Exocrine pancreatic insufficiency (EPI) is a condition where your cat's pancreas can’t produce enough enzymes to digest food properly. EPI is rare in cats, affecting fewer than 0.01% of the population. It may affect cats of any breed, sex or age, but EPI is most common in older cats with other health problems.

Cats with EPI lose weight and body condition. Unlike dogs with EPI, they rarely show increased appetite. The vague symptoms are shared by lots of other illnesses, making the condition harder to identify. Affected cats have bulky soft stools (poo) and a scurfy dry coat. EPI in cats usually follows chronic inflammation of the pancreas. EPI can’t be cured, but treatment with enzyme supplements and a special diet helps restore and maintain weight and body condition. Talk to a vet if you notice any unexplained weight loss in your cat.

What is exocrine pancreatic insufficiency in cats?

The pancreas is an important gland in your cat’s abdomen (tummy). It has 2 parts: The ‘endocrine’ portion produces hormones called insulin and glucagon to control blood sugar. The exocrine pancreas produces the digestive enzymes needed to break down food into small particles (nutrients) that can be absorbed and used by the body.

• EPI in cats happens when a damaged or diseased pancreas stops working properly

• Symptoms only develop when the pancreas loses 90% or more of its function

Causes include:

• Chronic pancreatitis: Prolonged or severe inflammation of the pancreas leads to scarring and withering of the gland.

• Pancreatic acinar atrophy: Cells producing digestive enzymes shrivel up and die when the body’s own defence cells attack them by mistake. Increasingly recognised in cats.

• Cancer: Rarely, a cancer may eat away at the gland or block the duct that carries pancreatic enzymes to the intestine.

• A birth defect: very rarely, a kitten’s pancreas fails to form properly while they are in the womb.

Without treatment, cats with EPI develop malnutrition, weight loss and gastrointestinal upsets. Advanced stages of the illness may include problems with blood clotting.

What are the symptoms of exocrine pancreatic insufficiency in cats?

Symptoms of EPI in cats result from lack of nutrients and the presence of undigested food passing through the bowel.

• Weight loss and body condition loss.

• Bulky soft stools (poo): yellow or grey colour; often fatty; occasional vomiting.

• A dry, poor hair coat.

• Gassy, rumbly tummy: Bacteria feeding on the undigested nutrients in the bowel produce lots of gas

• Reduced energy levels and behavioural changes, especially if pancreatitis or tumours are causing abdominal pain.

Which cats are at most risk of exocrine pancreatic insufficiency?

Although EPI may affect cats of any breed, age or size, older cats with chronic pancreatitis (inflammation of the pancreas) are most at risk. EPI is a disease of individual cats. It doesn't spread between cats or from cats to other animals.

Complications of EPI

• Gastrointestinal upsets: Severe or persistent diarrhoea, vomiting, occasional loss of appetite; bacterial overgrowth; inflammatory bowel disease

• Vitamin B12 deficiency: Over 70% of cats with EPI have low B12 (cobalamin); this results in poorer response to treatment with enzyme replacements alone.

Diagnosis of exocrine pancreatic insufficiency in cats

Vets will suspect EPI after discussing the history of your cat's illness and symptoms with you, and conducting a thorough clinical examination. They’ll advise further tests to confirm a diagnosis.

• Blood tests: A specific blood test called a TLI (Trypsin-like immunoreactivity) test; bloods for a general health check, including Vitamin B12

• Imaging: Investigating underlying disease, such as cancer, where indicated; X-rays, ultrasound, CT

What’s the vet treatment for exocrine pancreatic insufficiency in cats?

• Oral supplementation with digestive enzyme supplements: Powders, capsules or tablets, given with every meal. Powder is the most effective.

• Vitamin B12: many cats with EPI are deficient in Vitamin B12; weekly or monthly injections as required.

• Special (prescription) diet: Highly digestible, with moderate fat content. For example Hills z/d, Hills d/d, i/d; Royal Canin Gastrointestinal.

• Regular veterinary check-ups: monitoring weight, body condition score, coat and stool consistency. Treatment often requires adjustments over time to maintain control of the condition.

Treatment is lifelong, requiring consistency and commitment. It may be costly over your cat’s lifetime. Try to be open with your vet if you have any concerns about treatment and costs. It’s best for you and your cat to discuss this and explore options from the outset.

Caution

• Response to treatment may be variable and/or limited by the underlying cause and complications, such as inflammatory bowel disease. It can take some time with ‘trial and error’ to get the correct dose and format of supplements, as well as any prescription medicines needed to successfully control the symptoms.

• Always provide enzymes well mixed into food: Direct contact with digestive enzyme supplements irritates the lining of the mouth, throat or oesophagus (gullet). It may lead to inflammation and ulcers.

Are there any home remedies for exocrine pancreatic insufficiency in cats?

Your cat will receive the best, safest and most reliable treatment under the joint care of you and your vet.

• Raw supplements, in the form of fresh or frozen pig pancreas, are available and effective. But safety and reliability of supply is a major concern. The last thing your vulnerable cat with EPI needs is food poisoning!

• Vitamin supplements : Only use these under veterinary advice. Your cat can have too much of a ‘good’ thing.

Can we prevent exocrine pancreatic insufficiency in cats?

EPI usually develops because of pancreatitis. Prompt and effective veterinary care for cats with pancreatitis may reduce the risk of longer-term chronic issues, such as EPI. Early identification, effective individual treatment and regular monitoring are the keys to achieving the best long term outcomes for your cat.

When to worry

See your physical vet as soon as possible if your cat:

• Has severe vomiting and/or diarrhoea, especially with blood

• Stops eating

• Develops weakness, unsteadiness, collapses

• Continuing to lose weight, despite treatment

• Has persistently abnormal stools

Joii can help with advice on:

• Managing uncomplicated vomiting and diarrhoea at home

• Ideal diets for life stage and health conditions

• Weight management