Exocrine pancreatic insufficiency

From Dog
A dog with EPI, showing classic weight loss despite healthy appetite[1]
Dog with subclinical EPI showing a markedly diminished pancreatic mass, including areas of normal glandular structure and areas of tissue having lost its glandular appearance[2]

Exocrine pancreatic insufficiency (EPI) is a common condition in dogs, resulting from inadequate functional reserve of pancreatic acinar tissue[3].

The most common cause of EPI is pancreatic acinar atrophy, although other causes have been reported, including chronic pancreatitis[4], pancreatic neoplasia and congenital hypoplasia.

Clinical signs only develop when a critical mass (e.g. >90%) of exocrine tissue has been lost, and result from maldigestion and subsequent malabsorption[5].

Hypocobalaminemia (serum cobalamin concentrations <150 ng/l)[6] can be seen in the majority of dogs with EPI, and negatively impacts upon long-term survival[7].

Clinical signs are characterized by chronic intermittent diarrhea, often with large bulky stools. Weight loss and compensatory polyphagia are commonly observed in older dogs. The feces are usually pale and malodorous, and the high fat content of the feces can lead to a greasy appearance of the hair coat.

Diagnosis is based on evaluation of serum trypsin-like immunoreactivity (TLI) concentration, which in affected dogs is usually ≤2.5 µg/L. Fecal elastase in dogs has been developed but appears less reliable than serum TLI concentration[8][9].

Coprological parasite examination is essential to eliminate protozoan complications (e.g. Blastocystis spp) to the etiology[3].

Treatment of EPI in dogs usually involves various enzyme replacement therapies with the addition of highly digestible food and vitamin supplementation.

Recovery from this condition is rare due to the underlying loss of viable pancreatic tissue. However, clinical normality is usually achieved with appropriate therapy and most dogs gain weight and pass normal stools.


  1. EPI4Dogs
  2. Westermarck, E & Wiberg, M (2012) Exocrine pancreatic insufficiency in the dog: historical background, diagnosis and treatment. Topics in Companion Animal Medicine 23rd June
  3. 3.0 3.1 Westermarck E et al (2005) Textbook of veterinary internal medicine. 6. Ettinger SJ, Feldman EC, editor. Elsevier Saunders, St Louis. Exocrine pancreatic insufficiency in dogs and cats. pp:1492–1495
  4. Watson PJ et al (2010) Observational study of 14 cases of chronic pancreatitis in dogs. Vet Rec 167(25):968-976
  5. Mas A et al (2012) A blinded randomized controlled trial to determine the effect of enteric coating on enzyme treatment for canine exocrine pancreatic efficiency. BMC Vet Res 8:127
  6. Grützner N et al (2012) Evaluation of serum cobalamin concentrations in dogs of 164 dog breeds (2006-2010). J Vet Diagn Invest Sep 26
  7. Batchelor DJ et al (2007) Prognostic factors in canine exocrine pancreatic insufficiency: Prolonged survival is likely if clinical remission is achieved. J Vet Intern Med 21:54–60
  8. Steiner JM et al (2010) Evaluation of fecal elastase and serum cholecystokinin in dogs with a false positive fecal elastase test. J Vet Intern Med 24(3):643-646
  9. Mansfield CS et al (2011) Specificity and sensitivity of serum canine pancreatic elastase-1 concentration in the diagnosis of pancreatitis. J Vet Diagn Invest 23(4):691-697