EPI * Exocrine Pancreatic Insufficiency

To all who visit this website, thank you! My journey into EPI started when my own dog, Izzy, was diagnosed with EPI... making this website a personal passion of mine designed to help others seeking answers to EPI and to bring awareness to this disease.  Information is continuously added or updated as new technology, research/studies conclude, or when other EPI owners open their hearts and share their personal pictures, stories and management techniques with me. For the latest news I  personally keep in touch with EPI geneticists and gastroenterologists. Recently I had the great honor of meeting the developer of the TLI test, the world standard test for EPI. During this one-on-one meeting, I was given the unique opportunity of further learning of the many intricacies of EPI and it's mechanisms. Because of this new insight, some common mis-information about EPI has been revised on the following pages and will continue to be revised as new understanding of EPI becomes available .

EPI, Exocrine Pancreatic Insufficiency, is the inability of the acinar cells of the exocrine pancreas to produce and secrete the 3 necessary enzymes needed to digest food.

·         Amylase for digestion of carbohydrates (sugars & starches in grains, fruits & vegetables),      

·         Lipases for digestion of fats and oils,                                                 

·         Trypsin and Proteases for digestion of proteins.

EPI, the disease, is also referred to as Pancreatic Hypoplasia or Pancreatic Acinar Atrophy (PAA).  

EPI can also be the secondary condition of a chronic illness, such as chronic pancreatitis.

Without these naturally produced pancreatic digestive enzymes, food remains undigested and unabsorbed resulting in an EPI dog, who although is eating copious amounts of food, is constantly undernourished and can literally waste away. Without proper treatment, the EPI dog can die a painful death from malnourishment/starvation or organ failure.

With EPI, organs, the immune, nervous and all other body systems may become compromised to one degree or another.   A lack of nutrients often results in temperament changes which may express themselves in fear and/or aggression.

It is a devastating, frustrating disease that is all too often misdiagnosed. Symptoms usually do not appear until anywhere between 80% and 95% of the exocrine pancreas acinar cells are destroyed. What makes this disease even harder to diagnose is that not all dogs display any or all of the symptoms all of the time. Any breed can have EPI, not just GSDs.

This is a sample of what  a "cow-plop paddy" stool may look like when a dog has EPI prior to treatment . 

This is a sample of what an EPI stool looks like after the dog receives treatment and has become stable:

This is Fritzy, a Schnauzer, displaying physical EPI symptoms in Sept 2008.... and Fritzy 5 months later, stable, after receiving treatment for EPI.

• SIBO (Small Intestinal Bacterial Overgrowth) is when the bad bacteria overtakes the good bacteria in the tissue lining of the small intestine. Treat with 30 day regiment of with antibiotics Metronidazole or Tylan.
• PROBIOTICS need to be added to the diet either after an antibiotic regiment to replace good gut flora, or during antibiotic treatment 4 hours AFTER antibiotics are given.
• COBALAMINE (B12) and folate depletion. Treat with B12 injections.

In honor of Jan's Kita, the following 5 key-point list for managing EPI was developed by J. Robbins. Please feel free to print and use.

1. PORCINE(pfd)ENZYMES breaks down food /  Approx: 1tsp per 1 cup dry food, 1/2-3/4tsp per cup raw food, 3/4tsp per canned food / Soak with water to prevent mouth and throat sores / Soften food for minimum of 20 minutes - maximum of 1hr / Heat destroys enzymes, cold inhibits enzymes... use room temperature food / Store below 86 deg F (30 deg C) and at less than 70% humidity.
2. TYLAN or METRONIDAZOLE antibiotic for SIBO to be given for no less than 30 days (Tylan or Metronidazole).
3. B12 INJECTIONS needed if levels are below normal via cobalamin B12 blood test / For proper absorption of food and nutrients / 1st weekly for 6 wks, then biweekly for 6 weeks, then monthly.
4. FOOD high fiber can cause problems. Recommendations: Fiber max=4%, Reduce fat to approx 12 % intake if it apears to cause diarrhea. Otherwise do not eliminate fat. Lesser grain or no grain is best / Feed smaller meals but more frequently / Diet guidelines usually need to be tweaked for each individual dog. 
5. KEEP a JOURNAL detailed-to determine what works, what doesn't, and what triggers flare-ups /  Make 1 change at a time

Previously, canine EPI was “suspected” to be caused by autosomal recessive genes, but through recent 2008 research. it is currently thought to be multiple loci instead. Possibly a polygenic inheritance (traits vary in degrees of severity of the disease).  In 2005 researchers have honed in on 5 suspect genes, but further testing was needed. In 2007 Texas A&M Canine Genetics was awarded a grant by AKC-CH to further EPI research with the new SNP technology that can analyze multiple loci. Hopefully genetic markers will be identified in the next few years so the testing for carriers can be done prior to breeding. Please go to the EPI Research tab for the latest information on the research.

Once a dog is positively identified EPI with a cTLI test (a value of2.5 or lower), it is recommended to remove the dog from all breeding programs.

If possible, treat, stabilize then re-test again with cTLI procedure to confirm it is EPI not something else.

Unfortunately, sometimes before a dog displays symptoms, a breeding has already taken place.

Many times, EPI sometimes does not show up in a line until 3 to 5 or even more generations later.

Please be a responsible steward for our canine companions, once positively identified, please communicate with others to keep track of disease and share information.

This site was established 5/25/2008. Please check back frequently for updates and additional information.