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CANINE EXOCRINE
PANCREATIC INSUFFICIENCY
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EPI is most
commonly seen in German Shepherd Dogs but can also affect Collies and
English Setters. Exocrine Pancreatic Insufficiency (EPI) refers
to the failure of the pancreas to secrete digestive enzymes normally
which aid digestion. This stops the body from absorbing nutrients
from food. EPI is often characterized by diarrhea and weight
loss, often despite the presence of a normal or increased
appetite. EPI in dogs is usually due to a condition called
pancreatic acinar atrophy, or PAA. EPI can be diagnosed on the
basis of a blood test, and is usually treated with administration of a
pre-determioned dose of powdered pancreatic enzyme replacements, which
usually result in an
improvement of the symptoms. If EPI is accompanied by diabetes or
other conditions, it can be more difficult to treat. Once
treatment has begun a dog should start to gain weight within four weeks
and his appetite should return to normal.
What is Exocrine Pancreatic Insufficiency?
A Look at Pancreatic Insufficiency
Treatment Of a GSD with
EPI
GSD with P.I.
Pigs Pancreas and the E.P.I. Dog
Exocrine Pancreatic Insufficiency
The pancreas has 2
functional parts. The endocrine part secretes insulin and glucagon,
which
are essential for the metabolism of carbohydrates. The exocrine
part consists of units called acini that produce and secrete enzymes
essential for the digestion of protein, into the small intestine.
With exocrine pancreatic insufficiency (EPI), there is gradual wasting
away (atrophy) of the acini. Clinical signs do
not develop until most of the acini are gone. As dogs lose the ability
to digest protein, they progressively lose weight despite a voracious
appetite.
How is exocrine pancreatic insufficiency inherited?
This is thought to be an autosomal recessive trait in the German
shepherd.
What breeds are affected by exocrine pancreatic insufficiency?
There is a genetic predisposition to this disorder in the German
shepherd. It also occurs sporadically in dogs of other breeds.
For many breeds and many disorders, the studies to determine the mode
of inheritance or the frequency in the breed have not been carried out,
or are inconclusive. We have listed breeds for which
there is a consensus among those investigating in this field and among
veterinary practitioners, that the condition is significant in this
breed.
What does exocrine pancreatic insufficiency mean to your dog &
you?
Affected dogs lose weight despite voracious appetites, and usually pass
large amounts of semi-formed feces. They often
eat their own stools, or other inappropriate substances.
Some dogs with this condition do not show these typical signs, and may
experience intermittent watery diarrhea or vomiting.
How is exocrine pancreatic insufficiency diagnosed?
The clinical signs of weight loss and increased appetite may occur with
malabsorption of nutrients due to a variety of causes. Routine
diagnostic tests will eliminate some of these as possibilities. Once
EPI is suspected, there are specific laboratory tests that
will diagnose this disorder.
For the veterinarian: Assay of serum trypsin-like immunoreactivity
(TLI), bentiromide absorption test, and quantitative assay of fecal
proteolytic activity (azocasein substrate) are sensitive tests for EPI
in the dog. TLI is also a specific test, and requires only 1 sample for
diagnosis. (Check with your diagnostic laboratory).
How is exocrine pancreatic insufficiency treated?
Although this disorder can not be cured, management is generally fairly
straightforward. Powdered pancreatic enzyme extract is mixed in with
each meal. Within a few days, your dog's appetite and stools should
become more normal, and s/he will begin to gain
weight. Your veterinarian will work with you to determine the best
regime
(what dose of extract, 1 or 2 feedings per day) to keep your dog
free of clinical signs. Enzyme supplementation of your dog's food will
be necessary for life.
Some dogs fail to gain weight despite treatment, and
this may be due to chronic bacterial overgrowth. A course of antibiotic
therapy may be useful in these dogs.
Breeding advice
Affected dogs, and in German shepherds, their parents (considered
carriers) and siblings (suspect carriers) should not be used for
breeding.
FOR MORE
INFORMATION ABOUT THIS DISORDER, PLEASE SEE YOUR VETERINARIAN.
copyright © 1998 Canine
Inherited Disorders Database. All rights reserved.
Revised: April 27, 2001.
