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What Is EPI in Dogs?

EPI stands for exocrine pancreatic insufficiency. EPI in dogs is a health issue that has serious effects on the pancreas. It happens when most of the cells that produce digestive hormones don’t function normally.

The pancreas is a small organ located under a dog’s stomach, next to the beginning of the small intestine (the duodenum). The pancreas has two vital functions:

  1. Producing insulin, the hormone that moves sugar from the bloodstream into cells.

  2. Producing digestive hormones, including lipase to break down fat, proteases to break down protein, and amylase to break down starch.

Different cells within a dog’s pancreas are responsible for performing each of these functions. When enough insulin-producing cells are damaged, dogs develop Type I diabetes. And when the cells that produce digestive hormones aren’t working, the result is EPI in dogs.

Is EPI in Dogs Curable?

Unfortunately, there’s no cure for exocrine pancreatic insufficiency in dogs. Once the pancreas is damaged to the point that symptoms of EPI develop, you will need to give your dog pancreatic enzyme supplements and possibly other treatments for the rest of their life. However, with proper management, your dog can live a healthy and happy life.

Symptoms of EPI in Dogs

Without adequate digestive hormones, the food that a dog eats can’t be broken down and absorbed.

As a result, dogs with EPI typically lose weight. Your dog may also:

  • Have a ravenous appetite

  • Eat feces (coprophagia)

  • Eat other unusual things (pica)

  • Have soft stool or diarrhea that is pale, greasy, and/or especially smelly—this is due to the presence of undigested food within the intestinal tract

  • Have excess gas

  • Have flaky skin and a rough coat

Other symptoms may be present in severe cases or if a dog is suffering from another condition in addition to EPI.

Causes of Exocrine Pancreatic Insufficiency in Dogs

The most common cause of EPI in dogs is pancreatic acinar atrophy (PAA). This is especially true when EPI is diagnosed in a relatively young dog less than four years old.1

PAA appears to be an autoimmune disease, meaning that a dog’s own immune system attacks and destroys the pancreatic cells responsible for producing digestive enzymes. The primary risk factor for PAA in dogs is genetic, which is why EPI is seen more frequently in certain breeds of dogs.

German Shepherd dogs are most at risk, but studies have shown that these breeds also have an increased incidence of EPI 1,2,3:

However, any dog can develop EPI, and not all cases of EPI are linked to genetics. Diseases that destroy large parts of the pancreas, like pancreatic cancer or severe and/or chronic pancreatitis4, or other more rare conditions may also be to blame.

How Vets Diagnose EPI in Dogs

A veterinarian may suspect that a dog has EPI based solely on their symptoms and breed or history of health problems, but lab tests are still necessary because other diseases can have similar clinical signs. Here are three tests that can help diagnose EPI in dogs.

  • Blood Chemistry Test and Complete Blood Cell Count. The veterinarian will run blood chemistry tests and a complete blood cell count to get a picture of your dog’s overall health and to look for problems, like anemia (a low red blood cell count), that are sometimes associated with EPI.
  • Trypsin-Like Immunoreactivity Test (TLI). The best test specifically for EPI in dogs is the trypsin-like immunoreactivity test (TLI). Trypsin is a digestive enzyme produced by the pancreas that is normally present at low levels in a dog’s bloodstream. In dogs with EPI, blood-trypsin levels are significantly lower than they should be. The test is easy to perform by drawing blood, but dogs cannot eat for 8-12 hours before the sample is taken.

Other tests for EPI are available but don’t provide results that are as reliable as the TLI test. However, they may be appropriate under some circumstances.

Vitamin Deficiencies or Folate Abnormalities

Vitamin B12 (cobalamin) deficiencies, are common in dogs with EPI. Folate (another type of B vitamin) levels can be normal, high, or low.

In severe cases of EPI, dogs may become deficient in vitamin K, which can lead to bleeding. Your veterinarian will measure your dog’s cobalamin, folate, and possibly some other vitamin levels to determine which supplements are necessary to return your dog to good health.

Treatment for Exocrine Pancreatic Insufficiency in Dogs

In theory, treatment for EPI in dogs is fairly straightforward: Dogs eat the missing pancreatic digestive enzymes with their meals, and any other abnormalities, like low cobalamin levels, are addressed.

Unfortunately, the reality of treating EPI can be a bit more complicated.

Pancreatic Enzyme Supplements

You should add pancreatic enzymes to your dog’s food for every meal. Powdered pancreatic enzyme supplements like PancrePlus Powder for dogs and cats, Thomas Labs Bio Case Pancreatic Enzyme Powder dog and cat supplement, and PanaKare Plus Powder for dogs and cats are easy to use and usually effective.

Tablets are also available, but they don’t seem to work as well as the powders.

Tips for Administering Pancreatic Enzyme Powders to Your Dog

Mix the powder thoroughly into your dog’s food before you give it to your dog because it can irritate their mouth.

Some pet parents report that letting the food sit for little while to allow “predigestion” improves their dog’s response to treatment. Research doesn’t seem to back this up, but it doesn’t hurt to try if your dog’s condition isn’t improving as well as expected.

