EPI in Dogs

Alison Laurie-Chalmers, Senior Consultant, Crown Vets Inverness

The pancreas is an accessory digestive gland that has two different gland functions as both an endocrine gland excreting into the blood stream and an exocrine gland excreting into the bowel. The pancreas is the organ in the body responsible for producing insulin, which regulates the body’s blood sugar levels. Other acinar cells within the pancreas produce essential digestive enzymes which aid in the digestion of starches, fats, and proteins in an animal’s diet. All these digestive enzymes are very important for good digestive health. There are three major groups of enzymes critical to efficient digestion which breaks down protein, fats and starches. Without these enzymes the digestion of food is not complete and the absorption of nutrients is hindered. 

The result is what appears to be starvation in the face of an adequate food intake and often a ravenous appetite. If the pancreas fails to produce enough of these digestive enzymes, exocrine pancreatic insufficiency, or EPI, develops. The general cause of Exocrine Pancreatic Insufficiency (EPI) is insufficient cells that are responsible for the production of these enzymes. This can be the result of destructive inflammation such as after repeated bouts of severe chronic pancreatitis or it can be due to an immune based condition causing an atrophy and depletion of acinar cells. German Shepherd Dogs seem to be predisposed to this, but any breed can be affected. 

EPI Symptoms include:

• Chronic diarrhoea
• Marked weight loss, despite an adequate calorie intake and often ravenous appetite
• Frequent or greater volume of stools and gas
• The presence of undigested fat in the faeces that can result in a characteristically yellow or grey, oily appearance to the stools
• Abdominal discomfort
• Poor dull coat and hair loss
• Nervousness
• Irritability

These clinical signs and symptoms can lead to a high suspicion of EPI , but confirmation and monitoring by using specific Blood tests is very important. If symptoms of exocrine pancreatic insufficiency are apparent, specific pancreatic function and other blood tests can be done. A dog with EPI will have a notably reduced amount of an enzyme called Trypsinogen (TLI) on Blood tests. Folate and Cobalamin Blood tests are also checked too as these may also require some supplementation due to this condition.

Once EPI has been diagnosed, treatment most commonly consists of supplementing your dog's diet with a pancreatic enzyme replacement. Advice on an appropriate low fat diet is also very important and it is somewhat a trial and error process to find a food that will provide sufficient calorie content for the case, without greatly increasing the need for additional enzyme supplements to aid digestion. The pancreatic enzyme replacement supplements come in a capsule or powdered form which is given mixed with food. Also, vitamin supplements and other gut support treatments may also be necessary. 

The changes to the pancreas due to EPI are irreversible. This means that life-long enzyme supplements will be needed and regular monitoring of your dog’s progress by your Vet is very important.

EPI can be a challenging and frustrating condition to treat and it can take a while to tailor treatments to each individual case. Once the patient is eventually stabilised though, they will gradually begin to regain lost weight and condition, so although challenging these can be rewarding cases too if the patient responds well to the advised treatments.