EXOCRINE PANCREATIC INSUFFICIENCY

 
Stomach. pancreas, and intestine in a normal dog or cat belly.

WHAT THE PANCREAS NORMALLY DOES:

The pancreas is a small light pink glandular organ nestled under the stomach and alongside the duodenum (upper small intestine). The "endocrine" pancreas is the part of the pancreas that secretes hormones involved in blood sugar regulation, such as insulin and glucagon. The "exocrine" pancreas produces enzymes we use to digest our food. These two parts of the pancreas are not in separate areas but instead these two different types of pancreatic tissues are all mixed together throughout the entire pancreas.

Digestive enzymes include amylase to digest starches, lipases to digest fats, and trypsin and proteases to digest protein. They are stored in inactive forms inside special granules in the exocrine pancreatic tissue (the “acinar cells”) and are secreted into the duodenum (the first part of the small intestine after the stomach) when ground up food begins its passage out of the stomach. Once nutrients are broken down into smaller molecules (i.e. they are digested), they can be absorbed down the entire length of the GI tract. Without adequate productive of these enzymes, we cannot break down/digest our food. If we cannot digest the food, we cannot absorb the food. We get skinny, have especially nasty rather greasy diarrhea, or both. Often, a pet will develop a dry, dandruffy coat from inability to absorb dietary fats and can be anemic from a vitamin B12 deficiency.

EXOCRINE PANCREATIC INSUFFICIENCY (ALSO CALLED “MALDIGESTION”)

 
Stomach, pancreas, and intestine in a dog or cat with exocrine pancreatic insufficiency. Notice the atrophied pancreas.

DIAGNOSIS REQUIRES SPECIFIC TESTS

Another popular test is the Fecal Protease Test, where a stool sample is tested for protein digesting enzymes. Fasting is not necessary and any fecal sample will do; however, 3 consecutive samples are needed to get a consistent result as there is tremendous variability in fecal enzyme activity over the day. Sometimes soybeans are given to dogs to help stimulate release of pancreatic protein digestion enzymes and get a more accurate test.

The Fecal Elastase test (elastase being another digestive enzyme) is the newest test and it is only available for dogs. A single fecal sample is needed but the problem is that some times normal dogs will test negative for elastase. This means that EPI can be ruled out when the Elastase test is positive but not confirmed when the elastase test is negative.

TREATMENT

Raw beef or lamb pancreas can also be used as a possibly inexpensive form of enzyme replacement but the problems with raw foods include parasite and bacterial contamination. Cooking the pancreas relieves these concerns but inactivates the desired digestive enzymes. Raw pancreas can be stored frozen without losing digestive enzyme activity.

Generally a high digestibility diet is the best choice for an EPI patient. These foods are low in fiber and fat and may be especially helpful for patients with trouble gaining weight. Many animals simply use enzymes mixed with their regular food.

EPI patients commonly have an overgrowth of bacteria in their intestines which means that the unabsorbed nutrients in the tract have fed the bacteria living there (instead of the patient) and an over-population of bacteria has occurred. This results in a vitamin B-12 (also called “cobalamin”) deficiency as the bacteria consume the vitamin (instead of the patient getting his or her share). A course of antibiotics is helpful to correct this problem especially early in the course of treatment. Periodic injections of vitamin B-12 and blood test monitoring have been recommended for patients with EPI. The B-12/Cobalamin deficiency is a particularly big problem for cats with EPI, who typically require injections every couple of weeks for life. Folate deficiency is also common in the cat and supplements are required for the first month of therapy. Regular cobalamin and folate blood levels important for cats with EPI. Supplementation with the fat soluble vitamins (especially vitamin K and vitamin E) are not usually needed.

Treatment is for life and without enzyme supplementation, all the unpleasant symptoms will recur. The good news is that a response to therapy is generally seen within a week of beginning therapy. Response can be excellent but approximately one dog in 5 will simply not respond well. Many do not ever regain a normal amount of weight.

Want more support on line? Join the Exocrine Pancreatic Insufficiency Forum for dog owners at:

http://pets.groups.yahoo.com/group/k9-EPIGLOBAL/

www.epi4dogs.com/

Page last updated: 9/2/2016