Exocrine Pancreatic Insufficiency

Exocrine Pancreatic Insufficiency

               EPI may sound like an investment site or an insurance company, but, in reality, it is an uncommon disease in dogs and cats: EPI stands for exocrine pancreatic insufficiency.  But what does that mean? We’ll explore the causes, symptoms and treatment of EPI in this week’s blog.

               The pancreas is the organ that sits along the small intestine making insulin and digestive enzymes for the body.  In EPI, pancreatic cells called acinar cells that normally produce digestive enzymes are destroyed by either chronic inflammation of the pancreas known as pancreatitis or by a genetically inherited autoimmune disorder that causes atrophy or destruction of the cells.  Pancreatic cancer may also cause EPI.

               In dogs, German Shepherds are most frequently affected but other breeds may occasionally develop EPI.  Cats are rarely affected.  When cats develop EPI, it is nearly always due to chronic pancreatitis.

               Dogs with EPI are usually young-one to two years of age.  Again, German Shepherds are the most commonly affected breed.  Dogs with EPI typically have chronic diarrhea producing large volumes of greasy-looking stools.  Affected dogs also lose massive amounts of weight as they are unable to properly digest their food and therefore cannot utilize nutrients.  They are often very thin despite eating normal to increased amounts of food. Cats have similar signs.  Some pets may also experience vomiting or loss of appetite. 

               Diagnosis is usually by a blood test measuring the amount of a pancreatic enzyme known as trypsin and known as a TLI (trypsin-like immunoreactivity test).  Vitamin B12 and folate levels may also be measured and many pets are low in Vitamin B12 or cobalamin and may need supplementation with B12 injections.  Some patients may also have small intestinal bacterial overgrowth and may require antibiotic treatment or probiotics to correct diarrhea.

               The main form of treatment for a pet with EPI is use of a pancreatic enzyme powder mixed into the food to pre-digest it before the pet eats the food.  The enzyme must be supplemented for the rest of the pet’s life.  Side effects are rare but some patients experience ulcers in the mouth which usually resolve within a few weeks of starting treatment.  Powder is preferred but there are tablets available if pets will not eat or otherwise will not tolerate the enzyme powder. 

               While the initial symptoms can be quite dramatic, treatment is highly successful, and, though treatment is lifelong, pets should be able to live a normal, healthy life with EPI. 

               This blog brought to you by the Patton Veterinary Hospital serving Red Lion, York and the surrounding communities.

Lyman, Joe. “Exocrine Pancreatic Insufficiency.” Insight Companion Animal Edition Oct. 2019:  20-121. Print.