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Exocrine Pancreatic Insufficiency (EPI)

EPI is a disorder which affects the production and secretion of the enzymes in the pancreas which are essential for the digestion of protein in to the small intestine.
EPI is characterised by a progressive loss of the pancreatic cells that normally produce powerful enzymes required for the initial degradation of food in the small intestine. In EPI, fewer and fewer of these digestive enzymes are produced, which ultimately leads to maldigestion and malabsorption of nutrients. The situation is compounded by the fact that there may be secondary gut damage, whereas EPI also predisposes the animal to the development of small intestinal bacterial overgrowth (SIBO), which has an additional negative effect on intestinal function.

What causes EPI?

EPI in dogs is most frequently due to pancreatic acinar atrophy and recurrent inflammation of the pancreas or chronic pancreatitis

There is a high prevalence of EPI in German Shepherd Dogs including White Shepherds, in which breed the disease is reported to be heritable in an autosomal recessive manner.
A recent study has indicated that the pancreatic atrophy is preceded by lymphocytic-plasmacytic inflammation, which suggests that the disease may have an immune component. However, these are very preliminary findings.

What are the symptoms of EPI?

  • Weight loss despite the possibility of an increase in appetite.
  • Diarrhoea
  • Steatorrhoea. Steatorrhoea is the presence of excessive amounts of fat in in the faeces. Increased amounts of faecal fat give it a grey colour and a greasy appearance which will leave an oily spot on paper it comes into contact with.
  • Increased gut sounds are often present on auscultation(called borborygmi). Auscultation is the examination of internal organs by listening. Usually this involves using a tool to magnify the sound – such as a stethoscope, but internal sounds can be detected by placing the ear over the region of body closest to the organ under examination.
  • If the condition has been present for any length of time signs of nutritional deficiency might become obvious, including poor hair condition (dry and brittle) and sometimes pallor due to anaemia and low circulating blood protein concentrations – hypoproteinaemia.

If any of these signs are evident in your dog, please consult a vet.

Diagnosis

EPI is commonly diagnosed via the TLI-test. This is a blood test which measures the amount of a pancreatic digestive enzyme (trypsinogen) in the blood stream, providing an indirect assessment of pancreatic function.
Dogs with EPI can be identified by a low blood TLI concentration. Marked reductions in serum TLI concentration may precede the onset of clinical signs of EPI, and assay of serum TLI has been useful for the early identification of affected dogs.
TLI is the most common test used to diagnise EPI but other tests are often used, and are still needed in complicated cases with more than one concurrent disease.
Once an EPI diagnosis has been established, a vet might also check for diabetes mellitus as the pancreas is also involved in the production of insulin and a lack of insulin leads to the condition.

Treatment

EPI which has not been complicated by the presents of diabetes can often be treated by a modification of diet and the addition of pancreatic enzyme supplements. Modification of the diet may involve lowering the fat and fibre intake, mild cases of EPI can sometime only require a change in diet to overcome.
Vets may also advise antibiotics if a bacterial overgrowth is present.
With adequate treatment, the outlook for dogs with EPI is usually good, although the dogs will require life-long treatment.

This article was first published on Fellowship of White Shepherds.