This database is a joint
initiative of the Sir James Dunn Animal Welfare Centre at the Atlantic
Veterinary College, University of Prince Edward Island, and the
Canadian Veterinary Medical Association.
reprinted
with kind permission from:-
Alice Crook, DVM,Coordinator, Sir James Dunn
Animal Welfare Centre, Atlantic Veterinary College,University of Prince
Edward Island, 550 University Ave.Charlottetown, PEI C1A 4P3
Look at Pancreatic Insufficiency
Jane
James.
I have a gorgeous young male
GSD he is just 18 months old, weighs 45kg, very fit and active and if
it were not for the difficulty of getting handlers and the training to
'perform' (difficult when you are 70) he would be in the ring and
condition wise would be
in the cards.
The reason I am doing this spot of boasting is to show that not all
Pancreatic Insufficiency cases end up as walking skeletons and having
to be put down. Arnie is Pancreatic Insufficient (blood tested) and I
feel it is important to give the owners of newly diagnosed cases HOPE.
I am an old age pensioner and so I am short of money. Getting Arnie
blood tested, diagnosed, treated, initially with expensive drugs, cost
£300 (luckily I am insured) Now that I have got him 'balanced' he
costs me £15 a month for pigs pancreas (over and above normal
feed costs).
I am sure I am fortunate but I know many other PI dogs living good
normal rabbit chasing lives~ not all the cases I know about are GSD's
either!
Of course I can not see into the future with Arnie and maybe we will
become 'unstuck' ~ but that can happen to any dog at any time. My
wonderful Tanja had to be put to sleep with Cancer very suddenly.
Having HOPE that all can be well is very important. Before Arnie was
ill someone rang me in tears, his puppy had PI. At that time I thought
it was a fatal illness and I as good as told him this amongst my
sympathetic noises. I am haunted
as some weeks later, his puppy was put down. Perhaps if I had given him
some hope his puppy would be alive now.
Here is Arnies story to help others:
Arnie was bred by me from 2 very healthy parents. Certainly neither of
them had PI but Malcolm Willis in his
Genetics of the Dog mentions that PI is an autosomal recessive.
Arnie was a vigorous 'good dooer' and at 6 months weighed 44 kg. I
began to notice that he always seemed to pass about double the volume
of faeces compared to his sister. He seemed to be prone to attacks of
diarrhoea. By the time he was a year old his faeces were copious,
formed but soft with a terrible foul smell. At the same time Arnie had
a ravenous appetite and was loosing weight. He looked like an RSPCA
advert. His booster was due by now but the vet refused to do it. Arnie
was too ill. Instead he had a blood test for PI which proved to be
positive.
We started the treatment..... At this point I am not going into details
as I am not qualified to do so,
it's a matter for your vet. I am sure every case is different.
However. here are some points which I have learnt and which may help:
If you suspect PI go to the vet promptly, only a blood test can
diagnose PI. Delay will only let side
effects develop.
Never neglect diarrhoea. Treat immediately with STAT, Kaobiotics, bland
diet etc. Several times I have had
to starve Arnie who was already terribly thin. I get LECTADE (Calf
size) from my vet, it is a liquid feed to keep your dog going while his
tummy recovers from diarrhoea.
If your dog is debilitated keep him quiet
don't let him waste his precious strength running about. Funnily
enough these animals seem to have terrific energy even when they
are ill.
Your dog will be ravenous and it is not much good keeping him on a diet
and allowing him to eat all kinds of rubbish (Rabbit and bird droppings
seem most appealing)
Keep an accurate log of every meal, every
dose of treatment, every symptom, every faeces and also weight.
This is the vital key to what is doing your dog good and what
is not suiting him.
Dogs with this condition are very prone to diarrhoea so when
introducing anything do it gradually.
You will get a welter of conflicting advice with regards to diet!
Decide on a diet (with your vet) and
stick to it. Don't keep chopping and changing. Arnie has been
on chicken and rice plus SA37 for 6 months and in due course I want
to get him onto a good all-in-one.
Only change one thing at a time ~ this way you know what is causing
problems and what is not as the case may be. When you have your basic
diet you can find out what he needs in the way of doses of pancreas in
various forms. Faeces will indicate if you are on the right track.
