Exocrine Pancreatic Insufficiency

EXOCRINE PANCREATIC INSUFFICIENCY

Exocrine pancreatic insufficiency (EPI) is the inability to produce sufficient pancreatic enzymes needed to digest fats, carbohydrates, and proteins. This difficulty in digestion leads to poor absorption of nutrients which commonly causes weight loss despite a normal or increased appetite.
Affected dogs often have large volumes of pale, fatty feces. This condition is called steatorrhea or fat in the stool.

The causes of EPI can be congenital, inherited, or acquired as the result of pancreatic infection, inflammation, or injury.
The condition is seen more commonly in German shepherd dogs, rough coated collies, Cairn terriers, akitas, West Highland white terriers, Welsh corgis, border collies, Australian heelers, Shetland sheepdogs, and Australian shepherds. It is suspected to be an inherited condition in German shepherd dogs.
The main cause appears to be a progressive loss of pancreatic cells. This may be due to an autoimmune, or chronic pancreatitis.

Young adult dogs are often affected and have
- chronic diarrhea or very soft, bulky, fatty looking feces,
- increased appetite,
- occasional vomiting, and
- gradual weight loss.

Because of the high level of fats in the stool, the hair coat around the anus and on the tail may appear greasy.

Simple blood and fecal tests can accurately detect if the condition is present.
Canine trypsinogen-like immunoassay (cTLI) is the preferred diagnostic test for EPI.
cTLI, in combination with Vitamin B12 and folate level tests, gives the best assessment of pancreatic function.

Highly digestible, low-fat diets together with pancreatic enzyme replacement will usually stabilize the condition.
Cobalamin (vitamin B12) supplementation in hypocobalaminemia conditions.
Lifelong treatment is required.
Monitor for folate level, which indicates an overgrowth of bacteria in the small intestine.

EPI due to chronic pancreatitis will sometimes resolve as the pancreas heals.
However, the most common cause of EPI is the progressive destruction of the exocrine cells of the pancreas. This can only be managed with medications and diet, most pets do well with treatment, though treatment is required for the lifetime of the dog.