EXOCRINE PANCREAS INSUFFICIENCY

Is your dog losing weight even though he is eating every morsel of food available? Does he pass loose, foul smelling stools - if the answer is yes to either of those questions, then he may have a condition called exocrine pancreatic insufficiency (EPI). Animals with EPI are unable to produce enough digestive enzymes to properly digest food. Without these digestive enzymes, food passes through the digestive tract basically undigested -- this starves the animal of nutrients essential for survival.

This disease is found frequently in dogs. EPI is also found in humans afflicted with cystic fibrosis and Shwachman-Diamond Syndrome. EPI is caused by a progressive loss of the pancreatic cells that make digestive enzymes. Most commonly in dogs, this is caused by pancreatic acinar atrophy. The atrophy in turn can be caused by previous infections, a blocked pancreatic duct, or genetics. Chronic pancreatitis is the most common cause of EPI in humans and cats, but it is an uncommon cause in dogs. Loss of digestive enzymes leads to maldigestion and malabsorption of nutrients.

In dogs, EPI is most common in young German Shepherd Dogs, and Rough Collies, in which it is inherited. In the German Shepherd Dog the method of inheritance is through an autosomal recessive gene. In these two breeds, at least, the cause appears to be immune-mediated as a sequela to lymphocytic pancreatitis. The German Shepherd Dog makes up about two-thirds of cases seen with EPI.

Most dogs with EPI can be successfully treated by dietary supplementation with pancreatic enzymes. Powder is more effective than tablets, capsules, and especially enteric-coated products. Initially, 2 tsp/20 kg body weight is given with each meal/ Oral bleeding has been reported in 3 of 25 dogs with EPI treated with pancreatic enzyme supplements; the bleeding stopped in all 3 dogs after a dose reduction. Moistening the food and pancreatic powder mix may also decrease the frequency of this side effect. When clinical signs have resolved, the amount of pancreatic enzymes given can be gradually decreased to the lowest effective dose. Because of a slight risk of transmission of Aujeszky’s disease from raw porcine pancreas, only raw bovine pancreas should be used. Raw pancreas can be kept frozen for several months without loss of enzymatic activity. Preincubation of the food with pancreatic enzymes or supplementation with bile salts is not necessary.

Even though pancreatic enzyme supplementation decreases the clinical signs in almost all animals, nutrient absorption, especially of fats, is not normalized. Feeding low-fat diets to accommodate impaired fat digestion has been suggested, but this may further decrease fat assimilation and lead to deficiencies of fat-soluble vitamins and/or essential fatty acids. Some types of dietary fiber interfere with pancreatic enzyme activity, and a diet low in insoluble or nonfermentable fiber should be fed.

Enzyme supplementation alone may not lead to complete resolution of clinical signs; cobalamin deficiency should be considered as a possible cause. Cobalamin absorption depends on adequate synthesis and secretion of intrinsic factor. Some dogs may not respond to enzyme supplementation and cobalamin therapy and likely have concurrent small-intestinal disease. Dogs with EPI commonly have concurrent small-intestinal bacterial overgrowth and may need antibiotic therapy.

Currently, there is no known way to prevent the occurrence of pancreatic acinar atrophy in dogs. Research is ongoing to find genetic markers for this disease in affected animals. dogs that are known to have this condition should be surgically sterilized so that they cannot pass the genes to their offspring.