Dog - Exocrine Pancreatic Insufficiency (EPI)

What is the pancreas?

The pancreas is a v-shaped gland lying close to the duodenum (the first bit of gut after the stomach) in the anterior (head end) part of the abdomen. It consists primarily of large numbers of secretory cells producing pancreatic juice arranged around tiny ducts which ultimately join to form the pancreatic duct which enters the duodenum close to the bile duct. The pancreas also contains small groups of hormone-producing cells, the Islets of Langerhans, which produce insulin which is delivered directly into the blood.

What is the function of the pancreas?

Pancreatic juice contains enzymes which digest fats, carbohydrates and proteins in the food. This is the exocrine function of the pancreas.

Insulin regulates carbohydrate metabolism in the body and controls the level of circulating blood sugar. This is the endocrine function and is entirely separate from the digestive (exocrine) function.

What is exocrine pancreatic insufficiency, EPI?

This is the inability of the pancreas to produce sufficient pancreatic juice to adequately digest fats and also to a lesser extent carbohydrates and proteins from the food. This results in poor digestion and also poor absorption of nutrients, (malabsorption) especially fat. Weight loss is common despite a marked increase in appetite.

Affected dogs produce pale, fatty faeces, this is known as steatorrhoea.

What causes EPI?

Causes can be congenital, (present from birth) inherited or acquired as the result of infection or injury. The condition is seen particularly in German Shepherd Dogs but Collies and English Setters are also affected.

The main cause appears to be a progressive loss of the digestive enzyme producing cells (exocrine cells) of the pancreas. Chronic infection (pancreatitis) can, to a lesser extent, be responsible.

What are the signs?

Young adult dogs are usually affected. They often have chronic diarrhoea or very soft, bulky, fatty looking faeces. Excessive appetite, occasional vomiting and gradual weight loss over a period of months are other common signs.

How is the condition diagnosed?

Blood and faeces tests can reliably pinpoint the condition. Sometimes dogs showing these signs are found to have normal pancreatic secretions but have damage to the lining of the bowel, preventing absorption of digested food. This is malabsorption. Sometimes both conditions occur together but this will be detected during laboratory examination of blood samples.

What it the treatment for EPI?

A highly digestible, low fat diet together with pancreatic enzyme replacement will stabilise the condition. Treatment is usually for the rest of the dog’s life and can be expensive long term. Improvement of the patient is due to stabilisation and not to cure.

Does diabetes also occur?

Rarely. In cases that are the result of chronic pancreatitis (chronic infection of the pancreas) the Islets of Langerhans (insulin producing cells) can also be affected. In these cases diabetes mellitus (sugar diabetes) will also be present and will be detected both by urine and blood tests.

Is cure not possible?

Cases due to chronic pancreatitis, i.e. infection, sometimes recover after long term treatment with antibiotics but the main cause of EPI is progressive destruction of the exocrine cells of the pancreas which in many cases appears to be of genetic origin. This at present is incurable.

Is pancreatic enzyme replacement therapy likely to work?

Over 70% of affected dogs can be stabilised and improved with enzyme replacement therapy. Some, however, can have frequent relapses particularly if they have the opportunity to scavenge.