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Ada’s Story and EPI in Dogs

Exocrine Pancreatic Insufficiency is a condition that affects the gastrointestinal tract of a dog

“Ada” was a bouncy, young three-year-old German Shepherd. The Vets practice was not her favourite place, and I could always hear her distinctive voice in the car park as she arrived for her appointments. 

Ada was brought in more frequently recently as she had had diarrhoea and a marked notable weight loss, which was frustratingly unresponsive to all the usual treatments. 

Further tests including faeces sample tests and blood tests revealed that Ada had a condition called EPI, which would involve lifelong treatment to keep her healthy. 

EPI, or Exocrine Pancreatic Insufficiency is a condition that can affect the gastrointestinal tract of the dog, leading to severe weight loss, diarrhoea, and a failure to maintain weight and condition, despite a good appetite.  

EPI can manifest anytime in a dog’s life, from a young six-month-old pup to an elderly dog, with the severity and symptoms of the disease varying in each individual case. 

EPI, Exocrine Pancreatic Insufficiency, is the inability of the acinar cells in the exocrine part of the pancreas, to produce and secrete the necessary enzymes that are needed to properly digest food. These main enzymes are Amylase for digestion of carbohydrates (sugars & starches in grains, fruits & vegetables), Lipases for digestion of fats, and Trypsin and Proteases for the digestion of proteins. If the pancreas does not produce sufficient digestive enzymes to allow the dog to properly digest their food, Exocrine Pancreatic Insufficiency will develop. Left unchecked, the condition will lead to gastrointestinal upsets, chronic diarrhoea, malnutrition, and marked weight loss. 

While any dog can theoretically develop the condition, it is much more prevalent in some breeds of dog than others. German Shepherds are particularly prone. Other breeds predilected are Rough Collies, Cavalier King Charles Spaniels, Chow Chows, and English Setters. 

The usual cause of EPI in dogs is a condition called PAA, or (idiopathic) Pancreatic Acinar Atrophy, which means that for no known reason the acinar cells responsible for the normal functions of the exocrine pancreas malfunction. These acinar cells are important for the normal digestion of fats, starches, and proteins. 

EPI can also be a secondary condition from a chronic disease of the pancreas structure, such as chronic pancreatitis. Sometimes EPI symptoms usually do not appear until anywhere between 80% and 95% of the exocrine pancreas acinar cells are affected. 

EPI can cause a whole range of problems related to the digestive system of the dog, resulting in a poor absorption of the important nutrients that are required for good health, which can then lead to symptoms of serious malnutrition.  

Common symptoms of EPI include a noticeable, sudden, and inexplicable weight loss despite eating normally, or in some cases, eating much more than normal; chronic diarrhoea; flatulence, and an increased faeces production. The faeces are often soft, greasy, and voluminous, and sometimes pale grey or yellowish in colour. Coprophagia sometimes accompanies the condition too, which is the term used when a dog eats their own faeces. 

If your vet suspects that your dog is suffering from EPI, they will run a range of tests to check how that patient’s pancreas is functioning. This may involve taking a serum sample to measure the levels of Trypsinogen in the blood, this is a chemical that is released by the pancreas naturally when it is healthy. EPI can be confirmed with a Trypsin-Like Immunoreactivity (TLI) blood test. Reduced levels of trypsinogen in the blood sample may indicate a positive diagnosis of EPI. Other Blood tests, faeces tests and urine panels may also be used, as a range of other gastrointestinal problems and infections may sometimes be confused with EPI and produce similar symptoms. 

While EPI is a serious condition that can literally lead to symptoms of severe malnutrition if left untreated, fortunately, in most cases, careful treatment and management of the condition can in time return your dog to much better health. 

After an EPI diagnosis has been confirmed, the usual course of treatment involves feeding a specific dietary enzyme supplement to replace the missing pancreatic enzymes. Generally, this enzyme supplement comes in a powder form , or as a capsule added to each meal. 

It is now known that EPI dogs also often have a secondary condition called SID (small intestinal dysbiosis) which is an imbalance of the normal gut bacterial “flora”. Another secondary condition in EPI dogs that often occurs, is insufficient Cobalamin, B12, which also often needs to be supplemented with these cases.  

Once diagnosed EPI cannot be cured or reversed, and this means that the dog will require special care with their diet and the addition of the pancreatic enzyme and other gastrointestinal support supplements for the rest of their life. Successfully managing EPI is all about finding the right balance for each case of: Pancreatic Enzyme Supplementation, the correct easily digested Diet, Prebiotics, Prebiotics & Probiotics, and Cobalamin B12 supplementation, if required. 

Once the proper supplements and treatments are implemented, most EPI dogs respond well to treatment and go on to live a good, long, quality life. 

"Ada" became much more relaxed with her visits to the practice, and after a few adjustments, she thankfully responded very well to her advised treatments. Her owners kept her on a strict diet regime with her advised supplements, and she was soon bouncing again and gaining weight.  

If you have any concerns that your dog losing weight, despite a good or ravenous appetite, and there are diarrhoeic symptoms. Please contact your Vet practice for a suitable appointment for a full examination and tests as may be required. 

 

Alison Laurie-Chalmers, 

Senior Consultant 

Crown Vets.

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