One of the treatments is Pancrex Vet powder. I found, in the large
doses prescribed in the early days, that it gave Arnie diarrhoea. I
found I had to reduce the dose. I also found that 'Boots (the chemist)'
sell Pancrex-V-Forte tablets and these worked well, either with reduced
powder or alone.
If you are lucky enough to be able to get
pigs pancreas then this will work well but needs to be introduced
slowly 1 oz per feed working up to 6 or 8 ozs perhaps. It can be frozen
but not cooked. Thawing must be natural not heated or microwaved as
this destroys the enzymes. So its a good idea to freeze it in small
individual bags.
Hoping that someone is helped ~ we must dash off now Arnie is meeting
his friend Shadow for a lovely walk and rabbit chase. Shadow is PI too
and her mum helped with this article.
Stop Press:
Arnie is now on Wafcol Fish & Corn. He is fed 3 small meals a day
plus his lump of pigs pancreas (about 5 ozs) It took 4 weeks to change
from Chicken and Rice. he is
glowing with health and his faeces are normal.
******************
Treatment of a GSD with EPI
Bill Hughes
What is required is common
sense and dedication and a dash of luck. Over the past 7 years I have
gained experience of feeding a dog with EPI the hard way, but now its
easy with good results and an active happy 8 year old GSD.
First have the test done to confirm that your dog has EPI. Then keep a
logbook on what you feed and the result. Only ever change one thing at
a time. No 2 dogs are ever the same and what
suits one may not suit the other.
When changing over food types it is best to make
the change gradually over one or 2 weeks.
A cheaper medication/ come food than Pancrex Powder is pigs pancreas.
It must be kept frozen. Defrosting must be done the natural way, no
heat must ever be used and never put the pancreas in the microwave ~
heat of any sort will make it useless.
I only know of one dog who would not eat pigs pancreas.
I feed my dog 8 ozs of pigs pancreas per day, she has her first meal
between 7&8 am and the other meal between 5&6pm. Defrosting is
done overnight for the morning feed, and at 12 noon for the evening
meal.
Types of food that make up the meal are steamed chicken breast, tinned
tuna fish, lean raw braising steak, steamed rabbit (avoid all the fat)
all types of raw or steamed vegetables. One cube of garlic daily, and a
small tub of natural yogurt. Dry foods on
the market are plentiful so, if the first choice is not the right one,
then make a change. My choice is "Burns".
Food preparation ~ feed as for easy digestion by
feeding all food diced and NO large chunks. Give a variety of
food.
The average meal for my dog would be 4ozs pigs pancreas, 4ozs Burns
complete feed, 4 ozs mixed veg, 4 ozs steamed chicken, 2 desert
spoonfuls of natural yogurt. I have recently added to
this 1000mg of omega3 fish oil and 1000mg flax seed oil before each
meal.
Where to obtain pigs pancreas ~ A good butcher or abattoir where pigs
are slaughtered, or a pet meat supplier.
Editors note: And heres a photo of Bills dog Zara enjoying a
game on the agility equipment ~ as you can see,
she also plays golf:-)) 
Anyone Having Difficulty finding
an
outlet for pigs pancreas see a list of abatoirs
here.
Reprinted with kind permission from Bill Hughes. Bill Hughes is a
member of GSD League, White and Long Coat Show Society and GSD 2000
rescue and has a very good knowledge pertaining to Epi in
the GSD.
***********************
GSD
with PI
Hi,
Just wanted to e-mail someone with some information that may be of some
help.
After reading your article by Jane James on P.I., I decided to try and
get some Pig Pancreas for my GSD as he had just been prescribed some
enzyme powder from the vet at an absolutely extortionate price and
although the powder was proving efficient we could not afford to
continue with this for the rest of his life (he is 2 years old).
We have tried many different enzyme powders over the past 16 months
with varying degrees of success, but none has been anywhere near as
successful as the natural pig pancreas.
There are two things I would like to say. The first is that although
pig pancreas is not easy to obtain, it can be bought from large
Abattoirs and frozen.
I have managed to find a supplier called Muchmeats at Witney, and they
are extremely helpful, the meat comes already frozen and will keep in
the freezer for up to a year.
