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CANINE EXOCRINE PANCREATIC
INSUFFICIENCY
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Exocrine Pancreatic
Insufficiency (EPI) refers to the failure of the pancreas to secrete digestive
enzymes normally. 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 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.
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.
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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.
