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EXOCRINE PANCREATIC INSUFFICIENCY
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”) awaiting the chemical signal for their secretion. When food has been sufficiently ground up by the stomach, it is released downstream into the duodenum. When this food is perceived in the duodenum, the awaited chemical signal stimulates the pancreas to send its enzymes down the pancreatic duct and into the duodenum so as to continue the digestive process. 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 an adequate amount of 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. Difficulty clotting blood (vitamin K-related coagulopathy) can result as well.
EXOCRINE PANCREATIC INSUFFICIENCY (ALSO CALLED “MALDIGESTION”)
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 sometimes 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.
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 may be especially helpful for patients with trouble gaining weight. Many animals simply use enzymes mixed with their regular food if prescription diets prove too expensive.
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.
WHAT IF RESULTS ARE NOT AS RAPID AS EXPECTED?
Most pets respond in a matter of days to enzyme supplementation but if a week or so goes by and results are underwhelming, here are some tips to consider:
If all of these factors are already controlled and diarrhea still has not cleared up, it may be time to consider that a second disease is afoot. Discuss this possibility with your veterinarian.
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Page last updated: 9/4/2020