Does your dog regularly have digestive issues? Maybe you have started wondering whether there is more to it than ‘just a sensitive stomach’.
One condition you may have come across when investigating the causes of diarrhoea in dogs is exocrine pancreatic insufficiency (EPI). EPI is a relatively uncommon (but not rare) condition, and we diagnose it more in some dog breeds than others. We will explore this further, including the clinical signs, diagnosis and treatment of EPI.
While we hope to answer many of your questions, we would always advise that you speak to your vet for advice if you are concerned about your pet’s digestive health.
Table of contents
What is EPI in dogs?
It’s best to start by first discussing what the pancreas is. The pancreas is a small organ that performs some big jobs in the body, including exocrine and endocrine functions.
This organ sits on the right side of the abdomen, next to the stomach where it produces enzymes to help with food digestion. These pancreatic enzymes get released into the duodenum (the part of the small intestine that is attached to the stomach’s exit) where they help to break down complicated dietary molecules in your pet’s food like proteins, fats and carbohydrates. The pancreas also helps to regulate stomach acid by secreting bicarbonate. These are known as the exocrine functions of the pancreas.
The endocrine pancreas, however, is responsible for some of your dog’s hormones, insulin and glucagon. These hormones help to control blood sugar levels.
In exocrine pancreatic insufficiency (EPI) it is the exocrine part of the pancreas which is affected, leading to issues with digestion. Pancreatic enzymes and bicarbonate levels are significantly reduced in these animals, meaning that the food your dog ingests is not broken down into their smaller component pieces (such as proteins being broken down into amino acids and fats into fatty acids).
This leaves your dog unable to absorb their food properly through their digestive tract lining, an issue known broadly as malabsorption. This causes malnutrition in that animal and a negative energy balance that leads to weight loss.
Undigested food in the digestive tract also causes osmotic diarrhoea, due to water being drawn into the intestines. Unbroken-down food molecules create small intestinal bacterial overgrowth (SIBO) which can further contribute to diarrhoea as well as increased gas, abdominal discomfort and changes in appetite.
What causes EPI in dogs?
The most common cause of EPI in dogs is an issue known as pancreatic acinar atrophy (PAA). Certain dog breeds are more prone to PAA than others including German Shepherd dogs, Collies, Eurasians and English Setters. It is unclear exactly what makes PAA more likely in these breeds, but there is thought to be a heritable component (passed down through bloodlines). There have been proposals that PAA could be a type of autoimmune condition (the body’s own self destroying pancreas cells). Pancreatic acinar cells are replaced with non-functioning fatty tissue in these dogs.
In other breeds of dog, it is much more likely that their EPI is secondary to repeated bouts of pancreatitis, or (less often) cancer. Pancreatitis is inflammation of the pancreas and in most cases, a specific cause for this problem cannot be identified. However, some breeds are more prone to pancreatitis than others and it usually affects older dogs, especially those that eat fatty foods, table scraps or garbage. Repeat flare-ups of pancreatitis can cause fibrosis (scarring) of this organ, decreasing its functional ability.
Dogs tend not to show signs of EPI until around 90% of their exocrine pancreatic cells have been destroyed. Though dogs that have EPI secondary to PAA can develop signs of the condition at any age, they are more likely to be younger than dogs with other forms of pancreatic disease e.g. pancreatitis or pancreatic cancer.
Are there any signs of EPI in dogs?
Dogs with EPI are likely to have some or all the following clinical signs –
- Weight loss, despite having a good appetite
- Increased volume of stools
- Fatty looking stools
- Loose or liquid stools
- Increased flatulence
- Abdominal discomfort
- Poor coat quality
- Changes in behaviour
How is EPI diagnosed in dogs?
History taking
Your vet will start by taking a history. This will include asking about your pet’s diet and appetite, as well as discussing the nature of their stools and how long the issues have been going on.
Physical examination
The vet will then examine your dog. They will weigh them to assess for any weight loss and may body condition score them too. Your vet will do a physical examination including listening to their chest, feeling their abdomen and taking their temperature.
Haematology and biochemistry
If your vet is suspicious that there is an issue, then blood samples are the next step. They will start with a minimum database which will include haematology and biochemistry panels.
