We would like to thank Olesia Kennedy of EPI4Dogs Foundation for her assistance with this article, the photos, and tireless dedication to provide comprehensive, up-to-date information on Exocrine Pancreatic Insufficiency. I encourage everyone to visit EPI4Dogs.com.
Don’t be intimidated by the title. The basics of Exocrine Pancreatic Insufficiency (EPI) are easy to understand. However, research is rapidly proving that we have barely scratched the surface of this condition. In fact, I believe EPI is underdiagnosed.
Before we get ahead of ourselves, let’s have a biology 101 breakdown of EPI. The pancreas serves as a two-in-one organ, meaning that it functions as both an endocrine and exocrine gland.
Endocrine – The endocrine system secretes hormones directly into the bloodstream that do not leave the body. Hence, “endo.” The pancreas releases the insulin and glucagon hormones. The thyroid gland – which is one of my fields of emphasis – is a member of the endocrine system.
Exocrine – On the flip side, the exocrine system secretes a variety of substances to be eventually disposed of outside of the body. The exocrine system includes the sweat, tears and salivary glands. Functioning as an exocrine gland, the pancrease productes and then secretes digestive enzyme (juices) into the duodenum, the first section of the small intestine. These digestive enzymes aid in the digestion of proteins, fats and carbohydrates.
Insufficiency – “Insufficiency” is the inability or lack of sufficiency, in this case, to synthesize digestive enzymes by the acinar cells of the pancreas. These cells are destroyed or malfunctioning.
The acinar cells are “atrophied” – meaning they are wasting away or possibly already destroyed. Thus, these acinar cells cannot manufacture digestive enzymes properly. When the affected digested enzymes enter the duodenum maldigestion and malabsorption will set in, which will lead to another condition called Small Intestinal Dysbiosis (SID). (SID is also formally known as Small Intestinal Bacterial Overgrowth [SIBO].) SID is due to excessive bacterial overgrowth in the small intestine.
These bacteria feast on fermenting food that is not digesting Then, the amount of bacteria continues to increase and eventually lines the tissue of the small intestine, which further impairs the absorption of vital nutrients and also depletes the body’s reserve of vitamin B12.
Symptoms of EPI vary by severity. It has been widely stated that signs of maldigestion typically do not present until 90% of the functional reserve is lost. However, this is a wasting disease, so I would suspect that some signs would be present before 90% is lost. Your companion pet may exhibit the following signs:
- Voracious appetite
- Vomiting (generally concurrent with IBD, inflammatory bowel disease, or a food sensitivity)
- Ravenous, insatiable hunger
- Eliminating voluminous yellowish or grayish soft “cow patty” stools – this a “hallmark” sign
- Possibly aggressive behavior
- Anorexia or extreme thinness
- Gas formation
Types of EPI
We are continuously discovering more about this disease. So, I would not be surprised if more types or causes of EPI crop up over the next few years.
- Pancreatic Acinar Atrophy (PAA) is the most common cause of EPI in dogs. We will likely see more causes and cases of PAA over the next few years. PAA is thought to be an immune-mediated condition secondary to lymphocytic pancreatitis; German Shepherd Dogs and Rough Coated Collies have a genetic predisposition to EPI. Of course, these two breeds may be overrepresented in clinical trials.
- Chronic Pancreatitis can develop into EPI. My concern is that this is the sleeper condition. Pet caregivers figure out methods to manage chronic pancreatitis but do not realize when it has triggered EPI. This form of EPI is more common in cats than dogs. In fact, it is believed that cats also have EPI more often than it is diagnosed. Diabetes mellitus can be present.
- Congenital Hypoplasia is an underdeveloped or incomplete development of the pancreas organ or its tissue.
- Neoplasia causes an obstruction not allowing the digestive enzymes to flow from the pancreas to the duodenum. Technically, neoplasia is not EPI, but similar symptoms can ensue.
When presented with a skinny or SID dog or cat, I often think that veterinarians may search for cancer or other conditions as a possible cause and therefore order expensive and possibly invasive tests.
Personally, I would suggest the NutriScan Food Sensitivity Test, Serum Pancreatic Lipase Immunoreactivity (PLI) for pancreatitis, and the preferred EPI diagnostic blood test called Trypsin-Like Immunoreactivity (TLI). TLI measures the amount of the digestive enzymes, trypsin and trypsinogen, in the blood. If the blood is deficient in these enzymes, it means the pet has EPI. By the way, testing for TLI is best measured by the Texas A&M University diagnostic lab.
