Exocrine Pancreatic Insufficiency (EPI) Syndrome in Dogs & Cats
Exocrine Pancreatic Insufficiency (EPI) is a syndrome that is characterized by a lack of effective pancreatic exocrine secretion in the small intestine.
EPI is not a rare clinical condition in both dogs and cats. The most common cause of EPI in dogs is pancreatic acinar atrophy (PAA). The etiopathogenesis of PAA has not yet been determined. Although PAA has been reported in many breeds, a familiar predisposition exists in German Shepherd dogs, collies and English setters. Chronic pancreatitis, repeated episodes of acute or subacute pancreatitis and pancreatic neoplasia are also reported as a cause of canine EPI. In cats chronic pancreatitis is the most common cause of EPI. Eurytrema procyonis flukes attached in the pancreatic ducts have been reported as a cause of EPI in some cats.
EPI is characterized by loss of the majority of the functional reserve capacity of the exocrine pancreas. Therefore, a decrease of intraduodenal concentration of pancreatic enzymes, bicarbonate, antibacterial and enteric mucosal “trophic” factors, as well as pancreatic and GI regulatory peptides are observed. Finally, malassimilation of nutrients (fats, carbohydrates, proteins, vitamins, trace elements), small intestinal bacterial overgrowth, morphologic and functional changes of small intestine are produced as a result of EPI.
Dogs and cats with EPI usually have a history and clinical signs of small bowel diarrhoea with voluminous, semiformed, yellowish or gray feces, polyphagia, pica especially in young dogs with inherited EPI, extreme weight loss, intestinal borborygmus, and dermatological problems such as poor coat and seborrhoea sicca. Anorexia has also been observed in some cats.
Although the symptoms of EPI are typical, they are not pathognomonic. In dogs, the differential diagnosis includes the small intestinal disorders that cause malabsorption or maldigestion (intestinal parasites, inflammatory bowel disease, small intestinal villus atrophy, lymphangiectasia, diffuse small intestinal malignancies, short bowel syndrome, changes of the intestinal brush border enzyme activities). Differential diagnosis in cats includes intestinal parasites, inflammatory bowel disease, hyperthyroidism, chronic renal failure and triaditis (chronic pancreatitis-cholangiohepatitis-inflammatory bowel disease) and intestinal lymphoma.
Routine haematology results are usually within normal limits. Liver enzyme activity such as serum alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase are mildly increased and may reflect hepatocyte damage secondary to increased uptake of hepatotoxic substances through an abnormally permeable small intestinal mucosa or hepatic lipidosis. Concurrent hyperglycemia or abnormal glucose tolerance test are not common in dogs with EPI. Some dogs have subnormal cobalamin and high folate concentration. Cats with EPI have decreased serum cobalamin and folate concentration. Serum vitamin E and A concentrations are decreased in dogs, while serum vitamin K is decreased in some cats with EPI. Absorption of trace elements in EPI may be promoted or inhibited secondary to either loss of specific factors affecting absorption or to a change in intraluminal pH. In experimentally induced EPI in dogs, as well as in some clinical cases, serum total iron concentration and % transferring saturation have been increased, while serum copper and zinc concentration have been decreased.
What is Exocrine Pancreatic Insufficiency (EPI)?
EPI stands for exocrine pancreatic insufficiency. EPI in dogs is a health issue that has serious effects on the pancreas. It happens when most of the cells that produce digestive hormones don’t function normally.
The pancreas is a small organ located under a dog’s stomach, next to the beginning of the small intestine (the duodenum). The pancreas has two vital functions:
- Producing insulin, the hormone that moves sugar from the bloodstream into cells.
- Producing digestive hormones, including lipase to break down fat, proteases to break down protein, and amylase to break down starch.
Different cells within a dog’s pancreas are responsible for performing each of these functions. When enough insulin-producing cells are damaged, dogs develop Type I diabetes. And when the cells that produce digestive hormones aren’t working, the result is EPI in dogs.
EPI is a condition in which your pet’s pancreas is unable to make enough digestive enzymes to break down the food they eat. This means that your pet cannot digest and absorb nutrients from their food, causing them to become malnourished.
Unfortunately, there’s no cure for exocrine pancreatic insufficiency in dogs. Once the pancreas is damaged to the point that symptoms of EPI develop, you will need to give your dog pancreatic enzyme supplements and possibly other treatments for the rest of their life. However, with proper management, your dog can live a healthy and happy life.
What are the signs that your pet may have EPI?
The most common signs of EPI in dogs include:
- Loose “pulpy” feces, which may have a clay-color
- Weight loss despite a good appetite
- Occasional vomiting
- Poor hair coat (hair is dry and brittle)
- Eating feces (poop) or other objects.
Clinical signs can be more subtle in cats than in dogs and may include:
- Weight loss
- Poor hair coat (hair is dry and brittle)
- Either an increased or decreased appetite
- Vomiting and watery diarrhea are less common in cats than in dogs.
Your pet may also show other clinical signs depending on the underlying cause of EPI.
What are the causes of EPI?
The most common cause of EPI is a lack of the cells that make digestive enzymes. Cells can be lacking due to wasting away (atrophy), damage from inflammation, a blockage of the pancreatic duct, or other causes. In most cases, there are no digestive enzymes at all; however, in rare cases, just one enzyme may be missing in your pet.
Any dog or cat can develop EPI. Some dog breeds may be more likely to develop EPI than others, including young German Shepherds, Rough-Coated Collies, and Eurasiers. Cavalier King Charles Spaniels may be predisposed to EPI following chronic inflammation of the pancreas, also known as pancreatitis. Domestic shorthair cats may also be more likely to have EPI.
What tests are required?
After getting a complete history and performing screening tests to rule out other problems, a simple blood test can be used to diagnose EPI. This test is called trypsin-like immunoreactivity (TLI) and its concentration is low in dogs or cats with EPI. Your veterinarian may also evaluate your pet’s feces (poop) for the presence of fat and to rule out parasites. The TLI test is recommended to be performed along with measurement of cobalamin (B12) which is a vitamin that is commonly low in pets with this disease.
What is the treatment for EPI?
Daily pancreatic enzyme supplementation is the standard treatment for EPI. Your vet will prescribe these supplements, which you will then add to your pet’s food to help ensure they get the enzymes they need. Supplements usually come as a powder, capsule or tablet. Side effects of enzyme supplementation are rare but may include bleeding of the mouth. When this happens, some veterinarians will prescribe raw, chopped beef or pork pancreas for your pet to eat.
Your vet may also recommend that you change your pet’s diet. Typically, novel protein or hydrolyzed diets are prescribed. Novel protein diets use protein sources your pet hasn’t seen before such as kangaroo, venison, alligator, etc. Hydrolyzed diets are made so that the proteins themselves are so small that they are unlikely to cause an adverse food reaction. Cobalamin (B-12) supplementation is also commonly prescribed in both dogs and cats with EPI.
If your pet does not respond to standard treatment, your veterinarian may try a different brand or formulation of pancreatic enzymes or may alter the dose until they find the best treatment for your pet. Occasionally other medications (gastroprotectants, probiotics, or antibiotics) may also be used to improve your pet’s response. Your veterinarian may also look for more evidence of other diseases, such as intestinal problems, which could occur at the same time as EPI and may cause similar symptoms.
What is the outcome after treatment?
Most pets with EPI have a good quality of life and a normal life expectancy with ongoing treatment. Your pet should get regular check-ups to ensure the treatment is working and that they are getting the nutrition they need throughout their life.
Compiled & Shared by- Team, LITD (Livestock Institute of Training & Development)
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