Client Information Sheet Copyright Bilton Veterinary

Client Information Sheet Copyright Bilton Veterinary Centre 2011. All rights Reserved

Copyright Bilton Veterinary Centre 2011. All rights Reserved

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Both images on this page reprinted with permission from Hill’s Pet Nutrition Inc

Exocrine Pancreatic Insufficiency (EPI)

What is the pancreas? The pancreas is a small organ situated just next to the stomach and the first part of the small intestine (the duodenum). This highly glandular organ has a rich blood supply and has several ducts draining into the duodenum. The role of the pancreas is two-fold: 1. It produces digestive enzymes into the

small intestine that helps to break down the food into its constituent molecules that the gut can then readily absorb. (The “Exocrine” Function”)

2. It controls and regulates blood sugar in the body by means of producing hormones such as insulin and glucagon. (The “Endocrine” Function)

What is EPI? Exocrine Pancreatic Insufficiency (EPI) is a term used to describe a condition where the glandular portions of the pancreas (those responsible for producing the digestive enzymes) undergo atrophy/wasting and lose functionality. This then results in reduced/absent digestive enzymes being secreted into the duodenum and thus the animal finds it difficult to break down food properly. In contrast, Diabetes Mellitus (sugar diabetes) is an example of the endocrine pancreas not functioning properly.



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What causes EPI? There are several possible causes of EPI including:

• Inherited (particularly in certain breeds such as German Shepherds) • Atrophy of the pancreas • Damage from infections (pancreatitis etc) • Auto-immune disease • Cancerous processes

What are the symptoms of EPI? With inherited disease or pancreatic atrophy, the symptoms will usually start when the animal is quite young (<4 years old). However with acquired disease, the animal can be any age and so it should remain a suspicion (at any age) if any of the following symptoms are seen:

• Weight loss/Poor weight gain (often this is severe)* • Voracious appetite* • Foul smelling fatty/greasy stools (often greyish or

yellow in colour) * • Soft stools/diarrhoea* • Increased faecal volume and frequency* • Coprophagia (eating their own faeces) or “Pica”

(craving eating odd things like soil, wall paper etc) • Flatulence • Vomiting • Increased thirst

*Most commonly seen

How is EPI diagnosed? EPI can be suspected by clinical suspicion alone, but will need to be confirmed by blood tests. The main test used is a Fasting Canine Trypsin Like Immunoreactivity (Fasting cTLI) test. Trypsin is a molecule that is synthesised purely in the pancreas and is present in the blood stream in all animals. Measuring the concentration of these molecules in the blood is useful, as a very low reading suggests a poorly functioning glandular part of the pancreas (ie EPI). Conversely, a very high reading suggests active pancreatic damage/inflammation (ie pancreatitis). The fasting cTLI test is a simple blood test that is performed after the animal has been starved for around 12hrs. The sample is sent to our lab for analysis and the results are about 99.9% diagnostic for EPI. There is a normal acceptable range for dogs and so if the test reveals a low reading of cTLI then EPI can be confirmed.

Jack Russell with severe weight loss

A pale fatty/greasy stool which is typical of dogs with EPI



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Diagrams showing how the ability to absorb food molecules by the gut is compromised when there are reduced pancreatic enzymes present in EPI. The gut is only able to absorb small molecules after pancreatic enzymes have broken the larger molecules into their constituent pieces.



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Are there other problems that go with EPI? EPI is rarely diagnosed (and treated) on its own. Often there are other problems that become part of the “syndrome”. These can include: • Small Intestinal Bacterial Overgrowth (SIBO)/Antibiotic Responsive Diarrhoea

(ARD). This is where conditions in the gut have favoured and overgrowth of bacteria. This is very different to a bacterial gastroenteritis which is where it is usually a brief problem due to a very specific bug that is “caught”. The bugs involved with SIBO/ARD are often in themselves not particularly pathogenic, but have reached such high numbers that their cumulative effect can cause problems.

• Vitamin B12 (Cobalamin) deficiency. This is often present in animals with EPI (and

other forms of severe gastrointestinal disease). Although often used as a diagnostic indicator, it is vital for normal gut function.

• Gastric Irritation/Ulcers. Due to the often chronic nature of this disease,

sometimes the lining of the gut and stomach can become damaged. Usually this is mild, but occasionally severe ulcers can develop.

