When our pets are unwell it can be really distressing. The worry that there could be something seriously wrong, coupled with the heartache of seeing them struggle is upsetting for many pet owners. Living in a world where the internet is so readily available has its positives but can also have its downsides. ‘Dr Google’ as the world wide web has been affectionately coined, often offers a plethora of diseases and conditions that can send us panicking that our beloved pet is seriously unwell. Fortunately, in most cases our pets are not seriously ill, but knowing what symptoms should not be ignored is important to ensure we don’t miss things that may have a serious effect on our pet’s health. One particular disease process that it is good to understand in more detail is EPI.
What is EPI?
EPI is the acronym for exocrine pancreatic insufficiency. Exocrine pancreatic insufficiency (EPI) is the term given to describe a condition where part of the pancreas is not functioning correctly, and is not producing enough enzymes needed to correctly digest food.
What is the pancreas and what does it do?
To understand EPI in more detail, it is first important to understand how the pancreas functions. The pancreas is an organ that sits in the upper gastrointestinal tract and is made up of two limbs of tissue. The pancreas is split into two parts based on its function, these are called the endocrine and the exocrine pancreas.
The endocrine pancreas is responsible for the production of insulin and glucagon and plays an important role in the body’s metabolic health. You may have heard this mentioned before when discussing diseases such as diabetes.
The exocrine pancreas is responsible for the production of digestive enzymes which are used to breakdown food material in the small intestine to enable the nutrients to be absorbed by the body. The pancreas transfers these digestive enzymes to the small intestine through the common bile duct where they mix with bile and then are mixed with the food, allowing the enzymes to digest the food further, releasing important nutrients which are then absorbed by the body. You can think of the pancreatic enzymes as a form of digestive juice which is needed to break the food apart into useful pieces.
What causes EPI?
In many animals the most common cause of exocrine pancreatic insufficiency is thought to be due to chronic pancreatitis. This is the recurrent inflammation of the pancreas which eventually results in damage to the parts of the pancreas that are responsible for producing digestive enzymes, known as the pancreatic acinar cells.
Exocrine pancreatic insufficiency can also be a hereditary condition in some breeds including German Shepherds and Rough Collies. In these dogs a genetic defect causes the pancreatic acinar cells to waste away and become non-functional, known as atrophy of the cells.
What age do dogs typically get EPI?
Exocrine pancreatic insufficiency can occur at any age but is most commonly seen in middle aged and older animals, when the underlying cause is thought to be chronic pancreatitis. In German Shepherds, Rough Collies, and other breeds that are predisposed to the condition, it is often diagnosed in younger animals, as due to the genetic defect they are born without sufficient functioning pancreatic cells to produce enzymes, so symptoms are often seen from much earlier in life.
It is important to note that more than 90% of the pancreas’s cells that produce digestive enzymes need to be destroyed or damaged before the animal will show signs of exocrine pancreatic insufficiency, so there can be some time delay between your pet having issues with their pancreas and reaching the point where they have EPI and are no longer able to absorb their nutrients correctly.
What are the symptoms of EPI that I may see in my dog?
If your dog has EPI, some common symptoms that may occur include:
Increased appetite, also known as polyphagia
Your pet may seem particularly hungry and be keen to eat food a lot of the time, you may find you are having to top them up with food often, but they are not gaining weight.
Weight loss
As above, your pet may be very hungry and eating lots, but they won’t be gaining weight, in fact they may have weight loss. This is because without the enzymes needed to digest foodstuff in their small intestines, they are unable to absorb the key nutrients needed to remain a healthy weight and allow their bodies to function correctly. As a result, their bodies use stores of fat and muscle as nutrients instead, resulting in weight loss.
Diarrhoea
The poorly digested food in your pet’s intestines often results in them having an upset stomach and producing loose faeces. The faeces are commonly pale, loose and foul smelling.
It is important to remember that all of the symptoms described above can be the symptoms of many other diseases and conditions, so full examination and diagnostic testing by a veterinary surgeon is essential to avoid incorrect diagnosis.
How is EPI diagnosed?
Exocrine pancreatic insufficiency is diagnosed by using a blood test. The veterinary surgeon will take a blood sample from your pet and send it to the laboratory to measure a parameter called serum trypsin-like immunoreactivity (TLI). In animals with EPI, this value is very low. Based on these results your vet will be able to ascertain whether your pet is likely suffering from EPI or not.
How is EPI treated?
The main treatment for exocrine pancreatic insufficiency in dogs is to give them a supplement of pancreatic enzymes on their food to enable them to properly digest their food and release all the nutrients they need. This treatment helps improve a lot of the clinical signs but is not curative, and your dog will need treatment for the rest of its life to ensure it can digest its food properly.
It is also important to note that giving supplemental enzymes is not exactly the same as the body producing its own, so digestion will never be completely normal, and if your pet continues to have issues it is important to speak to your veterinary surgeon to see if there are any other underlying conditions that need treating, or any additional supplements that are needed. For example, it has been found that around 80% of dogs who have been diagnosed with exocrine pancreatic insufficiency are also deficient in the vitamin B12, and require supplementation with this as well.
Are there any other conditions that can be seen alongside EPI?
Other conditions are well recognised along with EPI. In some cases, animals can develop diabetes as well if other parts of the pancreas have been damaged. This is more common in cases where chronic pancreatitis is the underlying cause of the disease, as other cells in the pancreas are more likely to be damaged in this case. It is important to discuss with your veterinarian what they suspect the underlying cause of your pets EPI is, and any additional monitoring that is needed, such as screening for diabetes, if they may be at a higher risk.
Summary:
- EPI stands for exocrine pancreatic insufficiency
- EPI is caused by the cells in the pancreas that produce digestive enzymes not functioning correctly
- EPI can cause a range of symptoms including increased appetite, diarrhoea and weight loss
- If your veterinarian suspects EPI then diagnostic tests will be performed to confirm the diagnosis
- There are treatment options for EPI but they are not curative, EPI is a lifelong condition that will require management for the rest of your pet’s life
- If you are concerned your pet is showing symptoms of EPI it is important to get them examined by a veterinary surgeon as soon as possible
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