Exocrine pancreatic insufficiency (EPY) is a condition in which the ability of the pancreas to produce and secrete adequate enzymes is reduced in dogs. The pancreas plays an important role in the digestive process and aids in the digestion of food through the production and secretion of digestive enzymes. EPY results in the inability to digest food properly due to a lack of digestive enzymes.
EPY can have many causes. One of the most common causes is an inflammation of the pancreas called pancreatitis. Pancreatitis can cause damage to the pancreas and affect enzyme production. Other potential causes include hereditary factors, tumors, hormonal imbalances, and side effects of certain medications.
Symptoms in dogs with exocrine pancreatic insufficiency are usually problems with digestion. These symptoms include weight loss, increased appetite, diarrhea, greasy stools, gas, vomiting, and difficulty digesting food. If you notice such symptoms in your dog, it is important to consult a veterinarian.
Functions of the Pancreas in Dogs
The pancreas is a v-shaped gland located near the stomach and small intestine. Secretions from the pancreas are transported to the small intestine by the pancreatic duct. The pancreas has two separate and different functions, endocrine and exocrine functions. The pancreas produces enzymes that digest fats, carbohydrates and proteins. This is the pancreas is an exocrine function.
What Is Exocrine Pancreatic Insufficiency in Dogs?
Exocrine pancreatic insufficiency in dogs is a health problem with serious effects on the pancreas. It happens when most of the cells that produce digestive hormones don’t work normally. The pancreas is a small organ located under a dog’s stomach, near the beginning of the small intestine (duodenum). The pancreas has two vital functions:
- It produces insulin, the hormone that carries sugar from the bloodstream to the cells.
- To produce digestive hormones, including lipase to break down fats, proteases to break down protein, and amylase to break down starch.
Exocrine pancreatic insufficiency is the inability to produce enough pancreatic enzymes to digest fats, carbohydrates, and proteins. This difficulty in digestion leads to poor absorption of nutrients, which often results in weight loss despite normal or increased appetite. Affected dogs often have large volumes of pale, oily stools. This condition is called steatorrhea, or fat in the stool.
Different cells in a dog’s pancreas are responsible for performing each of these functions. When enough insulin-producing cells are damaged, dogs develop Type I diabetes and when the cells that produce digestive hormones are not functioning, the result is exocrine pancreatic insufficiency in dogs.
Symptoms of Exocrine Pancreatic Insufficiency in Dogs
Without adequate digestive hormones, the food a dog eats cannot be broken down and absorbed.
As a result, dogs with exocrine pancreatic insufficiency typically lose weight. Also in dogs
- increased appetite
- eating feces
- Other unusual eating (pica)
- Soft stools or diarrhea that is pale, greasy and/or particularly smelly – this is because there is undigested food in the intestinal tract.
- excess gas
- Scaly skin rashes
Other symptoms may be present in severe cases or if a dog is suffering from another condition in addition to exocrine pancreatic insufficiency.
Causes of Exocrine Pancreatic Insufficiency in Dogs
The most common cause of exogrine pancreatic insufficiency in dogs is pancreatic acinar atrophy (PAA). This is especially true when diagnosed in a relatively young dog less than four years old. Causes may be congenital (present from birth), inherited (genetic), or acquired as a result of pancreatic infection, inflammation or injury. The main cause appears to be the progressive loss of pancreatic cells, but chronic pancreatitis can also result in EPI.
PAA can also be an autoimmune disease, meaning a dog’s own immune system attacks and destroys the pancreatic cells responsible for producing digestive enzymes. The primary risk factor for PAA in dogs is genetics, so EPI is more common in some dog breeds.
German Shepherds are most at risk, but studies have shown an increased incidence of the following breeds as well:
However, any dog can develop exocrine pancreatic insufficiency and not all cases are linked to genetics. Diseases or other rarer conditions that destroy large parts of the pancreas, such as pancreatic cancer or severe and/or chronic pancreatitis, may also be to blame.
Diagnosing Exocrine Pancreatic Insufficiency in Dogs
The veterinarian may suspect that a dog has exocrine pancreatic insufficiency based solely on its symptoms and breed or history of health problems, but laboratory tests are still necessary as other diseases may have similar clinical manifestations. Here are a few tests that can help diagnose exocrine pancreatic insufficiency in dogs.
