreactivity) showing a concentration of ≤2.5 mcg/L in dogs or ≤8.0 mcg/L in cats means they have Exocrine Pancreatic Insufficiency. There is also a test for the presence of a pancreatic enzyme called elastase in the stool. However, this can be unreliable to diagnose EPI in dogs with chronic or co-existing gastrointestinal disease.
A blood test for cobalamin (vitamin B12) and folate levels should also be performed, as low B12 can lead to a poor prognosis for EPI patients.
Treatment Options for Pets with Exocrine Pancreatic Insufficiency
Treatment is chronic/lifelong. Your vet will prescribe your pet a pancreatic digestive enzyme powder (or tablet/capsule) to mix into your pet’s meals daily. Your vet should prescribe the amount of enzyme and monitor progress until the lowest amount needed to maintain a healthy pet has been ascertained. This may take weeks to months, depending on each animal and their condition when first presented to the vet. You may also discuss feeding raw pancreas as an alternative to enzyme powders with your vet. Sadly, many animals may have this condition and it goes undiagnosed or misdiagnosed for some time before treating it properly.
Supplementing your pet’s pancreatic enzymes will stop clinical signs but does not normalize the absorption of fats. Although there are low-fat diets that may help decrease this problem, in turn, the pet may develop fat-soluble vitamin deficiencies. Diets with fermentable fiber such as beet pulp are preferred over diets with insoluble/nonfermentable fiber, which can interfere with pancreatic enzyme activity. Discuss what diet to feed your pet with your veterinarian.
Deficiencies in cobalamin (vitamin B12) occur due to decreased absorption without the help of ‘intrinsic factor’, an exocrine pancreatic enzyme whose production is decreased due to damaged cells. Vitamin B12 can be supplemented with injections and/or oral supplements. Injections are often preferred since the intestinal tract may not absorb the B12 well enough.
If animals don’t respond to these treatments, they may have other gastrointestinal illnesses that need to be addressed and treated, such as an imbalance of bacteria in the intestinal tract, inflammatory bowel disease, and more.
Pets that are diagnosed early and treated appropriately and consistently can live a full, long, and happy life just like a pet without EPI.
Preventing Exocrine Pancreatic Insufficiency
Although you cannot prevent the genetics leading to the development of EPI in young dogs of certain breeds, you can certainly try your best to prevent pancreatitis in ALL pets, and therefore chronic pancreatitis, and potentially EPI. Avoid feeding your pet any buttery or oily table scraps, any high-fat content foods, and always feed a balanced pet food appropriate for your pet’s species and life stage.
Check out our articles on feeding dogs and cats!
When should you contact a veterinarian?
If you feel that your dog or cat is eating voraciously but not gaining weight or losing weight, if your pet has any vomiting, diarrhea, change in stool color, or change in appetite, please see your vet as soon as possible. Pets with untreated EPI will become extremely sick and can starve and die, even while being fed.
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