It is no more unpleasant to handle than any other meat from the
freezer, costs half the price of powdered enzymes, the dog absolutely
loves it and appears to be more effective than any man made preparation
on the market!
He is not requiring as much food, as he is obviously absorbing what he
needs from his diet now. He is not full of
wind, and he is now producing approx. 1/3 of the amount of faeces
that he did on the powders. I have also noticed that he is no
longer
ravenously hungry and has actually left some of his dinner on
a few occasions.
The second thing I wanted to say was that in the early days we tried
every type of dried food on the market and in the beginning even
chicken and rice did not work with him,
but a breeder told me to try Redmills Leader Adult which comes from
Ireland. I managed to get a bag of this (it is now sold in Jolleys
Pet Stores) and we have never looked back, and at £18.50 for
a 15 kg bag it is very affordable.
Everyone who sees our dog comments on how big and healthy he looks and
although he has this illness you would never guess it if you saw him!
I felt that I wanted to write to you as I really cannot believe how
much more effective the Natural pigs pancreas is compared with the
powders, and I do hope that Jane James's
article gets through to a lot more people with dogs with this
problem.
Regards
Lorraine Moore, Buckingham.
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Pigs Pancreas & the EPI dog…
I’d just like to pick up on a
couple of points mentioned by Joanne Kelly in order to put her mind at
rest.
Pigs Pancreas has been used for many years now in
order to control Epi, indeed checking back on my notes and talking
with local vets confirm that this has been the case up until at
least 20 years ago, before then most dogs were fed raw meaty diets
or table scraps before the onset of commercial, convenience foods
therefore
doing away with access to all types of offal.
The source product of Pancrex is Pigs Pancreas (in the UK), Cattle and
Pigs (in the USA), which is then freeze-dried, ground up and formulated
into either powders or pills, but it is expensive. However,
research is underway to develop synthetic digestive enzymes, which
hopefully will lower the price of treatment.
I can understand Joanne being enthusiastic about Pigs Pancreas and
congratulate both her and Bill for bringing it to
the fore but I feel Joanne’s comments are a little unjust as a lot
of animals can only be controlled by quote “the most horrendous form
of medication possible”, Pancrex vet pills/powders. I can only
conclude that her dog was one of the minority who do have adverse
effects
to these medications, either that or the dog was on a higher dosage
than needed as a high dose can cause diahorrea, cramping and
vomiting. As with Pigs Pancreas, it’s a case of getting the
dosage right.
What Joanne needs to realize is no two dogs are the same, to a lot of
affected dogs the pills/powders are the “be all and end all” this is
fact, same goes for dogs that are coping well on the natural version,
raw Pigs Pancreas.
However, I feel her opinion may be of cause for concern to any newly
diagnosed owners reading the article whose dogs are yet to
stabilise. These dogs will probably be on pills/powders as a vets
first priority when confronted with a newly diagnosed, seriously ill
dog, is to get the dog stabilised before considering the
natural option.
Many vets now will discuss all options & encourage clients to
explore all avenues, especially if they cannot afford expensive
replacement therapy. The vet-client relationship is a two way
street, your vet may not mention a natural treatment if
the client doesn’t ask what the alternatives may be.
May I also mention that Epi is now classed as an Auto Immune Disorder
of which there is an on-going study being undertaken at Cambridge
University, but this is not exclusively for Epi or the treatment of
Epi, it is a general study of all AI disorders.
I would be very interested to learn what research
Joanne mentions that is “going on, all with brilliant results”
as having dealt with Epi for the past 8 years, originally in the German
Shepherd and laterally medium/large sized working breeds, I am always
interested in new research.
As an AI disorder it is recommended that such dogs are not
re-vaccinated. More and more vets are advising that affected dogs
should have their titre levels (via a blood test) checked yearly to
check on the antibody levels, that way should any of the readings be
low the animal can get a single booster dedicated to that particular
disease.
I would also like to mention that some owners have been known to buy
enzyme replacement powders/pills from health food
shops in the belief that these are the same type of enzymes needed
to control Epi only to appear at the vets back to square one.
These enzymes although they are marketed to help digestive disorders do
not contain the special Pancreatic enzymes needed by an Epi dog.
