Exocrine Pancreatic Insufficiency (most commonly called EPI, also Malabsorption or Malassimilation) is an often under-recognized disease in dogs in which the pancreas does not make sufficient digestive enzymes and the dog shows an array of symptoms that may mimic many other conditions, including internal parasites, colitis and food allergies. Once properly diagnosed, the digestive enzyme pancreatin is an affordable alternative to veterinary prescriptions.
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Features
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Any breed can be affected by Exocrine Pancreatic Insufficiency, but it is most common in German Shepherds. Symptoms include chronic diarrhea or soft stool, flatulence, vomiting, and an inability to gain or maintain weight. Because the food is not properly absorbed, the dog will literally be starving no matter how much it is fed.
Dogs may be born with the condition, and it can manifest at any age.
Proper Diagnosis
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EPI is often misdiagnosed. Standard laboratory testing (blood, urine, fecal) on EPI dogs will not reveal the condition. If your dog is not responding to conventional treatment for these symptoms, ask your vet about the possibility of a TLI--trypsin-like immunoreactivity--test. This test entails fasting the dog for 12 to 18 hours, obtaining a serum sample and testing it for the pancreatic enzyme trypsin. EPI dogs will have low or nonexistent levels of trypsin.
Pancreatin Treatment
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The dog must be on a pancreatic enzyme supplement for life; the supplement is usually made from freeze-dried pig pancreas. Two common veterinary brands are Viokase and Pancrezyme. These are prescription medications and the dose must be carefully tailored to the individual dog depending on weight and tolerance.
The human supplement pancreatin (brand names Pancrex, Nutrizym, Pancrex and Pancrease HL) is a less expensive alternative available at drug stores and online. Containing pig pancreas, along with other digestive enzymes amylase, lipase and protease, it may be used to treat EPI in dogs. However, unlike the veterinary-prescribed pancreatic enzymes, the amount of pancreatin in non-prescription supplements may not be reliably formulated, and it will take some experimentation to find an effective dose.
Determining Pancreatin Dose
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Pancreatin is available in strengths like 4x and 5x. This means that the concentrated dose of pancreatic enzyme is four or five times the whole dosage of the pill. Therefore, a 500 mg pill will contain four times 500, or 2,000 mg of pancreatin; 8,000 mg per day is considered a good starting point for a 50-lb. dog. The supplement must be crushed onto the food in fine powder form to be effective.
Keep a diary noting the administered dosage, along with frequency and consistency of stool, and the dog's weight. Improved stool consistency and gradual weight gain are positive indications that the dose is effective. If no improvement is noted, gradually increase the daily dose.
Considerations
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Consult with your veterinarian and monitor your dog's progress on pancreatin. EPI dogs may have several co-morbid disorders, and pancreatin alone may not be sufficient treatment for some dogs. Prescription or homemade diets and other medications are often necessary to keep the dog healthy and comfortable. With proper management, EPI dogs can live long, normal lives.
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