If your dog is constantly losing weight, even though he's eating more than usual, has regular bouts of diarrhea, and seems generally unhappy and uncomfortable, he may be suffering from exocrine pancreatic insufficiency (EPI). Exocrine pancreatic insufficiency in dogs is a condition that results in insufficient synthesis, secretion, and release of pancreatic enzymes into the small intestines by the exocrine pancreas. Left untreated, EPI can cause serious health problems for dogs. Fortunately, early diagnosis and treatment with exogenous pancreatic enzymes can often restore your dog to good health.
What are the normal functions of the pancreas in dogs?
The pancreas is a small, but important, gland located near the stomach. It plays a crucial role in digestion, by producing digestive enzymes that break down food into nutrients the body can use. The pancreatic enzymes are released into the small intestines, where they help to digest proteins, carbohydrates, and fats. If the pancreas doesn't produce enough enzymes, or if they don't reach the small intestines due to exocrine pancreatic insufficiency, the dog will not be able to absorb essential nutrients from his food. This can lead to weight loss, malnutrition, and other health problems. The other important function of the pancreas is to produce and release insulin which is very important for blood sugar regulation. If the pancreas is unable to produce insulin, diabetes mellitus will occur.
What is exocrine pancreatic insufficiency in dogs?
Exocrine pancreatic insufficiency (EPI) is a condition that results in insufficient synthesis, secretion, and release of pancreatic enzymes into the small intestines by the exocrine pancreas. Left untreated, EPI can cause serious health problems for dogs, including weight loss, malnutrition, and other health problems. The mainstay of treatment for EPI is the addition of exogenous pancreatic enzymes to the dog's food. This helps to ensure that the dog's digestive system can properly absorb essential nutrients from its food.
A vitamin deficiency can result from malabsorption and maldigestion. Deficiencies in pancreatic enzymes result in impaired absorption and solubilization of fat-soluble vitamins A, D, E, and K. Patients with severe vitamin K deficiency may develop coagulopathy. Patients with EPI may also have difficulty absorbing cobalamin (Vitamin B12).
Additionally, there is a possibility that patients may suffer from concurrent small intestinal bacterial overgrowth (SIBO; also referred to as small intestinal dysbiosis). SIBO may result from a lack of antibacterial substances normally found in pancreatic secretions or from changes in immune function caused by malnutrition.
Breeds that are more prone to developing EPI include Cairn terrier, German shepherd, Akita, West Highland white terrier, Welsh corgi, border collie, Australian heeler, Shetland sheepdog, and Australian shepherd.
What causes exocrine pancreatic insufficiency in dogs?
Among the most common causes of EPI are pancreatic acinar atrophy (PAA), seen most often in dogs, and chronic pancreatitis, found in both dogs and cats. EPI occurs when pancreatic cells (acini) do not produce pancreatic enzymes or bicarbonate. The most common causes of this failure are a lack or destruction of pancreatic acini as well as chronic pancreatitis.
What are the symptoms of exocrine pancreatic insufficiency in dogs?
Studies have shown that the median age at the time of diagnosis was 4 years. Dogs with pancreatic acinar atrophy are generally diagnosed between the ages of three and six months, whereas dogs with EPI caused by other diseases tend to be in their middle years or older. Common clinical symptoms of dogs with exocrine pancreatic insufficiency include:
- Increased appetite
- Weight loss
- Poor body condition
- Unkempt and/or greasy hair coat
- Diarrhea that is pale and voluminous ("cow patty stools")
How is exocrine pancreatic insufficiency diagnosed?
EPI is diagnosed with blood tests. Specifically, blood tests that measure serum Trypsin-Like Immunoreactivity (TLI). The TLI test is the most reliable diagnostic test since it accurately detects low levels of TLI in dogs with clinical EPI.
Cobalamin (Vitamin B12) and folate measurement are also helpful diagnostic tests. Studies have shown that many dogs with EPI have low serum cobalamin (B12) levels and elevated folate levels in their blood.
How is exocrine pancreatic insufficiency treated in dogs?
Exogenous pancreatic enzymes added to the food are the cornerstone of treatment. It is possible to decrease dosages gradually in patients who show a good response to the drug until the smallest amount is necessary to maintain remission. Bovine or pork pancreatic extracts are also available (Viokase®, Pancreazyme®).
Dietary therapy also plays a role in the management of EPI in dogs. It is presumed that feeding a fat-restricted, fiber-restricted, and carb-restricted diet would be beneficial to digestion and nutrient absorption. According to research, fiber can potentially prevent the absorption of fat.
Vitamin supplementation is also an important treatment for EPI as cobalamin (Vitamin B12) levels are frequently low in dogs with EPI. Supplementation can be done either via subcutaneous injection with a tapering dose schedule to once monthly. Alternatively, oral vitamin B12 may be used and would be administered daily.
What is the prognosis of dogs with exocrine pancreatic insufficiency?
Loss of pancreatic cells in EPI is irreversible, so therapy is typically lifelong. However, dogs typically show improvement in clinical signs and weight gain within a few days of starting pancreatic enzyme therapy. With appropriate therapy and monitoring, dogs with EPI can live a normal lifespan.
Exocrine pancreatic insufficiency in dogs (EPI) is a condition that results in insufficient synthesis, secretion, and release of pancreatic enzymes into the small intestines by the exocrine pancreas. The most common causes of EPI are pancreatic acinar atrophy (PAA) and chronic pancreatitis. Dogs with EPI may exhibit symptoms such as increased appetite, weight loss, poor body condition, unkempt hair coat, and diarrhea. Blood tests can be used to diagnose EPI, and exogenous pancreatic enzymes added to the food are the cornerstone of treatment. Dietary therapy and vitamin supplementation are also important aspects of treatment for dogs with EPI. With appropriate therapy and monitoring, dogs with EPI can live a normal lifespan.