Download Exocrine Pancreatic Insufficiency

Seen a Super Skinny Pet? Consider Exocrine Pancreatic Insufficiency
By Dr. Ed Mapes
The pancreas is situated between the stomach and the initial portion of the small
intestine known as the duodenum. We all know that the pancreas produces insulin, a
hormone that drives glucose from the bloodstream into cells, but another important role
of this multi-faceted organ is the production of enzymes that promote digestion of food.
These substances include amylase to break down starches, lipase to digest fats, along
with proteases and trypsin for proteins. These enzymes are stored within specific
pancreatic tissue – acinar cells – and are released from the pancreas to the small
intestine when food leaves the stomach.
Exocrine Pancreatic Insufficiency (EPI) is the condition whereby the pancreas fails to
produce enough of these important digestive enzymes, and the body becomes unable
to absorb the nutrients it requires. The animal becomes exceedingly thin despite having
a healthy appetite, has a dry hair coat, produces excess volumes of stool, and
sometimes develops chronic diarrhea.
The most common cause of EPI is acinar atrophy; wherein the pancreas simply loses
the ability to produce these enzymes. German Shepherds seem most prone to acinar
atrophy, but we recently encountered a Bassett Hound and Irish Setter with the
condition.
Severe acute or chronic pancreatitis can damage the pancreas to the extent that
enzyme production stops. This is the most common cause of EPI in cats. Regardless of
the cause of onset, accurate identification of the disorder and appropriate treatment is
important to restoring the animal to health.
We always check these patients for intestinal parasites, and often perform blood
chemistries to examine for other diseases. The gold standard test to diagnose EPI
though is the TLI, or Trypsin-Like Immunoreactivity test. Trypsin, which aids in the
digestion of protein, is normally stored in the pancreas in an inactive form, but
detectable trace amounts are always present in the bloodstream. A patient with EPI has
below-normal or negligible trypsin-like immunoreactivity present, thus allowing us to
identify these patients. There are both canine and feline versions of the TLI test, and it
takes 2-3 days to get lab results back.
When patients have EPI, the normal population of bacteria in the gut is often by other
species. These bacteria tend to consume Vitamin B-12 (cobalamin) and folate, resulting
in deficiencies that are detectable with blood testing. We usually run tests for cobalamin
and folate when there’s a suspicion of EPI.
Supplementing the diet with digestive enzymes is the cornerstone of treatment for these
patients. Powdered preparations that are mixed with the food are the most effective
route for most animals. Tablets may not break down sufficiently to provide full benefit,
and enteric coated tablets do not seem to work. The powder can also be compounded
into capsules if that method of administration is easier.
The powder must be mixed thoroughly with the food before feeding. We’ve found that
some patients respond better if we block stomach acid production with medication when
giving meals.
Raw beef or lamb pancreas can also be effective, but be mindful of spreading parasites
and bacterial contamination in raw meats. Cooking the pancreas is not recommended
because that destroys s the enzymes.
A highly digestible diet that is low in fiber should be fed to these patients. The food
should also contain easily digestible protein. Your veterinarian will give advice about
appropriate diets.
Patients low in cobalamin and folate (especially cats) should receive intestinal
antibiotics to eliminate the unwanted bacteria, and then receive supplements to replace
the normal species. They may require periodic testing and injections given to maintain
proper levels.
Exocrine pancreatic insufficiency should be suspected whenever a dog or cat becomes
very thin in spite of having a robust appetite. Onset of the disorder can occur in young
animals if they’re born with the problem, or can develop later in life in pets that have had
a pancreatic disease. Treatment is usually very effective in restoring these animals to
health.