Currently, no cure for EPI is available. So, what we need to do is replace the deficient digestive enzymes and have them go directly into the duodenum via the stomach. We source the pancreas of another animal and make it into a powdered form that can be mixed with moist food. The preferred source is from porcine (pork) because their pancreas is the closest genetically to that of dogs and humans.
Now, NutriScan comes into play because if your pet has a food sensitivity to pork, you are really not getting ahead of EPI since the small intestine is battling the offending food. In this case, you can opt for pancreatic enzymes from bovine (cow), sheep or lamb if your pet did not show sensitivities to these proteins. If NutriScan showed your pet to have true classical leaky gut concurrent with EPI or IBD, you may try plant enzymes but these are not preferred.
Another option is to feed fresh raw pancreas but I would steer clear of pork pancreas and go for a beef source. However, you may need to vary the volume fed as the amount of digestive enzymes present can be different between these animal species.
Nutrition can be tricky with EPI dogs. We do know that you need to feed small frequent meals and start out with a low fiber food. [Fiber interferes with the function of pancreatic replacement enzymes needed to manage EPI.] However, fiber is essential for digestive health and can be increased based on your dog’s reaction. Nutrition is a very lengthy and detailed component of the EPI condition. So, I would visit the EPI4Dogs website, which has two pages of food options. Of course, I do not want you self-diagnosing your dog with EPI and applying these tips. You need to have confirmation from your veterinarian with the TLI blood test.
Dogs and cats with an EPI diagnosis will more than likely need vitamin B12 supplementation too. Additionally, the dog or cat will probably have SID, which is how veterinarians usually start narrowing in on the diagnosis of EPI. So, we would need to give antibiotics to clear up this infection. Often, SID recurs so companion pets are on and off antibiotics frequently.
As we all know, I am not a fan of using antibiotics, if an alternative approach will work. So, I am very excited about the ongoing research my colleague, Dr. Jan Suchodolski, is conducting.
He and other researchers have recently completed a study that demonstrated significant differences in the microbiome composition between healthy dogs and those with acute or chronic gastrointestinal disorders such as IBD or EPI. [The microbiome is the catalog of microbes and their genes that live inside bodies, which primarily, involves the bacteria residing in the gut.]
Dr. Suchodolski found an unusual anomaly within these bacteria between dogs with EPI and healthy dogs. So, the EPI4Dogs group and he are collecting fecal samples to test these bacteria in three types of EPI dogs: 1) stable EPI dogs; 2) newly diagnosed EPI dogs; and, 3) EPI dogs with chronic SID.
Once confirmed that these dogs do in fact have different microbiota, the hypothesis is that we could treat SID in EPI dogs with a more natural approach instead of the ongoing antibiotic treatment.
If you have a dog that fits into one of the three EPI categories listed above, I encourage you to email olesia.kennedy[at]gmail[dot]com for specifics. The more we know, the more we can save lives!
“Jan S. Suchodolski, MedVet, DrVetMed, PhD, AGAF, DACVM.” Texas A&M Veterinary Medicine & Biomedical Sciences, n.d. Web. 14 May 2016. http://vetmed.tamu.edu/gilab/staff/dr-jan-suchodolski.
Kennedy, Olesia C. “Exocrine Pancreatic Insufficiency in Dogs.” Whole Dog Journal, Mar. 2009. Web. 14 May 2016. http://www.whole-dog-journal.com/issues/12_3/features/Exocrine-Pancreatic-Insuffinciency-in-Dogs_16109-1.html.
Kennedy, Olesia. “Overview.” EPI4Dogs Foundation, Inc., n.d. Web. 14 May 2016. http://www.epi4dogs.com/.
Morgan, Jessica, DVM, and Lisa Moore, DVM. “A Quick Review of Canine Exocrine Pancreatic Insufficiency.” Veterinary Medicine. DVM360, 1 Sept. 2009. Web. 14 May 2016. http://veterinarymedicine.dvm360.com/quick-review-canine-exocrine-pancreatic-insufficiency.
Steiner, Jorg, DVM. “Exocrine Pancreatic Insufficiency (Proceedings).”Veterinary Calendar. DVM360, 1 Aug. 2011. Web. 14 May 2016. http://veterinarycalendar.dvm360.com/exocrine-pancreatic-insufficiency-proceedings?id=&sk=&date=&&pageID=1.
Suchodolski, Jan S., DVM, et al. “The Fecal Microbiome in Dogs with Acute Diarrhea and Idiopathic Inflammatory Bowel Disease.” PLOS ONE, 26 Dec. 2012. Web. 14 May 2016. http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0051907#s4.