Haematology looks at your dog’s red and white blood cells, screening for markers of anaemia, inflammation and infections. Biochemistry covers your pet’s liver and kidney parameters, as well as blood sugar and protein levels. This gives an overall picture of your dog’s health and helps to rule out some other conditions that might cause weight loss and diarrhoea.
TLI: Trypsin-like immunoreactivity
The next blood test that your vet may run is trypsin-like immunoreactivity which measures serum trypsin and trypsinogen concentrations. Trypsin is an enzyme released by the pancreas which works with other digestive enzymes to break down protein in food (trypsinogen is the inactive precursor created by the pancreas which is converted to trypsin). If levels in the blood are low, then this is diagnostic for EPI.
Your vet may also run a pancreatic lipase immunoreactivity (cPLI) test if your vet is suspicious that your dog also has pancreatitis. An elevated level can indicate that there is inflammation occurring in the pancreas.
Other tests
There is another test that can be used to diagnose EPI in dogs, which uses faeces to check for concentrations of faecal pancreatic elastase. However false positives can occur and the TLI test is still considered to be better in most cases.
Diagnostic imaging can be useful to help screen for other pancreatic issues like cancer or pancreatitis, which may be underlying factors in older dogs or breeds that don’t have a predisposition to EPI. It can also help rule out other intestinal disease processes.
Your vet may also screen your dog’s folate (vitamin B9) and cobalamin (vitamin B12) levels through a blood sample, as dogs with EPI and other intestinal disorders often have deficient levels.
What is the treatment for canine EPI?
There is no cure for EPI, as it is not possible to reverse the damage that has occurred to the exocrine pancreatic tissue. Instead, treatment is aimed at managing the condition long-term.
The following treatments may be recommended –
Pancreatic enzyme supplementation
Dogs with EPI require pancreatic enzyme supplementation therapy. Powdered pancreatic extracts are usually given with each meal to help your dog digest their food. This is carefully measured for your dog’s body weight using the manufacturer’s instructions. Dosing may need to be adjusted based on your pet’s response. Enteric-coated tablets and capsules are also available.
Raw chopped pancreas (usually from pigs) may be fed to dogs suffering from EPI as it contains pancreatic enzymes. However, it may also contain bacterial or other infectious pathogens which could present a risk to dogs already suffering from digestive issues (as well as their owners who need to handle their pets and the raw meat itself). So, this isn’t usually a first-line treatment.
Diet modification
As well as enzyme supplementation, dogs with EPI usually benefit from a change in diet. A highly digestible, moderate fat and low-fibre diet is advised in many cases.
Low-fat diets were traditionally recommended in the past, but it is now thought this could restrict much-needed calories for these dogs. High levels of fibre should be avoided, however, as they can alter the activity of pancreatic enzymes and the digestibility of other nutrients.
Different animals do well on different diets. For some a ‘gastrointestinal’ type of diet is effective, whereas others may require a hydrolysed (or hypoallergenic) diet is more helpful. Some trial and error may be involved.
Cobalamin supplementation
Many dogs with EPI have reduced levels of Vitamin B12 – cobalamin (hypocobalaminaemia). Low levels of cobalamin have been associated with poorer outcomes, so supplementation is advised in most cases. This can be given by injection or orally.
Other treatments
Sometimes other treatments are required such as antibiotics in cases where small intestinal bacterial overgrowth is affecting response to treatment. Prednisolone (steroids) may be used if other intestinal diseases are occurring.
Probiotics and prebiotics can also be helpful for some dogs, improving their gut flora.
What is the prognosis if my dog has EPI?
Life-long treatment is required for dogs with EPI. Most will improve greatly with pancreatic enzyme supplementation, dietary change and cobalamin supplementation. These dogs will show weight gain and improved stool consistency, in 60 -77% of cases according to one study. So, the prognosis for pets diagnosed with this condition is generally good but your vet will be able to advise you further.
Summary
If you suspect that your dog may have EPI, then make sure you get them checked over by your vet. It is important to rule out other health complaints and to get a proper diagnosis. Affected dogs can usually be well managed with the appropriate treatment, but only your vet can advise you on your individual pet’s condition.
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