Exocrine Pancreatic Insufficiency in Dogs

By Malcolm Weir, DVM, MSc, MPH; Krista Williams, BSc, DVM, CCRP; Ernest Ward, DVM

What is the pancreas?

The pancreas is a V-shaped gland lying close to the stomach and small intestine. Secretions from the pancreas are carried to the small intestine by the pancreatic duct.

What is the function of the pancreas?

The pancreas has two separate and distinct functions, which are its endocrine and exocrine functions. The pancreas produces enzymes that digest fats, carbohydrates, and proteins. This is the exocrine function of the pancreas.

What is exocrine pancreatic insufficiency?

Exocrine pancreatic insufficiency (EPI) is the inability to produce sufficient pancreatic enzymes needed to digest fats, carbohydrates, and proteins. This difficulty in digestion leads to poor absorption of nutrients which commonly causes weight loss despite a normal or increased appetite.

Affected dogs often have large volumes of pale, fatty feces. This condition is called steatorrhea or fat in the stool.

What causes this pancreatic insufficiency?

The causes of EPI can be congenital (present from birth), inherited (genetic), or acquired as the result of pancreatic infection, inflammation, or injury. The condition is seen more commonly in German shepherd dogs, rough coated collies, Cairn terriers, akitas, West Highland white terriers, Welsh corgis, border collies, Australian heelers, Shetland sheepdogs, and Australian shepherds. It is suspected to be an inherited condition in German shepherd dogs.

The main cause appears to be a progressive loss of pancreatic cells, but chronic pancreatitis can also result in EPI. This may be due to an autoimmune condition in which the body’s own immune system attacks the pancreatic cells, or chronic pancreatitis (inflammation of the pancreas).  It may also be secondary to cancer, either in the pancreas or in the surrounding tissues.

What are the usual signs of the condition?

Young adult dogs are often affected and have chronic diarrhea or very soft, bulky, fatty looking feces, excessive appetites, occasional vomiting, and gradual weight loss over a period of months. Because of the high level of fats in the stool, the hair coat around the anus and on the tail may appear greasy.

How is the condition diagnosed?

Simple blood and fecal tests can accurately detect if the condition is present. Canine trypsinogen-like immunoassay (cTLI) is the preferred diagnostic test for EPI. cTLI, in combination with Vitamin B12 and folate level tests, gives the best assessment of your pet's pancreatic function.

Is it possible to treat EPI?

Highly digestible, low-fat diets together with pancreatic enzyme replacement (Viokase®, Pancreazyme®) will usually stabilize the condition. Cobalamin (vitamin B12) supplementation may be considered by your veterinarian when hypocobalaminemia (low blood cobalamin level) is documented. Treatment is usually required for the rest of the dog’s life. If elevated folate levels are detected, indicating an overgrowth of bacteria in the small intestine, then an antibiotic called tylosin (brand name Tylan®) may be prescribed.

Is diabetes involved with the condition?

Rarely, in cases that are the result of chronic pancreatitis, the endocrine cells that produce insulin can also be affected. In these cases, diabetes mellitus (sugar diabetes) may also be present.

What is the prognosis?

Once an accurate diagnosis has been established, most pets do well with treatment, though treatment is required for the lifetime of the dog. 

Is it possible to cure the condition?

EPI due to chronic pancreatitis will sometimes resolve as the pancreas heals. However, the most common cause of EPI is the progressive destruction of the exocrine cells of the pancreas. This cannot be cured, only managed with medications and diet.

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