Exocrine Pancreatic Insufficiency

In this condition the exocrine (outer) part of the pancreas may lose its ability to make digestive enzymes. This is usually caused by irreversible atrophy of the pancreas which subsequently requires life-long substitution therapy. This problem may be an autoimmune condition, in which the immune system attacks its own tissue. Autoimmune conditions are the most common cause of canine diabetes; the immune system destroys the ability of the pancreas to produce insulin. EPI is a particular problem in families of German Shepherd Dogs, in which it is an inherited condition.

Pancreatic Acinar Atrophy

Pancreatic acinar atrophy (PAA) is a degenerative disease of the exocrine pancreas and is the most common cause of exocrine pancreatic insufficiency in the German Shepherd Dog. In pancreatic acinar atrophy (PAA) a selective destruction of digestive enzyme-producing acinar cells leads to poor digestion signs typical of exocrine pancreatic insufficiency (EPI). Chronic pancreatitis is a common cause of exocrine pancreatic insufficiency (EPI) in humans and cats but is rarely recognised in dogs in which pancreatic acinar atrophy (PAA) is reportedly more common. Chronic pancreatitis may be a more common cause of EPI in dogs than previously assumed and may be under-recognised because of difficulties in diagnosis. Evaluation of data by complex analysis is strongly suggestive of an autosomal recessive mode of inheritance for EPI in GSDs in the United States.

Exocrine pancreatic insufficiency results in small intestinal bacterial overgrowth that can be reversed by pancreatic replacement therapy, indicating that pancreatic secretions can have an important influence on the small intestinal bacterial flora of dogs.

Signs of Exocrine Pancreatic Insufficiency

Affected dogs eat voraciously but lose weight. They pass large quantities of gray diarrhea like cow manure or yellow and pulpy feces.

Diagnosis of exocrine pancreatic insufficiency is based on signs and laboratory tests. In addition, blood tests show low levels of digestive enzymes. Pancreatic disorders in dogs and cats are recognized with increasing frequency, and abdominal ultrasonography has assumed an important role in their diagnosis. Ultrasonography is useful in diagnosing pancreatic disease.

Treatment of Exocrine Pancreatic Insufficiency

The primary treatment of EPI is supplementing each meal with pancreatic enzymes. Dogs are given commercially produced dry pancreatic extract. If this not measure is not effective, you vet may suggest feeding fresh cow pancreas from a slaughterhouse, although health regulations make this a difficult solutions. Dogs also should be fed supplements of fat-soluble vitamins, especially vitamin E. Antibiotics and corticosteroids are used in some cases. Response to long-term enzyme treatment in dogs with EPI varies considerably, making it difficult to determine prognosis for individual patients. Response to initial treatment (RIT) and survival are affected by signs and therapeutic methods employed.

Research indicates that responses to different diets vary among individual dogs. Because responses to the diets were unpredictable, it is suggested that feeding regimens be individually formulated for dogs with EPI.

Prognosis for Exocrine Pancreatic Insufficiency

Long-term prognosis in canine EPI is favorable for dogs that survive the initial treatment period. Although it is possible to predict the long-term survival, severe cobalamin deficiency is associated with shorter survival. Therefore, cobalamin supplementation should be considered in some cases.

References:
1. Caring for Your Dog by Bruce Fogle, DVM, MRCVS
2. Sonographic evaluation of the normal and abnormal pancreas.Hecht S, Henry G. Department of Small Animal Clinical Sciences, The University of Tennessee College of Veterinary Medicine, Knoxville, TN 37996-4544, USA.
3. Prognostic factors in canine exocrine pancreatic insufficiency: prolonged survival is likely if clinical remission is achieved.Batchelor DJ, Noble PJ, Taylor RH, Cripps PJ, German AJ. Small Animal Hospital, Department of Veterinary Clinical Science, University of Liverpool, UK.
4. Effects of diet on clinical signs of exocrine pancreatic insufficiency in dogs.Westermarck E, Wiberg ME. Department of Clinical Veterinary Sciences, Faculty of Veterinary Medicine, University of Helsinki, Finland.
5. Exocrine pancreatic insufficiency as an end stage of pancreatitis in four dogs.Watson PJ. Department of Clinical Veterinary Medicine, University of Cambridge
6. Effects of exocrine pancreatic insufficiency and replacement therapy on the bacterial flora of the duodenum in dogs.Simpson KW, Batt RM, Jones D, Morton DB. Department of Biomedical Services, University of Leicester, UK.