Blood Chemistry Test and Complete Blood Cell Count: The veterinarian will do blood chemistry tests and a complete blood cell count to get a picture of your dog’s overall health and to look for issues sometimes associated with exocrine pancreatic insufficiency, such as anemia (low red blood cell count).
Trypsin-Like Immunreactivity Test (TLI): The best test for exocrine pancreatic insufficiency, especially in dogs, is the trypsin-like immunoreactivity test (TLI). Trypsin is a digestive enzyme that is normally found at low levels in a dog’s bloodstream and is produced by the pancreas. Dogs with exocrine pancreatic insufficiency have significantly lower blood-trypsin levels than they should be. The test is easy to do by drawing blood, but dogs cannot eat for 8-12 hours before the sample is taken. Other tests are available for exocrine pancreatic insufficiency but do not provide as reliable results as the TLI test. However, in some cases they may be appropriate.
Vitamin Deficiencies or Folate Abnormalities
Vitamin B12 (cobalamin) deficiencies are common in dogs with exocrine pancreatic insufficiency. Folate (another type of B vitamin) levels can be normal, high, or low.
In severe cases of exocrine pancreatic insufficiency, dogs may have a vitamin K deficiency which can lead to bleeding. Your vet will measure your dog’s levels of cobalamin, folate, and possibly some other vitamins to determine what supplements are necessary for your dog’s good health.
Treatment of Exocrine Pancreatic Insufficiency in Dogs
Theoretically, treatment for exocrine pancreatic insufficiency in dogs is fairly straightforward: Dogs eat the deficient pancreatic digestive enzymes with their meals, and other abnormalities such as low cobalamin levels are addressed. Unfortunately, the reality of treating exocrine pancreatic insufficiency can be a little more complicated.
Pancreatic Enzyme Supplements
You should add pancreatic enzymes to your dog’s food at every meal. Dogs and cats powdered pancreatic enzyme supplements are easy to use and generally effective. Tablets are also available, but they don’t seem to work as well as powders.
Tips for Giving Pancreatic Enzyme Powders to Your Dog
Thoroughly mix the powder into your dog’s food before giving it to your dog, as it can irritate his mouth. Follow the dosage instructions on the label or provided by your veterinarian, but once your dog’s symptoms are well controlled, the goal is usually to find the smallest amount of enzyme supplement that works for your dog.
Another source of pancreatic enzymes is raw pancreatic meat from other animals. You can buy organ meat from butchers, raw pet food suppliers, and other sources, but processing and feeding raw animal products increases the risk of foodborne illness like salmonellosis for everyone in the household.
Follow your veterinarian’s advice for a commonly recommended starting dose for pancreatic meat. The amount your dog needs will depend on the specifics of your dog’s condition.
Tips for Feeding Your Dog Raw Pancreatic Meat
You can grind and freeze pancreatic meat in appropriate portions and then thaw before mixing well at each meal. Whether they are delivered in powder form or with pancreatic meat, most pancreatic enzymes are broken down in a dog’s stomach. If there is concern, drugs that reduce stomach acid secretion such as omeprazole can be used.
Dogs with low blood levels of vitamin B12, folate, and other vitamins need supplements. Initially, vitamin B12 shots are superior to oral administration, but once your dog’s condition has stabilized, you can usually switch to an oral cobalamin supplement.
Some dogs with exocrine pancreatic insufficiency develop an overgrowth of bacteria in their intestines, which can be treated with antibiotics. Most dogs only need a month or two of antibiotic treatment as their condition improves, but some may benefit from long-term treatment. Your veterinarian can recommend other treatments based on a dog’s symptoms and additional health issues.
Healing and Management of Exocrine Pancreatic Insufficiency in Dogs
Once appropriate treatment is started, most dogs with exocrine pancreatic insufficiency begin to feel better quickly. Their symptoms may improve in a few days to weeks. If this is not the case and your dog’s symptoms are not improving, discuss other treatment options with your veterinarian. Ask if it makes sense to switch to a different diet.
Exocrine Pancreatic Insufficiency Diets for Dogs
There is no single type of diet that benefits all (or even most) dogs with exocrine pancreatic insufficiency. Some dogs do better when they switch to a highly digestible food with relatively low fat and fiber, while others recover with more fiber or fat or do just fine with whatever they normally eat.
If your dog continues to respond poorly to treatment, he may be suffering from multiple health conditions and may require additional diagnostic tests.