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 dedicated to helping others seeking answers to EPI and to bring awareness to this disease.  Sources of information for this site are from Veterinary Journals, EPI geneticists, EPI gastroenterologists, Veterinary Schools, current EPI Research Studies, and from other EPI owners who have opened their hearts and shared their personal pictures, stories and management techniques with me. We are also involved in researching the actual cause of EPI. Updates are posted frequently so please check back often.

Please feel free to visit our "FORUM" ... sign up and participate with other EPI owners in discussions about various techniques that have helped them manage EPI. And no matter how bleak things may look, please know that there is always HOPE ... once you find the right balance of treatment.

Sue, one of our EPI FORUM members, pulled this little gal called Claire, from a county shelter. Sue is a very special lady who gives her time and her heart as a foster mom for a wonderful organization called the
New Rattitude - Rat Terrier Rescue  http://www.newrattitude.org/ who supported the fostering of Claire both financially and emotionally throughout this journey.
With the help of an awesome vet, Claire was properly diagnosed in July with Diabetes and EPI .. but as you can see, back then things looked very bleak for Claire.

Below, this is Claire today, 5 months later on January 8, 2010, almost double the weight from July, after finding the "right balance".  In Sue's own words, "There were many times initially when I questioned if keeping her alive was the right thing to do.  The support and advice I received from this forum is why I can show her "After photos" today. Her EPI is under control and we are managing the diabetes. To those of you who are new to this tragic disease I hope that seeing these dogs before and after will give you hope.  It's a long journey but one worth taking, and there are so many people here who will guide you every step of the way."

  
I would like to extend a HUGE thank you to Sue for allowing me to share Claire's pictures and story with everyone... to give hope to others battling EPI. Thank You!

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, is sometimes referred to as Pancreatic Hypoplasia or Pancreatic Acinar Atrophy (PAA).  

Or 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, organ, 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... see http://www.epi4dogs.com/notjustgsds.htm.

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 Tylan or Metronidazole are the most commonly recommended antibiotics used. 
• 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: 1 tsp powdered enzymes 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 normal fat amounts appear 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 only 1 change at a time. Give it 3-5 days before making the next change.

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 of 2.5 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.