ISSN 2398-2969      

Exocrine pancreatic insufficiency

icanis

Synonym(s): EPI


Introduction

  • Congenital, inherited or acquired disease.
  • Inherited predisposition common in German Shepherd Dog, Collies and English Setters.
  • Acquired disease secondary to pancreatitis, or pancreatic duct obstruction.
  • May predispose to small intestinal bacterial overgrowth.
  • Cause: absence of pancreatic exocrine secretion → maldigestion.
  • Signs: weight loss, polyphagia, bulky feces/diarrhea.
  • Diagnosis: sub-normal serum trypsin-like immunoreactivity (TLI).
  • Treatment: enzyme replacement, digestible diet, +/- low fat diet +/- H2 antagonists +/- antibiotics.
    Print off the owner factsheet on Exocrine pancreatic insufficiency (EPI) Exocrine pancreatic insufficiency (EPI) to give to your client.

Pathogenesis

Etiology

  • Most common - idiopathic atrophy of pancreatic acinar tissue, (age of onset usually <1-2years of age).
  • Less common - as a consequence of chronic pancreatitis Pancreatitis: chronic - older age group (>4 years of age).
  • Very rare - congenital pancreatic hypoplasia, usually associated with diabetes mellitus Diabetes mellitus.

Pathophysiology

  • Progressive pancreatic acinar atrophy → lack of pancreatic digestive enzymes → maldigestion → polyphagia and profound weight loss.
  • Atrophy preceded by accumulation of lymphocytes, and acinar apoptosis (in GSD).
  • No evidence of specific anti-pancreatic antibodies in circulation.
  • Destruction of pancreatic enzymes in intestine, eg gastric hypersecretion.
  • Possible small intestinal bacterial overgrowth.
  • Malabsorption of vitamin B12 Vitamin B12, and vitamin E Vitamin E, rarely vitamin K Vitamin K:
    • Metabolic consequences of vitamin B12 deficiency.​

Timecourse

  • Gradual weight loss over months.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Toresson L, Steiner J M, Suchodolski J S, Spillmann T (2016) Oral Cobalamin Supplementation in Dogs with Chronic Enteropathies and Hypocobalaminemia.J Vet Intern Med 30(1), 101‐107 PubMed Full Article.
  • Mas A, Noble P J, Cripps P J, Batchelor D J, Graham P, German A J (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 PubMed Full Article.
  • Westermarck E & Wiberg M E (2006) Effects of diet on clinical signs of exocrine pancreatic insufficiency in dogs. JAVMA 228 (2), 225-229 PubMed.
  • Wiberg M E, Saari S A, Westermarck E & Meri S (2000) Cellular and humoral immune responses in atrophic lymphocytic pancreatitis in German Sheperd dogs and Rough-coated Collies. Vet Immunol Immunopathol 76 (1-2), 103-115 PubMed.
  • Simpson et al (1994) Long-term management of canine exocrine pancreatic insufficiency. JSAP 35 (3), 133-138 VetMedResource.
  • Williams D A & Batt R M (1983) Diagnosis of exocrine pancreatic insufficiency by assay of serum trypsin-like immunoreactivity. JSAP 24 (9), 583-588 VetMedResource.

Other sources of information

  • Simpson J W & Else R W (1991) Diseases of the exocrine pancreas. In: Digestive Disease in the Dog and Cat. pp 198-303. Oxford. Blackwell Scientific Publications. (Good synopsis of disease.)

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