Exocrine Pancreatic Insufficiency (EPI)

What is the pancreas?

The pancreas is a v-shaped gland lying close to the duodenum. Secretions from the gland are carried to the duodenum by the pancreatic duct which opens close to the bile duct.

What is the function of the pancreas?

The pancreas produces pancreatic juice containing enzymes which digest fats, carbohydrates and proteins ingested in the food.  This is the exocrine function of the pancreas.

In addition the pancreas also produces insulin in entirely separate cells known as the islets of Langerhans. Insulin regulates carbohydrate metabolism in the body and the level of circulating blood sugar. This endocrine function is separate from the digestive (exocrine) function.

What is exocrine pancreatic insufficiency?

It is the inability of the pancreas to produce sufficient pancreatic juice to adequately digest fats and also to a lesser extent carbohydrates and proteins ingested in the food. Because there is poor digestion and malabsorption of the nutrients, especially fat, weight loss is common despite a marked increase in appetite.

Affected dogs produce large volumes of pale, fatty faeces. This condition is called steatorrhoea.

What causes this disease?

The 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 frequently affected with the condition.

The main cause appears to be a progressive loss of pancreatic cells producing the digestive enzymes but chronic infection (chronic pancreatitis) can, to a lesser extent, also be responsible.

What are the usual signs of the condition?

Young adult dogs are usually affected and it will be noted that they have chronic diarrhoea or very soft, bulky, fatty looking faeces and excessive appetites, occasional vomiting and gradual weight loss over a period of months.

How is the condition diagnosed?

Simple blood and faeces tests can accurately detect if the condition is present. Sometimes dogs showing these signs can be found to have normal pancreatic secretions but have damage to the lining of the bowel, preventing absorption of the digested food. This is called malabsorption and is often associated with EPI. Blood tests will establish whether one or both conditions are present.

Is it possible to treat the condition?

A highly digestible, low fat diet together with pancreatic enzyme replacement will stabilise the condition but treatment is usually for the rest of the dog’s life and can be expensive long term.  Improvement in the patient is due to stabilisation and not to cure. Sometimes antibiotic and vitamin treatment will be required since this disease may predispose to bacterial overgrowth and vitamin deficiencies.

"A highly digestible, low fat diet together with pancreatic enzyme replacement will stabilise the condition but treatment is usually for the rest of the dog’s life and can be expensive long term."

Is diabetes involved with the condition?

Rarely. In cases that are the result of chronic pancreatis (chronic infection of the pancreas) the islets of Langerhans which are the cells that produce insulin can also be affected. In these cases diabetes mellitus (sugar diabetes) will also be present.

What is the prognosis?

Once an accurate diagnosis has been established, with replacement therapy, (pancreatic extracts) and special diet, there is usually resolution of diarrhoea within a week and some weight gain within one month.

Is it possible to cure the condition?

Cases due to infection (chronic pancreatitis) sometimes recover but the main cause of EPI is the progressive destruction of the exocrine cells of the pancreas. There appears to be a hereditary cause for this condition and it is at present incurable.

What are the chances of having to have my dog put to sleep?

Over 70% of affected dogs can be stabilised with care. Some dogs, however, are difficult to stabilise and have frequent relapses.