Exocrine pancreatic insufficiency (EPI) is a condition where your dog's pancreas can’t produce enough enzymes to digest food properly. EPI is relatively rare in UK dogs, affecting around 0.1 to 0.3% of the population. Although any dog can develop EPI, it’s most commonly diagnosed in young adult German shepherds.

Dogs with EPI lose weight and body condition, despite eating more. They’ll have bulky soft stools (poo) and a scurfy dry coat. EPI usually happens because of an inherited (genetic) defect, but can also result from chronic inflammation of the pancreas. EPI can’t be cured, but treatment with enzyme supplements and a special diet returns most dogs to a full life and a normal lifespan. Talk to a vet if you notice any unexplained weight loss in your dog.

What is exocrine pancreatic insufficiency in dogs?

The pancreas is an important gland in your dog’s abdomen (tummy). It has 2 parts: The ‘endocrine’ portion produces hormones called insulin and glucagon that 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 dogs 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:

• Pancreatic acinar atrophy: Cells producing digestive enzymes shrivel up and die when the body’s own defence cells attack them by mistake. An inherited form of EPI is seen in certain breeds.

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

• 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 puppy’s pancreas fails to form properly while they are in the womb.

Without treatment, dogs with EPI develop malnutrition, weight loss and gastrointestinal upsets, despite having a good, or even ravenous, appetite.

What are the symptoms of exocrine pancreatic insufficiency in dogs?

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

• Weight loss and body condition loss, despite increased appetite

• 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 dogs are at most risk of exocrine pancreatic insufficiency?

Although EPI may affect dogs of any breed, age or size, significant risk factors exist.

• Belonging to particular breeds: German Shepherds account for almost two thirds of EPI cases diagnosed. Affected dogs inherit a faulty gene that may be present in up to 1% of the breed. Also seen in Rough Collies.

• Age: Inherited forms of EPI are most likely in younger dogs and puppies: EPI from other causes, such as neoplasia and chronic pancreatitis, affect mature adult and senior dogs of any breed.

EPI is a disease of individual dogs. It doesn't spread between dogs or from dogs 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: 75-80% of dogs with EPI have low B12 (cobalamin); results in poorer response to treatment with enzyme replacements alone

Diagnosis of exocrine pancreatic insufficiency in dogs

Vets will suspect EPI after discussing the history of your dog'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 dogs?

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

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

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

• 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. Treatment will be costly over your dog’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 dog to discuss this and explore options from the outset. Caution

• Response to treatment may be variable and/or limited by 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 of digestive enzyme supplements with the lining of the mouth, throat or oesophagus (gullet) may lead to inflammation and even ulcers.

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

Your dog with EPI 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 dog with EPI needs is food poisoning!

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

Can we prevent exocrine pancreatic insufficiency in dogs?

The most common form of EPI is an inherited condition and can’t be prevented. Prompt and effective veterinary care for dogs with pancreatitis will 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 dog

When to worry

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

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

• Stops eating

• Develops weakness; collapses

• Still losing weight, despite treatment for EPI

• 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