• Gut-lining atrophy can occur if the condition has been long standing and this results in a poor-ability for the gut to absorb nutrients. This is usually reversible thought with treating the EPI primarily.

What other tests are necessary other than cTLI? If EPI is confirmed (or often as part of ongoing gastro-intestinal investigations) further tests may be required. These can include:

• Faecal sample to check for parasites or pathogenic bacteria that may be complicating the issue. It is not usual to find opportunistic infections of E coli, Campylobacter or Salmonella

• Bloods to check B12 levels and Folate Levels. • Absorption tests may be required to check the guts ability to absorb nutrients. • Ultrasound/Xrays are very rarely used, unless we need to rule out other causes

of weight loss, such as foreign bodies or tumours for example. • Intestinal biopsies again are occasionally required if response to treatment is

not as aspected.



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What is the treatment for animals with EPI? The main aim of treatment of dogs with EPI is to replace the pancreatic enzymes that are not being produced by the dog’s own pancreas as well as control any secondary disease that may be present.

• Pancreatic supplements. These are the mainstay of treatment and are vital to try and control the animal’s EPI. These are available as coated capsules, powder or granules and these are normally added to each meal that your pet has. Sometimes it is possible to use fresh ox pancreas and this works well, but can occasionally be difficult to source.

• Antibiotics may be required if there is evidence of SIBO/ARD and may be required for at least 4-6 weeks. Antibiotics used for this are very “gut-specific” and are suitable for long term use if necessary. Currently oxytetracycline, metronidazole or tylosin is used.

• Vitamin B12 supplements. If the animal has low B12 then restoring this is essential to help the gut start to function normally again. B12 injections are normally given weekly for 6 weeks, and then monthly if required.

• Antacids/Gastro-protectants may also be required if any ulceration/GI irritation is suspected. Some animals seem to struggle to tolerate the pancreatic supplements too (it can make them vomit), and so treatments with protectants such as sulcralfate often help reduce side effects.

It is also useful to modify the diet to one that the dog can digest more easily. There are several on the market which may be suitable including Hills i/d. Also some small changes can be undertaken that may help, including:

• Feed little and often. Aim for around 3-4 meals a day with the supplement.

• If you find a dietary regime that works – STICK TO IT!

• If using the powder or granules pancreatic supplement, add it to the food with some water (NOT BOILING) for about 15-20 minutes before giving the food to your dog.

• If using dry food, try crushing it before hand. This creates a larger surface area for the enzymes to work on. Other people have tried using the largest kibble they can get, so the dog is forced to chew and crush each bit.

• Regular weight checks to ensure adequate maintenance. • Get to know your dog’s stools!

Treatment will usually be required for the rest of the dog’s life.



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Can dogs make a recovery from EPI? Yes they can! The photos on the right show the Jack Russell terrier that was diagnosed with EPI. You can see the difference before and after treatment! As long as the correct diagnosis is made, a treatment regime is created and followed and any other concurrent disease/problems are dealt with, then you and your dog stand a pretty good chance of being able to lead a perfectly normal life and have a good quality of life!

What about cats? Cats do suffer from EPI, but it is VERY rare and testing for it can be a little more tricky.

Is it contagious? EPI is not contageous and so there is no risk of incontact dogs getting EPI. However there is a hereditary nature to this condition, so if your dog is diagnosed, we recommend that:

1. You contact the breeder to let them know. This is important to they can recognise/spot other cases.

2. Advise against breeding from the parents again as there is increased risk that further offspring may be affected.

3. You consider neutering your pet to ensure that they cannot breed and potentially pass the condition on.

Summary EPI is a condition that can be difficult for both dog and owners. However a prompt diagnosis as well as good life long care can be very satisfying and effective. Our vets will help you all the way and give advice and treatment as required. For further information either talk to us, or you can visit a very good website at www.epi4dogs.com which has lots of additional information about this condition.

Some images in this information sheet are from (and adapted from) Hill’s Atlas of Veterinary Anatomy. They cannot be reproduced without written consent from Hill’s Pet Nutrition Inc.

http://www.epi4dogs.com/

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Client Information Sheet Copyright Bilton Veterinary