EPI * Exocrine Pancreatic Insufficiency
managing EPI
The Disease, The Condition
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.
common symptoms
The most common symptoms are:
- Gradual wasting away despite a voracious appetite
- Eliminating much more frequently, sometimes every hour or two
- Stools are greasy voluminous yellowish cow-plops, but sometimes grayish
- Eating their own stools, or other inappropriate substances
- Increased rumbling sounds from the abdomen
- Increased passing amounts of flatulence
- Some dogs do not show any typical signs
- Some experience intermittent watery diarrhea or vomiting
Detecting EPI
· EPI can manifest anytime in a dog’s life - - from a young pup to an elderly dog, with the severity and symptoms of the disease varying somewhat with each dog. Sometimes the dog has the disease but symptoms do not appear at all, until exacerbated or triggered through a stressful physical or emotional situation.
· Always confirm EPI with a trypsin-like immunoreativity (cTLI) blood test (12 hour fast). Normal range is between 5.0 – 35.0
· Because GSD and their crossbreeds make up 50-70% of positively diagnosed EPI case, when gastro upsets persist, a fasted cTLI test is strongly advised.
treatment & management
- Supplemental animal-sourced pancreatic enzyme replacement (commercially manufactured and expensive) placed on every piece of food (incubated), that the dog eats. Tablet (should be crushed), Enteric-coated tablets and capsules are also available.
- Powdered porcine pancreatic enzyme is the preferred method, most effective and convenient.
- Raw pig or beef pancreas, the best treatment, but may be difficult to obtain in some places because of local food regulations.
- Plant-based enzymes, least effective but used if dog has pork allergies.
- Change food to grain-free kibble, home-cooked, raw food or a combination.
- General guidelines are to avoid food with more than 4% fiber and more than 12% fat content (some dogs can tolerate more fat %).
- Supplement food with medium chain fats, easily absorbed by an EPI’r such as coconut oil and/or omega3 wild salmon oil.
- Other supplements such as extra Vitamin E and Zinc are often administered.
Secondary conditions to 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 after an antibiotic regiment to replace good gut flora.
- COBALAMINE folate depletion. Treat with B12 injections.
Canine Genetics
Canine EPI is “suspected” to be caused by autosomal recessive genes, but it is still unclear if it is one gene or multiple loci. 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.
Breeding
Once a dog is positively identified EPI with a cTLI test, it is recommended to remove the dog from all breeding programs.
Unfortunately, sometimes before a dog displays symptoms, a breeding has already taken place.
EPI sometimes does not show up for 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.