Understanding Dog Exocrine Pancreatic Insufficiency (EPI) Maldigestion Syndrome
My Dog has Exocrine Pancreatic Insufficiency What's Wrong with his Pancreas?
So your dog has been having digestive problems and finally your vet was able to pinpoint the issue after running some tests: the diagnosis was exocrine pancreatic insufficiency also known as "maldigestion.". Your vet may have briefly explained this condition, but you may not recall most of his explanation or you may have not well understood it's exact dynamics. In order to better understand EPI in dogs, it's important to first better understand how a healthy pancreas works and what happens in the case of exocrine pancreatic insufficiency.
You may not even be aware of the existence of your dog's pancreas until it starts giving problems. The pancreas is a glandular organ that sits right under the stomach and alongside the upper small intestine known as the duodenum. The pancreas gland has both an endocrine and an exocrine function. The endocrine function involves sending secretions into centralized locations such as the dog's blood stream. In this case, the pancreas secretes the hormones insulin and glucagon which is sent into the blood stream. The exocrine function involves carrying secretions to more localized locations. In this case, the pancreas secretes enzymes that are sent into the duodenum located right nearby when the food passes out the stomach.These enzymes consist of amylase which helps digest starches, lipases which help digest fats and trypsin and proteases which help digest protein. The role of these enzymes is to aid digestion by breaking down nutrients into smaller molecules that are easily absorbed by the dog's gastrointestinal tract.
Problems start when these enzymes aren't produced as needed. When this happens, food cannot be properly digested and the dog doesn't receive necessary nutrients. One of the most common causes of digestive enzyme insufficiency seems to have a genetic basis and is most often seen in the German shepherd dog(70 percent) and the rough-coated collie (20 percent). Another causes for EPI is a history of chronic pancreatitis. Chronic pancreatitis may cause irreversible damage to the glands responsible to secreting enzymes. Cancer of the pancreas may be another cause.
Because dogs who don't digest well have great amounts of fermenting food crowding the small intestine, they are prone to developing a secondary condition known as small intestinal bacterial overgrowth (SIBO). Dogs with SIBO are gassy, their stomachs makes grumbling noises and they are prone to having diarrhea and vomiting. On top of that, the fermenting food nourishes bad bacteria which robs the dog from absorbing nutrients, and most of all, vitamin B12. Vitamin B12 insufficiency is therefore often seen in dogs affected by SIBO.
Symptoms of Exocrine Pancreatic Insufficiency in Dogs
Not digesting well and not receiving adequate nutrition leads to a cascading chain of events in dogs affected by EPI. Yet, according to Ettinger, Stephen J.;Feldman, Edward C. in the Textbook of Veterinary Internal Medicine, signs of EPI are not present until 85 to 90 percent of the pancreas is unable to secrete enzymes. Affected dogs develop the following symptoms:
- Chronic diarrhea
- Weight loss
- Poor hair coat
- Coprophagia (eating own feces)
- Pica (eating dirt, bedding, paper etc.)
- Great stool volume
- Multiple bowel movements a day
- Grey/yellowish feces
- Cow-pie stools
- Polydypsia (increased drinking)
- Reduced muscle mass
- Behavior changes, irritability,fearfulness,anxiety.
Because vets consider this a rare condition, it's easily misdiagnosed and dogs with EPI are often assumed to not be suffering from this condition simply because they don't belong to a breed more commonly represented. This often results in many dogs with EPI not being properly diagnosed. Several vets will prescribe antibiotics, the stools return to a normal consistency and then the problem resurfaces time later in a waxing and waning manner.
How is EPI Diagnosed in dogs?
Clinical symptoms won't suffix to diagnose EPI; vets often will often attempt to rule out other more common conditions first. By exclusion, and when traditional treatments for more common conditions fail, a diagnosis for EPI finally arrives. The most accurate test for EPI today is attained by running a blood test known as serum trypsin-like immunoreactivity test (TLI). The dog will need to be fasted for this test. In a dog with a healthy pancreas, small trace amounts of trypsin, an enzyme which helps digest protein, is found in the bloodstream. In a dog suffering from EPI, there will be almost no trypsin in the bloodstream. Another test consists of a fecel test where the levels of protease (another enzyme that helps digest protein) are checked. Repeated testing may be needed to get a more accurate diagnosis.
EPI Treatment in Dogs
How is EPI treated? Mostly through dietary changes. The administration of enzymes is the most important step to make up for the deficiency. This doesn't mean giving a bit in the morning; rather, all food given should have enzymes to help with digestion. The best type of enzymes so far appear to be freeze-dried, powdered porcine enzymes. These are superior to plant enzymes. Ideally, prescription enzyme powders should contain from 56,800 to 71,400 units of lipase; 280,000 to 434,000 units of protease; and 280,000 to 495,000 units of amylase per teaspoon. Enzymes should be supplied at body temperature as cold inhibits its function and hot kills the enzymes. Caution: at times, enzymes may cause blisters and mouth sores. To prevent this, it's best to add enzymes to moistened food and let it sit for about 20 minutes. This also helps distribute better the enzymes and aids in better absorption since the food is allowed to soften. Some owners prefer to give raw beef, pork, or lamb pancreas instead.
Diet plays an important role, it appears that dogs with EPI do best with no more that 4 percent fiber and no more than 12 percent fat. Yet, this isn't written in stone, some dogs do well with little fat, some others can tolerate more. Many EPI dogs seem to thrive on a raw or homemade diet. Veterinarians will sometimes prescribe diets with hydrolized ingredients that are broken down in easier to assimilate particles meant to aid digestion--yet their starch content makes them questionable to give long term. Feeding more frequent and smaller meals seems to help aid digestion.
Owners of EPI dogs should always inspect the dog's stools as this is the best indication of good digestion. The stools should be nice and brown and solid. Keeping a daily journal of stool quality helps track possible digestive issues.
Dogs who are suffering from SIBO are often prescribed antibiotics so to kill the growth of bad bacteria. Flagyl and Tylan are the most commonly prescribed antibiotics. B12 injections are given to dogs with a B12 deficiency.
Was your dog diagnosed with EPI? Not much is known about this condition, and new things are still being discovered. There are many helpful websites and groups that offer a goldmine of information and support. A great resource is the Epi4dogs website, the yahoo group on EPI and Enzyme Diane offers lower cost enzyme options.
Disclaimer: this article is not to be used as a substitute for professional veterinary advice. If your dog has symptoms of EPI, please see your vet for proper diagnosis and treatment.
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