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EPI in Dogs (Exocrine Pancreatic Insufficiency in Dogs)

What Is EPI in Dogs?

EPI, or exocrine pancreatic insufficiency, is a condition in dogs characterized by dysfunction of the pancreas, leading to serious health issues. This occurs when the majority of cells responsible for producing digestive hormones do not operate normally.

Situated beneath the dog’s stomach, adjacent to the beginning of the small intestine (the duodenum), the pancreas plays two essential roles:

  • Production of insulin, facilitating the movement of sugar from the bloodstream into cells.
  • Production of digestive hormones, including lipase for fat breakdown, proteases for protein breakdown, and amylase for starch breakdown.

Distinct cells within the pancreas are tasked with executing these functions. Damage to a sufficient number of insulin-producing cells results in Type I diabetes in dogs. Conversely, when the cells responsible for producing digestive hormones malfunction, EPI manifests in dogs.

Is EPI in Dogs Curable?

Regrettably, there is no known cure for exocrine pancreatic insufficiency in dogs. Once the pancreas reaches a state of damage where symptoms of EPI surface, administering pancreatic enzyme supplements and potentially other treatments becomes necessary for the remainder of your dog’s life. Nevertheless, with diligent management, your dog can lead a healthy and content life.

Symptoms

When a dog lacks sufficient digestive hormones, the food they consume cannot be properly broken down and absorbed. Consequently, dogs afflicted with EPI commonly experience weight loss. Additionally, your dog might:

  • Display a voracious appetite
  • Engage in coprophagia (eating feces)
  • Exhibit pica (consuming other unusual items)
  • Experience pale, greasy, and unusually smelly diarrhea or soft stool due to undigested food in the intestinal tract
  • Have excessive gas
  • Develop flaky skin and a coarse coat

In severe instances or if other underlying conditions accompany EPI, additional symptoms may manifest.

Causes

The predominant cause of EPI in dogs is pancreatic acinar atrophy (PAA), particularly when diagnosed in dogs under four years old. PAA is believed to be an autoimmune disease, where the dog’s immune system targets and damages the pancreatic cells responsible for producing digestive enzymes. Genetic predisposition is a primary risk factor for PAA, leading to a higher prevalence of EPI in certain dog breeds.

German Shepherds are particularly susceptible, and studies indicate increased incidences in the following breeds:

  • Rough-Coated Collies
  • Chow Chows
  • Cavalier King Charles Spaniels
  • Cairn Terriers
  • Akitas
  • West Highland White Terriers
  • Cardigan Welsh Corgis
  • Border Collies
  • Australian Heelers
  • Australian Shepherds
  • Shetland Sheepdogs

While these breeds are at higher risk, it’s important to note that EPI can affect any dog, and not all cases are genetically linked. Conditions such as pancreatic cancer, severe and/or chronic pancreatitis, or other rare disorders that damage significant portions of the pancreas may also contribute to the development of EPI.

Diagnosis

A veterinarian might suspect EPI in a dog based on its symptoms and breed or health history, but laboratory tests are essential as other illnesses can present similar clinical signs. Several tests aid in diagnosing EPI in dogs:

Blood Chemistry Test and Complete Blood Cell Count: These tests help assess the overall health of the dog and detect issues like anemia, which can be associated with EPI.

Trypsin-Like Immunoreactivity Test (TLI): The TLI test is the most reliable diagnostic tool for EPI in dogs. It measures the levels of trypsin, a pancreatic digestive enzyme present in low amounts in a dog’s bloodstream. Dogs with EPI typically exhibit significantly lower blood-trypsin levels. The test involves drawing blood after an 8-12 hour fasting period.

Although other tests for EPI exist, they may not offer results as dependable as the TLI test. Nonetheless, they could be appropriate in certain situations.

Vitamin Deficiencies or Folate Abnormalities

Dogs with EPI commonly experience deficiencies in vitamin B12 (cobalamin). Folate levels, another type of B vitamin, can vary—being normal, high, or low. In severe instances of EPI, dogs might also develop vitamin K deficiencies, resulting in bleeding issues. Your veterinarian will assess your dog’s cobalamin, folate, and potentially other vitamin levels to identify the required supplements for restoring your dog’s health.

Treatment for Exocrine Pancreatic Insufficiency in Dogs

In principle, treating EPI in dogs seems straightforward: Dogs consume the lacking pancreatic digestive enzymes alongside their meals, and any additional abnormalities such as low cobalamin levels are managed.

