Exocrine Pancreatic Insufficiency (EPI) is a condition where the pancreas does not produce enough digestive enzymes, leading to maldigestion and malabsorption. Fortunately, most dogs and cats diagnosed with EPI can be successfully managed with a multi-faceted approach involving Pancreatic Enzyme Replacement Therapy (PERT), cobalamin supplementation, and dietary adjustments. This guide outlines the key strategies for effectively treating and managing EPI in your feline and canine companions.
Pancreatic Enzyme Replacement Therapy (PERT)
PERT is the cornerstone of EPI management. Various enzyme formulations are available, with powders generally proving more effective than tablets, capsules, or enteric-coated products. The recommended initial dosage for dogs is 1 teaspoon per 10 kg of body weight, mixed with food at each meal. For cats, the initial dose is typically 1 teaspoon per cat, also mixed with their food.
An alternative to enzyme powders is fresh pancreatic tissue. Approximately 30–90 grams (1–3 ounces) of raw, chopped pancreas can substitute for 1 teaspoon of pancreatic extract. Raw pancreas can be stored frozen for extended periods without losing its enzymatic potency. It is important to note that pre-incubation of food with enzymes or supplementation with bile salts is not generally necessary.
Once clinical signs have completely resolved, the PERT dosage can be gradually decreased to the lowest effective level. However, be aware that enzyme efficacy can vary between batches. Some studies have reported adverse effects such as oral bleeding in a small percentage of dogs treated with pancreatic enzyme supplements; this typically resolves upon dose reduction. Moistening the food and enzyme mixture may also help mitigate this side effect.
While PERT significantly improves clinical signs in nearly all affected animals, it does not fully normalize nutrient absorption, particularly that of fats. Therefore, feeding low-fat diets, while seemingly logical, is generally not recommended as it can further impair fat assimilation and lead to deficiencies in fat-soluble vitamins and essential fatty acids.
Dietary Modifications for EPI
Certain types of dietary fiber can interfere with pancreatic enzyme activity. It is advisable to feed a diet low in insoluble or nonfermentable fiber. Conversely, fermentable fibers, such as fructooligosaccharides or beet pulp, can be safely incorporated into the diet.
Cobalamin Supplementation
Enzyme supplementation alone may not always lead to a complete resolution of clinical signs. Cobalamin (Vitamin B12) deficiency is a common concurrent issue in animals with EPI and should be considered as a potential cause for persistent symptoms. A severely decreased serum cobalamin concentration suggests a deficiency.
Animals diagnosed with cobalamin deficiency should be supplemented. This can be administered parenterally (via injection) or orally. For parenteral administration, the recommended dose for dogs is 25 mcg/kg subcutaneously once weekly, and for cats, 250 mcg/cat subcutaneously once weekly. Oral supplementation involves 25 mcg/kg for dogs every 24 hours, and 250 mcg/cat for cats every 24 hours.
Addressing Concurrent Conditions
Some animals may not respond adequately to enzyme supplementation and cobalamin therapy, potentially indicating concurrent small intestinal disease. Animals with EPI often exhibit small intestinal dysbiosis (an imbalance of gut bacteria) and may benefit from antimicrobial therapy, such as tylosin, or fecal microbiota transplantation (FMT). Chronic inflammatory enteropathy, often referred to as inflammatory bowel disease, can also occur in some animals with EPI.
While antacid therapy is not typically required for EPI, in cases where animals do not respond to PERT, a proton pump inhibitor like omeprazole (0.7–1.0 mg/kg every 12 hours) can be attempted to prevent the inactivation of pancreatic enzymes as they transit to the small intestine.
Conclusion
Successfully managing Exocrine Pancreatic Insufficiency in dogs and cats hinges on a consistent and comprehensive approach. By diligently implementing Pancreatic Enzyme Replacement Therapy, appropriate dietary adjustments, and addressing potential cobalamin deficiencies and concurrent gastrointestinal issues, you can significantly improve your pet’s quality of life and help them lead a healthier, more comfortable existence. Always consult with your veterinarian for a proper diagnosis and a tailored treatment plan for your pet.
