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Exocrine Pancreatic Insufficiency in Dogs (EPI)

By: Dr. Bari Spielman

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Veterinary care should include diagnostic tests and subsequent treatment recommendations.

Diagnosis

Certain diagnostic tests are needed to confirm the diagnosis of EPI and exclude other diseases that may cause similar symptoms. The following diagnostic tests often are recommended:

  • Your veterinarian will take a complete medical history and perform a thorough physical examination.

  • Multiple examinations of fecal specimens (fecal flotations, direct smears, zinc sulfate preparations) may be performed to exclude chronic intestinal parasitism before proceeding with additional diagnostic tests.

  • A complete blood count (CBC or hemogram) to evaluate low total protein concentration, inflammation, anemia or low platelet count.

  • A serum biochemistry profile to evaluate the general health of your pet and to determine the effect of EPI on other organ systems. Tests such as serum albumin and total protein concentration and serum cholesterol concentration help exclude protein-losing intestinal disorders. Animals with EPI usually have normal serum protein concentrations.

  • Urinalysis to evaluate kidney function and check for urinary tract infection.
  • Abdominal X-rays to evaluate abdominal organs (liver, kidneys, spleen) and check for masses. Abdominal X-rays usually are normal in dogs with EPI.

  • Serum trypsin-like immunoreactivity (TLI) is considered the "gold standard" for the diagnosis of EPI. Dogs with EPI have extremely low serum concentrations of TLI. Blood for TLI should be drawn after a 12-hour fast. A limited number of laboratories perform this test, but most veterinarians will be able to draw the blood sample and send it to the appropriate lab.

    Your veterinarian may recommend additional diagnostic tests to exclude or diagnose other conditions or to better understand the impact of EPI on your dog. These tests ensure optimal medical care and are selected on a case-by-case basis. Examples include:

  • Serum folate and cobalamin concentrations may be recommended if small intestinal bacterial overgrowth is suspected.

  • Abdominal ultrasound examination to evaluate the size and internal structure of abdominal organs (liver, spleen, kidneys) and to assess for the presence of abnormal structures or masses that may be present in dogs with chronic diarrhea or weight loss. You may be referred to a veterinary internist experienced in ultrasonography for this test.

  • Gastrointestinal endoscopy and biopsy may be recommended if the dog with EPI is not responding appropriately to therapy or if results of other tests are not consistent with a diagnosis of EPI. If anemia or hypoproteinemia (low serum protein concentration) has been identified, endoscopy may be recommended to identify inflammatory bowel disease, gastrointestinal ulceration, or cancer. This procedure necessitates general anesthesia and usually requires referral to a veterinary internist.

  • An adrenocorticotropic hormone (ACTH) stimulation test may be recommended to rule out hypoadrenocorticism (Addison's disease). This test may be recommended in dogs with certain electrolyte abnormalities (low serum sodium and chloride concentrations, high serum potassium concentration) or a chronic history of gastrointestinal signs and weight loss.

    Treatment

    Most dogs with EPI are treated as outpatients. They generally are otherwise in good health, and most respond well to therapy. Some animals with EPI may have concurrent disorders (bacterial growth, inflammatory bowel disease). These disorders should be considered in the patient that is not responding well to therapy for EPI. Treatment of EPI must be individualized based on the severity of the condition and other factors that must be analyzed by your veterinarian.

    Treatments may include:

  • Dietary modification is the cornerstone of treatment. It is best to use a diet that is highly digestible, low in fat, and low in fiber. Severely malnourished dogs initially may require supplementation with vitamins and minerals.

  • Pancreatic enzyme replacement is crucial. Powdered, non-encapsulated preparations are the most effective. A product called Viokase® is commonly used and is very effective. Enzyme supplementation must accompany each meal, and is a lifelong commitment.

  • Antibiotic therapy using drugs such as metronidazole or oxytetracycline is recommended in patients with suspected bacterial overgrowth. Bacterial overgrowth is not uncommon in dogs with EPI, and intermittent antibiotic treatment may be necessary over the course of the animal's lifetime.

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