Exocrine Pancreatic Insufficiency

Your pet’s pancreas is one of the most important glands in the endocrine and digestive systems. The pancreas is located next to the stomach and small intestine. It is composed of two types of cells that provide critical functions:

• Endocrine cells produce insulin and hormones that regulate the body’s blood sugar level.

• Exocrine cells secrete digestive enzymes the body needs to properly digest and absorb nutrients.

Normally, the pancreas secretes inactive enzymes into the small intestine, where they are activated for digestion. In some dogs and cats, inactive enzymes become inappropriately active in the pancreas itself and create an inflammatory condition known as pancreatitis. Essentially, the pancreas attacks itself.

Pancreatitis can be a one-time problem or a chronic condition; it can also be life-threatening. Fortunately, most pets with uncomplicated pancreatitis recover after a single episode and do well, as long as high-fat foods are avoided or they follow a special diet.

Other pets face another pancreatic problem called Exocrine Pancreatic Insufficiency (EPI). In these pets, the pancreas fails to produce and secrete necessary digestive enzymes and can result in severe malnutrition in a short period of time.

EPI is a condition that prevents the body from absorbing food and nutrients. In a pet with EPI, the pancreas fails to produce and secrete digestive enzymes that help to break down carbohydrates, fats and protein. Without a steady supply of these vital enzymes, the body is unable to absorb nutrients, and pets with EPI can literally starve — no matter how much food they eat. If EPI goes untreated, the lack of nutrients needed for growth, renewal, and maintenance will seriously affect a pet’s health eventually leading to malnutrition, starvation and, in the worst cases, death.

EPI is most often found in dogs, although advances in testing have shown the disease also affects cats more than previously thought.

In dogs, EPI is most often caused by atrophy of specific cells in the pancreas (known as acinar cells) that produce digestive enzymes.¹ This is why EPI is sometimes referred to as Pancreatic Acinar Atrophy (PAA). EPI is most commonly caused by an auto-immune condition of the pancreas, but can also be found in pets with chronic pancreatitis or exocrine tumors of the pancreas.

The signs of EPI are associated with maldigestion and vary depending on the severity and duration of the disease.² Weight loss despite an increased appetite is the hallmark sign of EPI. Other symptoms that may be noticed include large volumes of pale stool, flatulence and burping (borborygmi).

Some pets face a greater threat of EPI. Although cats and many different breeds of dogs have been diagnosed with EPI, researchers have learned that all breeds are at risk although some breeds are considered to be of higher risk²:

• German Shepherd Dogs

• Rough-coated Collies

• English Setters

If EPI is suspected, a veterinary visit is advised. History and signalment will provide information to guide proper testing to rule out other potential causes. Blood work will indicate if the body organs are working optimally and a fecal test will indicate if a parasite or infection is present. A serum Trypsin-like immunoreactivity test (TLI) is submitted to an outside lab for definitive diagnosis of EPI.³ In a pet with EPI, the trypsin and trypsinogen found in normal animals will be dramatically reduced. The combination of all of these diagnostic tools will provide the most complete picture of the pet’s health and guide the veterinarian’s treatment recommendations.

Relief from EPI starts with providing key essential enzymes (lipase, amylase and protease) to digest nutrients as the pet eats.⁴ The primary treatment for pets with EPI is to supplement each meal with these prepared pancreatic enzymes. Numerous enzyme extracts are available; however, they are NOT all alike. The supplements may vary widely in enzyme content and in their ability to be absorbed by the intestinal tract. Veterinarians will select and recommend trusted enzyme replacement supplements. Dietary modification of frequent small meals  highly digestible low fat and fiber food is recommended. Additionally, vitamin B12 supplementation, addition of a probiotic, and the use of antibiotics may be recommended in some cases. Remember that EPI is managed and not cured.

Two websites, www.epi4dogs.com and www.veterinarypartner.vin.com, are reliable sources for additional information regarding exocrine pancreatic insufficiency.

1. Wiberg ME, Saari SA, Westermarck E. Exocrine pancreatic atrophy in German Shepherd dogs and Rough-coated Collies: an end

result of lymphocytic pancreatitis. Vet Pathol 1999; 36:530-541.2. “Starving, Not Starved: Exocrine Pancreatic Insufficiency (EPI) prevents absorption of food,” Whole Dog Journal, March 2009. 3. Stanley L. Marks, “Pancreatic Disease: Exocrine Pancreatic Insufficiency (EPI).” Virbac Proceedings, April 2012. 4. Rutz GM,Steiner JM, Williams DA (2002) Available on request from author. Reprinted in IVIS with the permission of the Congress Organizers.Proceedings of the 33rd World Small Animal Veterinary Congress 2008.