A Potentially Unknown Killer

Exocrine Pancreatic Insufficiency (EPI) is a potentially life-threatening disease in some dogs, yet most dog owners know very little about it and a lot of contradictory information has been published. EPI occurs when the part of the pancreas (acinar tissue) that produces digestive enzymes no longer functions properly.

As a result, the dog can’t digest its food. That’s why an EPI dog will literally starve to death without proper care. Even good veterinarians may not recognize EPI since it’s not a common disease. It’s estimated that more than half the cases occur in German Shepherd Dogs (GSDs) or dogs that are closely related to GSDs, such as Shiloh Shepherds, but any breed can get EPI.

EPI is sometimes also referred to as PAA (Pancreatic Acinar Atrophy), Pancreatic Hypoplasia, Malabsorption, or Malassimilation. There is no cure, although for unknown reasons a very tiny percentage of dogs diagnosed with EPI return to normal after a number of months. Some EPI dogs stabilize fairly quickly and are relatively easy to maintain; others have a very difficult road filled with constant challenges. Set-backs are not unusual. However, with proper care, many EPI dogs live long, full, and normal lives.

What Does The Pancreas Normally Do? The pancreas has 2 functional parts:

1. The Endocrine: Secretes hormones like insulin and glucagon, which are essential for the metabolism of carbohydrates and regulate blood sugar.

2. The Exocrine: Consists of units called acini (one of the small saclike dilations composing a compound gland) that produce and secrete enzymes to help digest food. With EPI, there is gradual wasting away of the acini. Clinical signs do not develop until most of the acini are gone. As dogs lose the ability to digest protein, symptoms such as weight loss despite an increased appetite and diarrhea will appear.

Can My Pet Get EPI?

Young adult dogs, especially German Shepherds, are most likely to be affected with PAA-associated exocrine pancreatic insufficiency. Older dogs affected by EPI will usually develop the disease as a consequence of endstage chronic pancreatitis.

How Does My Pet Get EPI?

Pancreatic acinar atrophy (PAA), is the most common cause of exocrine pancreatic insufficiency in dogs. It is common in young adult dogs, but not recognized in cats. The cause for PAA is still not known. Possible causes include: Nutritional imbalances, pancreatic duct obstruction, toxins, interruption of blood flow to the pancreas, viral infection, immune system abnormalities, and defects in pancreatic development or enzyme secretion.

End-stage inflammation of the pancreas, or pancreatitis, may also result in EPI. When this is the case, diabetes mellitus in dogs may also be seen due to damage to the endocrine portion of the pancreas. Pancreatitis is more commonly the cause of EPI in older dogs.

End-stage inflammation of the pancreas, or pancreatitis, may also result in EPI. When this is the case, diabetes mellitus (a group of metabolic diseases characterized by high blood sugar (glucose) levels, that result from defects in insulin secretion, or action, or both) in dogs may also be seen due to damage to the endocrine portion of the pancreas. Pancreatitis is more commonly the cause of EPI in older dogs.

How is EPI Diagnosed?

Clinical Signs: Clinical signs associated with exocrine pancreatic insufficiency include weight >loss, polyphagia (excessive hunger), coprophagia (consumption of feces), pica (appetite for substances largely non-nutritive (e.g., clay, coal, soil, feces, chalk, paper,etc.) diarrhea, increased borborygmus (bowelsounds, the gurgling, rumbling, or growling noise from the abdomen), and flatulence (toots!). Routine diagnostic tests eliminate some of these as possibilities.

Once EPI is suspected, there are specific laboratory tests that can be used for a diagnosis.

There are 3 major types of tests for EPI:

1. The Serum Trypsin-like Immunoreactivity Test: A blood test is the biggest breakthrough in the diagnosis of Exocrine Pancreatic Insufficiency so far.

2. The Fecal Protease Test: A stool sample is tested for protein digesting enzymes.

3. The Fecal Elastase Test: The newest test and it is only available for dogs. A single fecal sample is needed although sometimes normal dogs will test negative for Elastase. This means that EPI can be ruled out when the Elastase test is positive but not confirmed when the Elastase test is negative.

What is The Prognosis?

Treatment of EPI is usually necessary for life. Most dogs with EPI due to pancreatic acinar atrophy respond well to enzyme replacement alone, and have a good long-term prognosis. While dogs who have suffered weight loss do not always regain it, most of them will no longer continue to lose weight. Animals requiring additional medications to boost the effectiveness of enzyme therapy generally do well. In cats and in older dogs with EPI due to chronic pancreatitis, the outcome is much less predictable. If other conditions are present, particularly diabetes mellitus, then the prognosis may depend more on the ability to treat these complicating factors successfully.

What Is The Treatment?

Some treatments available and some things you can do on your own.

• Enzyme replacements: Diarrhea will begin to resolve in a few days, followed by gradual weight gain in most dogs.

• Augment enzyme replacement therapy: For pets who do not respond appropriately to enzyme replacement alone. Certain drugs that block H-2 receptors in the stomach that may increase enzyme replacement effectiveness by preventing breakdown of the enzymes in the stomach.

• A low fat, low fiber (less than 4%), highly digestible diet - grain-free kibble, home-cooked, raw food or a combination. Oral vitamin E supplementation or intra muscular injections of vitamin B-12 may be administered to restore serum concentrations of these substances in dogs with EPI. Dietary supplementation with digestive enzymes is effective even though most of the supplement given is digested in the stomach along with other dietary proteins. The little bit that survives the acid bath of the stomach and its own protein-digesting chemicals turns out to be enough to stop the diarrhea and enable the patient to actually gain some weight.

• Raw pig or beef pancreas, the best treatment, but may be difficult to obtain in some places because of local food regulations.

• Plant-based enzymes, least effective but used if dog has pork or beef allergies.

• Supplement food with medium chain fats, easily absorbed by an EPI’r such as coconut oil.

• Wild salmon oil is widely used (1) reduces inflammation (2) promotes good coat and skin.. alleviates dry, brittle and itchy conditions.

• Slipper elm (herb) powder is used on a temporary basis to help sooth irritated intestines. It’s mucilage substance coats intestines allowing irritation to heal.

• Many times there is a Vitamin E deficiency and it needs to be supplemented. Zinc supplements are also sometimes administered but only under a vet’s guidance.

• If there is bleeding check for rare but sometimes possible Vitamin K depletion.

A response to therapy is generally seen within a week. Response can be excellent, however, about 1 in 5 dogs will simply not respond well. Many never regain a normal weight.

Secondary Conditions to epi:

• SIBO (Small Intestinal Bacterial Overgrowth) is when the bad bacteria overtakes the good bacteria in the tissue lining of the small intestine. Treat with 30 day regiment of with antibiotics Tylan or Metronidazole.

• PROBIOTICS may be needed to be added to the diet either after an antibiotic regiment to replace good gut flora, or during antibiotic treatment 4 hours AFTER antibiotics are given.

• COBALAMINE (B12) and folate depletion. Treat with B12 injections.

The Good News: A response is generally seen within a week of beginning therapy. Response can be excellent, however, about one in 5 dogs will simply not respond well. Many never regain a normal weight.

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