Exocrine pancreatic insufficiency

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Exocrine pancreatic insufficiency (EPI) is a common condition in dogs, resulting from inadequate functional reserve of pancreatic acinar tissue[1].

The most common cause of EPI is pancreatic acinar atrophy, although other causes have been reported, including chronic pancreatitis, 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[2]. Hypocobalaminaemia can be seen in the majority of dogs with EPI, and negatively impacts upon long-term survival[3].

Clinical signs are characterized by chronic intermittent diarrhea, often with large bulky stools. Weight loss and compensatory polyphagia are commonly observed in older dogs.

Clinical management usually involves enzyme replacement therapy with the addition of dietary modification (e.g. highly digestible diet) and ancillary therapies (e.g. antibacterials) if response to enzyme alone is poor [1]. Most dried pancreatic extracts are given as a powdered formulation, although ‘enteric-coated’ preparations have been developed in which granules of enzyme powder are coated in a lacquer that protects the enzymes from degradation in the stomach.


References

  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
  2. Mas A et al (2012) A blinded randomised controlled trial to determine the effect of enteric coating on enzyme treatment for canine exocrine pancreatic efficiency. BMC Vet Res 8:127
  3. 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