It should also be noted that pigs pancreas should
not be fed to any animal who isn’t suffering from Epi as too many
enzymes can bring on the life threatening condition Pancreatitis.
As for Pancrex verses Pigs Pancreas, the natural version is always a
better option (and cheaper) but some dogs have to rely on the
conventional version, my own included therefore, I am more than happy
to treat my dog with this “most horrendous form of medication possible”
with no ill effects.
For owners who cannot afford the expense of enzyme replacement therapy,
or cannot change their dog over to Pigs Pancreas, there are websites
selling direct to the public at anything up to half the price a vet
will charge, just type in Pancrex into your search engine. You
can also buy the human version from your local chemist at a slightly
cheaper rate. There is also a support group dedicated to Epi owners.
With regards to slaughter houses selling pigs pancreas, despite my
having a slaughter house dedicated to slaughtering
pigs 9 miles away., they will not sell what they call a “by-product”
to the general public. True, some slaughter houses will sell pigs
pancreas but you usually have to buy in bulk, usually with another
meat order so it may well be worth asking a local butcher to get it in
for you or if your friends with a local kennel, ask them to order it
for
you along with their meat order.
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Freya Woods
Epi
& 38.7kilo’s
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I cannot echo Bill Hughes
words enough, no two dogs are the same and so long as the dogs diet is
controlled (not necessarily with the most expensive diet) as well as
the right medication (whether it be conventional
or natural) there is no reason why the dog can’t live out a full and
healthy lifespan.
I hope this clears up a couple of points and offers a more balanced
view.
All the best.
Liz
Read more about Freya and other canines with
EPI at
www.gsdsrus
reprinted with kind permission from Liz Woods
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Exocrine Pancreatic Insufficiency (EPI)
What is EPI?
Exocrine pancreatic insufficiency, or EPI, refers to failure of the
pancreas to normally secrete digestive enzymes.
This results in diarrhea and weight loss, often despite the fact
that the animal’s appetite has 
increased. While EPI occurs in both
dogs and cats, the most common cause is different in each species. EPI
in dogs
is usually due to a condition called Pancreatic Acinar Atrophy,
or PAA, but in cats it is most commonly due to end-stage pancreatitis.
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 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?
While it is more common in dogs, cats can also be affected by EPI.
Young adult dogs, especially German Shepherds, are most
likely to be affected with PAA-associated exocrine pancreatic
insufficiency. Older dogs and cats affected by EPI will usually develop
the disease as a consequence of end-stage 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 and
cats may also be seen due to damage to the endocrine
portion of the pancreas. Pancreatitis is more commonly the cause of
EPI in cats and older dogs.
How is EPI Diagnosed?
Clinical Signs:
Clinical signs associated with exocrine pancreatic
insufficiency include weight loss, polyphagia, coprophagia, pica,
diarrhea, increased borborygmus, and flatulence. 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?
While there is no cure or any preventatives for EPI, there are some
treatments available.
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, highly digestible diet: 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. Powdered enzymes
like (Viokase-V, Pancreazyme) work the best.
The Good News:
A response to therapy 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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EXOCRINE PANCREATIC INSUFFICIENCY
(EPI)
This information is provided by Provet for
educational purposes only. You should seek the advice of your
veterinarian if your pet is ill as only he or she can correctly advise
on the diagnosis and recommend the treatment that is most appropriate
for your pet.
Note for Pet Owners:
If you have an animal diagnosed as having this disorder there are some
important guidelines that you should follow:
Always give the medications that your
veterinarian has prescribed at the correct dose and at the correct
times
Contact your veterinary practice if you are concerned
that your animal is having a relapse, or if it appears to react
abnormally following treatment. Your observations may simply be normal
side-effects to the treatment - but they may not be and, even if they
are common side-effects, the drug dosage may need to be altered.
Topics on this Page:
|
Description
Cause
Breed Occurrence
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Signs
Diagnosis
Treatment
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Description
Exocrine pancreatic insufficiency (or EPI as it is often known) is a
condition in which the pancreas stops producing and secreting enough
digestive enzymes to digest food in the small intestine. Diarrhoea and
foul smelling faeces due to high fat content (called steatorrheoa)
results, and because food ingredients are not being digested the animal
becomes malnourished, and in some cases nutritional deficiency as
well as energy deficiency results.
