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Exocrine Pancreatic Insufficiency (EPI)

by Hilary Kiell

Anytime you hear your pet is sick, or needs treatment it is a scary confusing time. EPI dogs can continue to live a full life and do all the activities they did before, EPI, in and of itself, when treated , does not shorten a dog's lifespan, The key is successful management. Pictured to the left is Maia. Maia, now 7 1/2 years old, was diagnosed with EPI when she was about a year old. She is a joy and we can't imagine our family without her.  She has mentored GSD fosters who have come in and out of our home - teaching them the ropes of life in a loving home.  Her EPI care is routine for us.  She gets love, toys and ice cubes in lieu of most treats, although she enjoys a dried tripe stick or probiotic treat, on occasion.  She gets a combination of powdered enzyme and fresh frozen pancreas with each meal and thrives on this diet.  At more than 90 lbs, we actually have to watch her weight, now that she is getting older.  Maia's idea of a great day includes chasing squirrels, hiking in the park and going for a car ride.

The information below is not intended to replace advice or guidance from veterinarians or other pet care professionals.  It is being shared to assist you in understanding the disease and identifying the right questions to ask your veterinarian. 

What is EPI?

EPI is a digestive disorder which impacts a dog’s ability to produce the pancreatic enzyme needed to digest his/her food.  It may also be referred to as pancreatic acinar atrophy (PAA).  Without supplemental pancreatic enzyme added with each meal, dogs with EPI are not able to digest their food and show symptoms of starvation, including weight loss, loose stools, and increased appetite.  While currently there is no cure, EPI is readily treated by adding appropriate pancreatic enzyme supplements to each meal.

Symptoms

The most common symptoms include:

  • Weight loss
  • Chronic diarrhea (may include foul-smelling, yellowish, greasy stools from cow-pie to watery consistency)
  • Ravenous appetite
  • Coprophagia (stool eating) and pica (eating non-food items)
  • Failure to gain weight or thrive

Diagnosis

The definitive test for EPI is cTLI (canine Trypsin-like Immunoreactivity ).  A blood sample is sent to a specialized lab for testing.  A single test is required.   In addition, the Cobalamin/Folate test for B12 deficiency is recommended.  This test may be repeated after treatment commencement to confirm that the B12 level is appropriate.  As some veterinarians are not familiar with EPI, you may need to be your dog’s advocate.  If you have any reason to believe your dog might have EPI, ask for these tests! 

Treatment

Treatment consists of supplementation with pancreatic enzymes.  Your vet may provide guidance on how much to use, based on the results of the cTLI test, however, there is often quite a bit of experimentation involved to get the amount just right, and to find the right food.  The enzyme must be added with each meal (it does not stay in the body but is digested with the food).  Without the enzyme, your dog is starving as s/he passes anything it eats through her/his system - basically undigested.  Hence, the large cow-pie poops and the weight loss. 

Food

Dogs with EPI require a highly digestible diet for their entire lives.  This does not have to be a prescription diet if a high quality, highly digestible over-the-counter pet food is used.  Some dogs do best with a raw diet; others with a grain free diet.  At the beginning of treatment, the dog’s daily food intake may be divided into several meals per day.  As the diarrhea resolves and weight gain begins, the number of meals may be reduced to two per day.  Enyzme supplements must be added with each meal, regardless of how many meals per day.  Remember, your dog can not digest his food, without the additional enzyme (this goes for treats, too)!

The optimal food should be based on:

Optimal

Protein

Fat

Fiber

 

20 -25%

<20%, optimal 10-15%

1-2%

Enzyme Replacement

Porcine (pig) enzyme powder is the main method used to manage EPI.  It is commercially available and easy to use.  The enzyme supplements, typically, contain a combination of 3 digestive enzymes (lipase, protease and amylase).  The enzyme is mixed with warm water to activate and the food is coated with the enzyme.  There are many enzyme brands available (e.g., Viokase-V, Pancreatin 6X, Pancreatin 8X, Bio Case V, etc.); some require a prescription, others do not.  Most dogs do equally well on any brand.  Powdered forms are more effective than tablets or capsules.

An economical source for the enzyme is:  http://www.enzymediane.com  Note:  this website also offers a comprehensive discussion of EPI and associated links.

Costs to manage EPI dogs are discussed in depth at:  http://www.enzymediane.com/coststomanageepi.htm

An alternative, if available, is fresh frozen beef or swine pancreas. You can use this in place of or in addition to the powdered enzyme.  Fresh frozen pancreas may be difficult to find but the following two sources are offered as options:

Probiotics

Probiotics may help to maintain a healthy digestive and immune system by increasing the good bacteria in the digestive system.  The addition of daily probiotics to an EPI dog’s diet may reduce the frequency of SIBO and diarrhea.  Canine probiotics come in several forms: capsules, powders, liquids, pills, gels and soft chews.  FortiFlora and Proviable DC are two such products.  These products do not require a prescription.

Other Conditions to Look Out For:

SIBO:  The most common complication is SIBO (small intestinal bacterial overgrowth). It occurs when undigested food sits in the small intestine and is attacked by bad bacteria, causing diarrhea and weight loss.  SIBO usually responds to a course of antibiotics (typically, metronidazole (flagyl) or tylan).  Prophylactic daily use of probiotics (see above) helps to repopulate the beneficial bacteria and maintain a level high of good bacteria.

B12 Deficiency:  Many dogs with EPI lose the ability to absorb vitamin B12 which is needed for digestion.  If your dog is diagnosed with this deficiency, B12 supplemental injections may be recommended by your veterinarian.  Most oral B12 supplements have been found to be ineffective. 

Summary

  • Costs for managing EPI can be greatly reduced if you obtain quality enzymes economically,
  • Preparing food for your EPI dog isn't hard – it does take some extra planning and effort but becomes the norm in short order,
  • EPI dogs may continue to live a full life and do all the activities they did before,
  • EPI, in and of itself, when treated , does not shorten a dog's lifespan,
  •  The key is successful management.

Links

“Enzyme Diane, Digestive Enzyme Supplements for EPI”, http://www.enzymediane.com

EPI  Exocrine Pancreatic Insufficiency - http://www.epi4dogs.com/

“EPI in Dogs”, Globalspan.net, - http://www.globalspan.net/epi.htm

“EPI Research Fund” http://www.epi-research-fund.com/index.htm

K9-EPI Global  - a (yahoo group) support site, membership required - http://pets.groups.yahoo.com/group/k9-EPIGLOBAL/

Wolfie’s Wild Dog Food  http://www.wilddogfood.com/

Hare Today, Gone Tomorrow -  http://www.hare-today.com/

References:

“EPI Research Fund” http://www.epi-research-fund.com/index.htm

“Enzyme Diane, Digestive Enzyme Supplements for EPI”, http://www.enzymediane.com

“EPI in Dogs”, Globalspan.net,  http://www.globalspan.net/epi.htm

Pancreatic Enzyme Insufficiency (PEI)” Veterinary Nutritional Consultants, Inc. email: PetDIETS@att.net ® 


P.O. Box 23231 •  Baltimore, MD 21203  •  (410) 775-6473 •  adoptions [ at ] allshepherdrescue.com