However, the practicality of treating EPI can be somewhat more intricate.

Pancreatic Enzyme Supplements

Pancreatic enzyme supplements should be added to your dog’s food at every meal. Powdered forms such as PancrePlus Powder for dogs and cats, Thomas Labs Bio Case Pancreatic Enzyme Powder, and PanaKare Plus Powder for dogs and cats are convenient and typically effective.

Although tablets are available, they appear to be less effective compared to powders.

Here are some tips for administering pancreatic enzyme powders to your dog:

  • Thoroughly mix the powder into your dog’s food before serving to prevent mouth irritation.
  • Some pet owners suggest allowing the food to sit for a brief period to facilitate “predigestion,” although scientific evidence supporting this is lacking. Nonetheless, it can be worth trying if your dog’s response to treatment is not as expected.
  • Adhere to the dosage instructions on the label or as provided by your veterinarian. Once your dog’s symptoms are well-managed, the objective is often to determine the smallest effective dose of the enzyme supplement for your dog.

Raw Pancreas Meat 

Another source of pancreatic enzymes is raw pancreas meat obtained from other animals. You can acquire this organ meat from butchers, raw pet food suppliers, and other sources. However, handling and feeding raw animal products increase the risk of food-borne illnesses such as salmonellosis for everyone in the household.

A common starting dose for pancreas meat is 1-3 ounces mixed with each meal, although it’s important to follow your veterinarian’s recommendation. The quantity required by your dog will depend on the specifics of their case.

Here are some tips for feeding your dog raw pancreas meat:

  • Grind up and freeze pancreas meat in appropriate portions, thawing it before thoroughly mixing it with each meal.
  • Whether delivered in powder form or through pancreas meat, most pancreatic enzymes are broken down in a dog’s stomach. If this is a concern, medication that reduces stomach acid secretion, such as omeprazole, may be used.

Vitamin Supplementation

For dogs with low blood levels of vitamin B12, folate, and/or other vitamins, supplementation is necessary. Initially, vitamin B12 shots are more effective than oral administration. However, once your dog’s condition stabilizes, you can typically transition to an oral cobalamin supplement.

Antibiotics

Certain dogs with EPI may experience bacterial overgrowth in their intestinal tract, which can be controlled with antibiotics, commonly Tylosin. While many dogs may only need antibiotic therapy for a short period, typically a month or two as their condition improves, some may find benefit from long-term treatment. Your veterinarian may suggest other treatments based on a dog’s symptoms and additional health considerations.

Living and Management

Following the initiation of appropriate treatment, most dogs with EPI experience a swift improvement in their condition. Their symptoms can ameliorate within a few days to weeks.

However, if your dog’s symptoms persist without improvement, it’s important to consult your veterinarian regarding alternative treatment options. Consider discussing the possibility of switching to a different diet for your dog’s management.

EPI Diets for Dogs

There isn’t a singular type of diet that universally benefits all dogs with exocrine pancreatic insufficiency (EPI). Certain dogs may thrive when transitioned to a highly digestible diet that is relatively low in fat and fiber. Conversely, others may show improvement with increased fiber or fat content, while some may fare well with their regular diet.

If your dog’s response to treatment remains unsatisfactory, it’s conceivable that they might be grappling with more than one health issue, warranting further diagnostic testing.

EPI in Dogs FAQs

What is the primary cause of EPI in dogs?

Pancreatic acinar atrophy (PAA) stands as the leading cause of EPI in dogs. PAA is predominantly a genetic disease wherein a dog’s immune system targets and destroys the pancreatic cells responsible for producing digestive enzymes.

What should you feed a dog with EPI?

A common recommendation is to provide dogs with a highly digestible dog food that contains relatively low levels of fat and fiber. However, various types of food may yield better results for different dogs, necessitating experimentation with several diets to find a suitable match. Your veterinarian can offer guidance in determining the best food for your dog.

Can I manage my dog’s EPI at home?

Treating a dog’s EPI at home without prior veterinary consultation is not recommended. Effective management of your dog’s EPI entails a visit to the veterinarian to determine the optimal balance of supplements and medication. However, once this equilibrium is established, the home management of EPI in dogs is generally straightforward. Dogs with EPI are typically managed at home through the administration of pancreatic enzyme supplementation, cobalamin supplementation, and possibly additional vitamin supplements, antibiotics, medications to reduce stomach acid secretion, and other treatments to alleviate symptoms.

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