EPI is
one of
the conditions which can contribute to the malabsorption syndrome.
Cause
Exocrine pancreatic insufficiency (EPI) can result from primary
pancreatic disease (discussed here) or from a number of
functional causes resulting from any disease that interferes with
secretion of enzymes by the pancreas or of activation of the enzymes
in the intestine lumen.
Juvenile pancreatic atrophy and recurrent inflammation of the pancreas
(chronic pancreatitis) are by far the most common causes of EPI, but
other causes are seen including obstruction of the pancreatic duct (by
inflammation or cancer) which carries the secreted enzymes from the
pancreas into the lumen of the duodenum. Recently the cause of
pancreatic acinar atrophy has been determined to be
immune-mediated
In dogs and cats the result is inadequate concentrations of all the
pancreatic enzymes and of bicarbonate in the intestine lumen.
Breed Occurrence
Exocrine pancreatic insufficiency (EPI) occurs most frequently in dogs,
and rarely in cats. The German Shepherd Dog is the breed most likely to
be presented with EPI - see also pancreatic atrophy. In Finland the
Rough-coated Collie is also predisposed to develop the condition.
Signs
EPI can be subclinical for many months or even years
Weight loss.
Diarrhoea.
Steatorrhoea.
Increased gut sounds are often present on auscultation(called
borborygmi).
If the condition has been present for any length of time signs of
nutritional deficiency might become obvious, including poor hair
condition (dry and brittle) and sometimes pallor due to anaemia and low
circulating blood protein concentrations - hypoproteinaemia.
Diagnosis
The diagnosis of exocrine pancreatic insufficiency needs to be
confirmed by use of laboratory tests. The most often used test for dogs
is the TLI test but other tests are often used, and are still needed in
complicated cases with more than one concurrent disease:
Laboratory tests for faecal fat (to confirm the presence of
steatorrhoea.
Direct-indirect Sudan III staining.
Faecal analysis for % fat content.
Trypsin-like immunoreactivity (TLI) Test.
BT-PABA Test.
Xylose absorption test - If bacterial overgrowth is present.
Breath hydrogen test.
Treatment
Treatment involves the use of replacement pancreatic enzymes given
orally. Suitable products are available in powder or crushed
non-enteric-coated tablets. Enteric-coated tablets are not usually
recommended because dissolution of the coating by alkaline pH in the
intestine is unreliable. Because some enzyme is denatured by acid in
the stomach, premixing the enzyme supplement with the food and left for
about three quarters of an hour at room temperature is sometimes
recommended.
H2 - receptor inhibitors (e.g. cimetidine) are useful
because they reduce gastric acid secretion, and so less pancreatic
enzyme is denatured during passage through the stomach.
If bacterial overgrowth is present oral antibiotics (e.g. neobiotic)
may be indicated.
With enzyme replacement and cimetidine (300mg), or (if appropriate)
300mg neomycin, faecal fat concentrations can be returned to
normal.(Strombeck and Guilford - Small Animal Gastroenterology 2e
Wolfe) Other authors recommend different doses eg 300mg cimetidine / 20
kg body weight (Murdoch DB in Canine Medicine and Therapeutics -
Blackwell Scientific Publications 3e 1991)
The following dietary management is recommended:
Feed a highly digestible, palatable, complete ration.
Avoid home made rations.
The ideal profile is a diet that is : low in fat content, contains
medium-chained fatty acids, avoid excess carbohydrate,
low fibre.
Feed multiple small meals (at least 3 times daily)
Join
k9-EPIGLOBAL
A Yahoo list group for owners of dogs with EPI, a great source for
information and support
The above information is simply
informational. It's intent is not to replace the advice of a
veterinarian nor to assist you in making a diagnosis of your pet.
Please consult with your own veterinarian for confirmation of any
diagnosis. Your pets life may depend on it.
increased. While EPI occurs in both
dogs and cats, the most common cause is different in each species. EPI
in dogs
is usually due to a condition called Pancreatic Acinar Atrophy,
or PAA, but in cats it is most commonly due to end-stage pancreatitis.
