Treating pancreatic insufficiency

The pancreas is a flat glandular organ found in the upper part of the abdomen, near the stomach and liver. The pancreas has three major functions. One part of the pancreas produces the hormone insulin, which regulates blood glucose. The bulk of the pancreas produces the enzymes necessary to digest food. The last major function of the pancreas is to produce fluid and bicarbonate for mixing of food in the intestines. A disease called exocrine pancreatic insufficiency, or EPI, occurs when the pancreas no longer produces the enzymes necessary to digest food.

Dogs with EPI gradually lose the exocrine cells in the pancreas, for reasons that are unclear. This condition is most common in German shepherds and rough-coated collies. In these breeds, this is thought to be an inherited disease. However, EPI can affect dogs of any breed, and is common in small dogs and cats that have chronic pancreatitis for an extended period of time. Pancreatitis is an inflammation of the pancreas, usually caused by excessive fat ingestion.

Without the pancreatic enzymes being produced, the animal is unable to digest food properly. Signs of maldigestion are always present, commonly diarrhea. The animal usually passes feces that are very soft, oily and in large volumes. Since food is not being absorbed properly, the animal is unable to take in enough energy and usually loses weight. Dogs often have a dramatically increased appetite and may teeth their own feces. Vomiting may occur occasionally, and the hair coat may be of poor quality.

Because the major clinical sign of EPI is diarrhea, other diseases that can cause diarrhea need be ruled out. Routine laboratory tests, stool exams and X-rays may all be recommended. One of the enzymes produced by the pancreas is called trypsin. We can measure the trypsin levels in the blood, and if these levels are low, we know that the pancreas is not producing enough enzymes.

The best treatment for EPI is to provide an oral supplement of digestive enzymes. These enzymes come in both tablet and powder forms that are extracted from the pancreases of cows and pigs. Dietary supplements using plant enzymes do not work as well as enzymes from animal sources. The digestive enzymes are given with every meal and are usually required for the rest of the animal’s life. Vitamin supplementation is often recommended, especially vitamins A, K and B12.

A significant improvement in diarrhea and weight gain is seen within 14 days after starting the enzyme supplements. Body weight, consistency of the feces, appetite and coprophagia are all monitored. The prognosis for most dogs with EPI is good. Affected dogs need to be monitored closely for secondary diabetes, as the cells that produce insulin in the pancreas can also be destroyed, causing secondary diabetes.

Dr. Karsten Fostvedt is a veterinarian at St. Francis Pet Clinic in Ketchum.

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