Exocrine Pancreatic Insufficiency: EPI in Dogs

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A big part of the job of a dog's pancreas is to produce enzymes that break down the fats, carbohydrates, and proteins in food ingested. When the pancreas isn't producing enough of those enzymes, the condition is called exocrine pancreatic insufficiency.

EPI does not affect the endocrine functions of the pancreas, which are to produce insulin and other hormones.

Causes of EPI in Dogs

Exocrine pancreatic insufficiency can have a few different causes:

• Idiopathic acinar atrophy: This unknown mechanism of destruction of pancreatic cells is the most common cause of EPI in dogs.
• Chronic pancreatitis that destroys the exocrine pancreatic cells.
• Adenocarcinoma (cancer) that obstructs the ducts that carry the enzymes to the small intestine.
• Injury to the pancreas can traumatically damage the cells.

EPI is thought to have a genetic component in German shepherds, which is the breed it is diagnosed in the most.

Signs of Exocrine Pancreatic Insufficiency in Dogs

In EPI, the lack of proper digestive enzymes leads to maldigestion, malabsorption of nutrients, and diarrhea. Basically, despite eating well, the dog is starving. The signs that may be noticed include:

• Weight loss with normal or increased appetite
• Chronic diarrhea
• Stool may look watery, fatty, or very soft and bulky
• More stool than normal
• Lots of flatulence and grumbly intestines
• Dog may develop coprophagia (stool eating) that was never noted before or pica (eating dirt or other non-food items)
• Thin
• Decreased musculature
• Poor hair coat

Diagnosis of EPI in Dogs

Other causes of malabsorption like small intestine disease or chronic intestinal parasites will need to be ruled out.

A canine trypsin-like immunoreactivity test (cTLI) is the best diagnostic test available for EPI. Serum TLI concentrations are dramatically low in dogs with EPI.

There are other tests available to assess exocrine pancreatic function, including fecal proteolytic activity tests, but multiple fecal samples over a few days need to be collected for that test.

Treatment of Exocrine Pancreatic Insufficiency in Dogs

Diet modification is an essential part of therapy for EPI. The dog should be fed a low fat, low fiber, highly digestible diet. Dogs that are already severely malnourished may need some supplements for a period.

Pancreatic enzymes in a powdered form that can be added to food are the treatment of choice for EPI. These enzymes replace those not being made by the pancreas. Once the dog responds positively to the supplement, the amount given can be gradually reduced until the lowest dose that works well for the dog is found. If the dog doesn't respond after a week of treatment, antibiotics are generally added.

Lifelong therapy will be required, but the prognosis is good if the dog is kept on enzymes and the proper diet.

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