Exocrine Pancreatic Insufficiency

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What is it?

Exocrine Pancreatic Insufficiency, or EPI, is a fairly common condition where the dog's pancreas isn't able to make enough digestive juices. This results in poor digestion, altered gut function and usually weight loss.

What causes it?

The pancreas gland in a dog's abdomen has a role in controlling blood glucose levels (secreting insulin and other hormones). However, it also produces a number of other substances that the dog needs to digest their food - especially the enzymes needed to digest fat properly. There are a number of possible underlying causes - ongoing pancreatitis (pancreas inflammation), or certain tumours, can damage the gland so it doesn't work properly, but in many cases it is due to a particular genetic defect.

What dogs are at risk?

Any dog may develop pancreatitis; however, one breed is at an unusually high risk - the German Shepherd. In all breeds, it is most common in younger dogs (usually under 4 years of age), or those older individuals who have suffered from ongoing pancreas problems for some time.

What are the symptoms?

Without pancreatic juices, the dog cannot digest food (especially fat) properly. The common symptoms are therefore those of maldigestion and malnutrition, with chronic diarrhoea (often very loose or cowpat-like), loud gut noises and flatulence, and weight loss despite increased appetite; in the later stages, this may lead to emaciation. Sometimes, dogs are so hungry that they will eat abnormal objects or items - this is called pica.

How is it diagnosed?

Although it is important to rule out other possible causes of diarrhoea (such as parasites or bacterial infections), EPI can usually be easily diagnosed with a simple blood test. This is called the TLI test (Trypsin-Like Immunoreactivity), and measures an enzyme released by normal, healthy pancreatic tissue. A dog with EPI has little or no functional pancreatic tissue left, so the TLI is abnormally low in these dogs.

How can it be treated or managed?

The good news is that the condition can very easily be managed! The dog isn't making enough enzymes of their own, so we simply give them extra ones. There are a range of different pancreatic enzyme supplements, as a powder that is mixed into the food, or as capsules or tablets that they swallow. Occasionally, however, resolving the EPI won't clear up all of the symptoms - this may be because there is a secondary problem (such as SIBO, or Small Intestinal Bacterial Overgrowth) that can cause similar symptoms. In these cases, the secondary problems need to be addressed as well, but usually the dogs make a good recovery. Although the treatment is life-long, it is very effective and most affected dogs can live a normal life.

Can it be prevented?

Sadly, there is no way to prevent EPI from developing in genetically susceptible dogs. However, some cases of secondary EPI (due to other pancreatic diseases) may be preventable if cases of pancreatitis are rapidly and effectively treated.