Pancreatic enzyme disease is better known as exocrine pancreatic insufficiency or EPI. Affected dogs develop pancreatic malabsorption. The pancreas aids in food digestion. If Frankie has EPI, you may notice him rapidly losing weight and developing soft stool.
The Pancreas and EPI
The pancreas is divided into two main parts: endocrine and exocrine. The endocrine portion produces chemicals like insulin, while the exocrine portion produces enzymes to break down carbohydrates, fats and proteins. According to “The Merck Veterinary Manual,” the majority of dogs with EPI develop it due to pancreatic acinar atrophy, whereby the pancreas atrophies and loses effectiveness. Chronic inflammation of the pancreas is the second most common cause. Masses can also obstruct the function of the pancreas. The damage leads to the clinical signs in affected dogs.
Without the enzymes to break down the food, Frankie’s intestines can’t absorb nutrients. His stool will look greasy due to the undigested fats, and it is generally loose. Weight loss develops rapidly. Frankie may begin to eat anything he can in order to get needed nutrition. The most commonly affected breeds are young German shepherds and collies -- as many as 70 percent of dogs affected are German shepherds. A dog of any breed can be affected.
Your veterinarian will be able to diagnose EPI. A blood test, serum trypsin-like immunoreactivity, is diagnostic for EPI. Trypsin levels are very low in dogs with EPI. Frankie would have to be fasted before the test. Tests based on fecal material are also available, namely the fecal protease test and fecal elastase tests. These need multiple samples or odds of false positive diagnoses are higher and therefore less reliable.
Treatment for affected dogs is lifelong. Enzymes are available as a powder that you can add to Frankie’s food. Other products such as capsules are available but do not work as well. The enzymes can ulcerate Frankie’s mouth as he chews, so you'll need to mix the powder well with the food. Enzymes from the stomach will degrade some of the enzymes as food is broken down, but the remaining amount is generally enough to alleviate the symptoms. Some pets need additional supplementation with gastric acid blockers like famotidine. Frankie will need a diet low in fiber and fat, as he will still have trouble digesting these. If you stop treatment, Frankie’s symptoms will recur.
Frankie needs vitamin B-12, or cobalamin, but the cobalamin in his diet may be absorbed by intestinal bacteria. Cobalamin deficiency is a major factor in pets who do poorly even with enzyme supplementation. Frankie’s vitamin B-12 levels can be evaluated, and your veterinarian can supplement him, if needed. Bacterial populations feed on undigested nutrients in the gut and increase in number, resulting in small intestinal bacterial overgrowth. Antibiotics are often needed to treat this overgrowth at the time of diagnosis.
Elizabeth Muirhead is a practicing veterinarian with an undergraduate degree in biological sciences. She has real-world experience with the husbandry, grooming, training and feeding a variety of household pets.