Exocrine Pancreatic Insufficiency in Dogs (EPI)
Overview of Canine Exocrine Pancreatic Insufficiency (EPI)
Exocrine pancreatic insufficiency, commonly abbreviated and referred to as EPI, is a disorder in which the pancreas does not produce an adequate amount of digestive enzymes. This deficiency results in maldigestion (poor digestion) and malabsorption (poor absorption). EPI is most commonly found in German shepherd dogs, but can be seen in any breed. It is rare in cats.
EPI is seen most commonly in young dogs secondary to pancreatic acinar atrophy (a decrease in the enzyme producing cells of the pancreas). EPI, however, can occur in older animals secondary to chronic pancreatitis (pancreatic inflammation).
General Causes of Exocrine Pancreatic Insufficiency in Dogs Pancreatic acinar atrophy (most common cause) Chronic pancreatitis Pancreatic cancer Congenital abnormality (an abnormality present since birth)
What to Watch For Chronic diarrhea Excessive food intake Weight loss Flatulence (gas) Coprophagia (eating feces) Pica (eating unusual things such as dirt) Borborygmus (a rumbling noise caused by gas passing through the intestines)
Diagnosis of Exocrine Pancreatic Insufficiency in Dogs
Veterinary care includes diagnostic tests and subsequent treatment recommendations. Diagnostic tests are needed to identify EPI and exclude other diseases. Your veterinarian will take a complete history and perform a thorough physical examination. A thorough knowledge of the history and clinical signs is very important in the diagnosis of EPI. Tests may include: Fecal examination to check for the presence of fat and starch which indicates maldigestion or malabsorption. A fecal flotation and direct smear also will be performed to evaluation for parasites. A complete blood count (CBC or hemogram) to evaluate for anemia, inflammation, infection or low platelet count. Serum biochemistry profile to evaluate the general health of your dog and to determine the effect of EPI on other organ systems. Urinalysis to evaluate kidney function and to check for the presence of urinary tract infection. Abdominal X-rays to evaluate organs such as liver, spleen, and kidneys and to check for masses. Serum trypsin-like immunoreactivity (TLI) to evaluate for the presence of the pancreatic enzyme trypsin. Animals with EPI have extremely low concentrations of this enzyme in their serum.
Treatment of Exocrine Pancreatic Insufficiency in Dogs
Dogs with EPI generally feel well and are otherwise healthy. Treatment often is administered on an outpatient basis and may include one or more of the following: Dietary modification Pancreatic enzyme replacement Concurrent antibiotic therapy
Home Care and Prevention of EPI
Administer any medications that your veterinarian has prescribed. Feed your dog as directed by your veterinarian. Watch your dog carefully for resolution of symptoms, especially resolution of diarrhea and gain in body weight. Contact your veterinarian if improvement is not observed over the first few weeks.
The cause of pancreatic acinar atrophy is unknown and this cause of EPI cannot be prevented. Diets high in fat can predispose pets to pancreatitis. Thus, feed your pet a diet low or moderate in fat content and avoid feeding high fat table scraps.
Information In-depth on Exocrine Pancreatic Insufficiency in Dogs
Exocrine pancreatic insufficiency (EPI) is most often caused by pancreatic acinar atrophy (a shrinking of the enzyme producing cells of the pancreas) the cause of which is unknown. It is seen most commonly in young dogs, especially German shepherd dogs.
EPI can have major impact on the animal because severe longstanding diarrhea and profound weight loss are commonly observed. Other medical problems can lead to symptoms similar to those encountered in EPI. These conditions should be excluded before establishing a definitive diagnosis of EPI: Bacterial infectious diseases, such as Salmonella, Clostridium and Campylobacter. Viruses, such as Coronavirus and Parvovirus. Fungal infections, such as Histoplasma, Mycobacteria and Phycomyces Parasitic disease, such as roundworms, hookworms and whipworms Protozoal infections, such as Coccidia, Giardia and Trichomonas Inflammatory Bowel Disease (IBD). The cause of IBD is unknown, but it is thought to be immune-mediated. Diarrhea and weight loss are commonly observed in dogs with IBD. An intestinal biopsy is the only way to diagnose IBD definitively. Dietary intolerance or dietary allergy usually occurs in response to a particular dietary protein, but can occur secondary to almost any component in the animal’s food. Diarrhea and abnormalities of the skin are most commonly seen with this disorder. Drugs and toxins are more often associated with acute diarrhea, but chronic exposure to certain medications or toxins can be associated with chronic diarrhea. Cancer of the gastrointestinal tract can cause diarrhea and weight loss. Obstruction (blockage) of the gastrointestinal tract due to cancer, foreign bodies, intussusception (telescoping of the bowel onto itself), or stricture can be associated with chronic diarrhea. Metabolic disorders including kidney and liver failure, diabetes mellitus and hypoadrenocorticism (Addison’s disease) may be associated with weight loss and diarrhea. Duodenal ulcers can cause diarrhea and melena (black tarry stools secondary to the presence of digested blood). Small intestinal bacterial overgrowth is characterized by an overgrowth of normal intestinal bacterial flora and may be associated with chronic diarrhea. Lymphangiectasia is a chronic protein-losing disorder of the intestinal tract that is associated with chronic diarrhea. Short bowel syndrome may develop after a large portion of the intestinal tract has been removed surgically. Chronic diarrhea may be observed in this syndrome. Gluten-sensitive enteropathy is an intestinal disorder seen most commonly in Irish Setters. It is an inflammatory disease that occurs in response to diets containing gluten (a protein of wheat). Irritable bowel syndrome (spastic colon) is a chronic intermittent disorder that is associated with diarrhea, abdominal pain and gas.