Follow the dosage instructions on the label or provided by your veterinarian, but once your dog’s symptoms are well-controlled, the goal is often to find the smallest amount of the enzyme supplement that works for your dog.

Raw Pancreas Meat 

Another source of pancreatic enzymes is raw pancreas meat from other animals.

You can purchase the organ meat from butchers, raw pet food suppliers, and other sources, but handling and feeding raw animal products increases the risk of food-borne illnesses like salmonellosis for everyone in the house.

A commonly recommended starting dose for pancreas meat is 1-3 ounces mixed with each meal, but follow your veterinarian’s recommendation. The amount your dog needs will be based on the specifics of your dog’s case.

Tips for Feeding Your Dog Raw Pancreas Meat

You can grind up and freeze pancreas meat in the appropriate portions and then thaw it before mixing it thoroughly with each meal.

Whether they are delivered in powder form or with pancreas meat, most pancreatic enzymes are broken down in a dog’s stomach. Medication that decreases stomach acid secretion, like omeprazole, may be used if this is a concern.

Vitamin Supplementation

Dogs who have low blood levels of vitamin B12, folate, and/or other vitamins need supplementation. Initially, vitamin B12 shots are superior to oral administration, but once your dog’s condition is stable, you can usually switch to an oral cobalamin supplement.

Antibiotics

Some dogs with EPI develop an overgrowth of bacteria in their intestinal tract, which can be managed with antibiotics (often Tylosin). Many dogs only require antibiotic treatment for a month or two as their condition improves, but some may benefit from long-term treatment.

Your veterinarian may recommend other treatments based on a dog’s symptoms and additional health concerns.

Recovery and Management of EPI in Dogs

After proper treatment is started, most dogs with EPI quickly start to feel better. Their symptoms can improve over the course of a few days to weeks.

If that’s not the case, and your dog’s symptoms aren’t improving, discuss other treatment options with your veterinarian. Ask if switching to a different diet makes sense.

EPI Diets for Dogs

There is no one type of diet that benefits all (or even most) dogs with exocrine pancreatic insufficiency.

Some dogs seem to do better when switched to a highly digestible food that is relatively low in fat and fiber, while others improve with more fiber or fat, or they do just fine with whatever it is that they normally eat.5

If your dog continues to respond poorly to treatment, it’s possible that they could be suffering from more than one health problem, and additional diagnostic testing may be necessary.

Frequently Asked Questions

What is the most common cause of EPI in dogs?

Pancreatic acinar atrophy (PAA) is the most common cause of EPI in dogs. PAA is primarily a genetic disease that leads to a dog’s immune system destroying the cells in the pancreas that make digestive enzymes.

What do you feed a dog with EPI?

A common recommendation is to feed dogs a highly digestible dog food that is relatively low in fat and fiber. However, different types of food seem to work better for different dogs, so you may have to try several diets before finding a good fit.

Your veterinarian can help you figure out the best food for your dog.

How do you test a dog for EPI? How much does it cost to test for EPI in dogs?

The best test for EPI in dogs is the trypsin-like immunoreactivity (TLI) test, which involves taking a blood sample after a dog hasn’t eaten for 8-12 hours.

The cost of a TLI test varies but is usually around $100. Other tests will be necessary to plan appropriate treatment.

How can I treat my dog's EPI at home?

You can’t treat dog EPI at home without going to the vet first.

Treatment of your dog’s EPI will require a veterinary visit and you will need to go through a process of finding the right balance of supplements and medication. However, once that balance is found, the management of EPI in dogs at home is fairly straightforward.

Dogs with EPI are usually managed at home with pancreatic enzyme supplementation and cobalamin supplementation. Some dogs also require additional vitamin supplements, antibiotics, medications to reduce the secretion of stomach acid, and other treatments to manage their symptoms.

References

1. Wiberg ME. Pancreatic acinar atrophy in German shepherd dogs and rough-coated collies. Etiopathogenesis, diagnosis and treatment. A review. Vet Q. 2004 Jun;26(2):61-75. doi: 10.1080/01652176.2004.9695169. PMID: 15230051.

2. Batchelor DJ, Noble PJ, Cripps PJ, Taylor RH, McLean L, Leibl MA, German AJ. Breed associations for canine exocrine pancreatic insufficiency. J Vet Intern Med. 2007 Mar-Apr;21(2):207-14. doi: 10.1892/0891-6640(2007)21[207:bafcep]2.0.co;2. PMID: 17427378.

3. Parambeth JC, Suchodolski JS, Steiner JM: Epidemiological Data in Dogs with Exocrine Pancreatic Insufficiency - A Retrospective Study (2003–2012). ACVIM 2014.

4. Watson PJ. Exocrine pancreatic insufficiency as an end stage of pancreatitis in four dogs. J Small Anim Pract. 2003 Jul;44(7):306-12. doi: 10.1111/j.1748-5827.2003.tb00159.x. PMID: 12866928.

5. Westermarck E, Wiberg ME. Effects of diet on clinical signs of exocrine pancreatic insufficiency in dogs. J Am Vet Med Assoc. 2006 Jan 15;228(2):225-9. doi: 10.2460/javma.228.2.225. PMID: 16426193.

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