Exocrine Pancreatic Insufficiency - Dog

Description

Pancreatic acinar atrophy is reported to be the most common cause of EPI in the dog.

Signalment

German Shepherd dogs and rough collies are over-represented, in both breeds it is thought to be inherited. Many other breeds however can also be affected by EPI.

Diagnosis

History

Dogs usually have a history of small bowel diarrhoea with weight loss whilst maintaining a normal or increased appetite. There may be a history of vomiting, borborygmus, Coprohagia and flatulence with signs of abdominal discomfort.

Clinical signs

Weight loss and muscle wastage are usually seen in assosiation with EPI.Diarrhoea and steatorrhoea are also common. Hair coat is often in a poor condition and animals may be associated with a foul smell due to haircoat soiled with fatty faecal material.

Laboratory Tests

Modest increases in Serum alanine aminotransferase (ALT) and a decrease in cholesterol concentration are seen on routine biochemical studies in some dogs. Serum concentrations of cobalamin may be low whilst serum folate concentrations may be high. Low serum concentrations of Vitamin E are also frequently documented in dogs with EPI. The most sensitive and specific test for the diagnosis of EPI is the TLI serum assay. The values are greatly reduced as compared to normal animals. Values <2µg/l in dogs are considered diagnostic. This test must be carried out after withdrawing food for several hours.

Other

Atrophy of the pancreas seen via exploratory laparotomy or laparoscopy.

Treatment

Enzyme replacement

EPI can be managed with the supplementation of pancreatic enzymes from dried pancreatic extracts. Meals should be fed twice a day to allow weight gain. Many clinical signs resolve within 5 days. Doses can then be lowered to a minimum effective dose which is different for each animal. Cheaper alternatives include chopped raw cow or pig pancreas.

Dietary modification

Diets containing high volumes of non-fermentable fibre and low fat should be avoided. It has been suggested that animals suffering from EPI may also benefit from readily hydrolysed and absorbed medium chain triglycerides within the diet.

Vitamin supplementation

Levels of vitamin B12 (cobalamin) and vitamin E (tocopherol) are often found to be low and hence should be supplemented. Similarly Cobalamin supplementation is often required.

Antibiotic therapy

Dogs with EPI often have Small Intestinal Bacterial Overgrowth (SIBO). This can be treated with oral oxytetracycline, tylosin or metronidazole.

Glucocorticoid therapy

Oral prednisolone may be useful in animals that do not respond to the above treatment.

Dogs that do not respond well to the treatment listed above may have small intestinal disease causing malabsorption despite adequate pancreatic enzyme replacement. These cases usually require further investigation of the small intestine.

Prognosis

EPI is generally irreversible and hence life-long treatment is needed. The prognosis is generally good as long the owner is aware of the longevity of the disease and the cost involved with treating it.