Maldigestion Disorder in Dogs (EPI): Everything Owners Need to Know

Maldigestion Disorder in Dogs or EPIMaldigestion disorder in dogs, also known as exocrine pancreatic insufficiency (EPI), is a common canine health problem that pet owners often have to deal with.

Weight loss and diarrhea are general symptoms and can be an indication of any number of health issues.

If your vet investigates and reaches a diagnosis of canine exocrine pancreatic insufficiency, you may be left wondering what the future holds and how to help your dog.

What are the Symptoms of EPI in Dogs?

EPI is a condition caused when the pancreas fails to produce sufficient digestive enzymes to digest fatty foods which results is bulky feces, diarrhea, and weight loss.

The signs usually come on gradually over several months.

The dog often has a good appetite but struggles to keep weight on.

As the condition progresses the dog is liable to lose weight and become very thin [1].

The dog produces bulky feces or diarrhea, which often have a rancid smell and a greasy appearance.

Some dogs have greasy fur around their rear end, as a result of the fatty composition of feces they pass.

Some dogs with EPI feel compelled to eat their own feces, probably in an effort to reclaim some of the lost nutrition.

What Causes Maldigestion Disorder in Dogs?

Some dogs inherit genes from their parents which makes them more likely to develop EPI. These breeds are the German shepherd dog, collie breeds, and English setters [1, 2].

Dogs with inherited EPI usually start to show signs around 1 – 4 years of age.

Other dogs can develop EPI as a result of low grade, long term inflammation of the pancreas [2]. This can happen as a result of grumbling pancreatitis.

Dogs that develop EPI due to pancreatic inflammation are usually a bit older, at around 4 – 8 years of age, when they start to show symptoms.

The absolute cause of the symptoms is a lack of digestive secretions, caused by damage to the pancreatic cells which manufacture those enzymes, which in turn means the dog is not able to digest fatty foods [1].

How Does a Vet Diagnose Maldigestion Disorder?

How Vets Treat Maldigestion Disorder in Dogs or EPI

The vet performs a thorough physical exam of the dog to troubleshoot problems and draw up a list of possible diagnosis.

Screening blood tests are needed to rule out disease which can cause similar symptoms to EPI, such as liver or kidney problems.

Fecal analysis rules out infectious causes of soft stools such as bacterial infections, worms, and parasites such as giardia.

A definitive diagnosis is made by running bowel function blood tests. These measure the levels of pancreatic digestive enzyme and highlight other complicating factors such as bacterial overgrowth in the bowel [3].

Other conditions which need to be differentiated from EPI include inflammatory bowel disease (IBD), intestinal cancer, parasites, liver failure, small intestinal bacterial overgrowth, protein-losing enteropathy, and gluten sensitive enteropathy.

What’s the Outlook for the Dog?

There is no ‘cure’ for EPI and dogs need treatment for the rest of their lives.

Pancreatic supplements are expensive and costs can mount in the long term.

With an appropriate diet and regular replacement enzymes, many dogs lead normal lives.

What’s the Treatment for EPI in dogs?

EPI is controlled by feeding a supplement of digestive enzymes alongside a highly digestible, low-fat diet [4].

Pancreatic enzyme replacements come in powder, capsule, or tablet form. To aid digestion the supplement is mixed with every meal.

The powdered form of pancreatic replacement is most effective, although the efficacy of tablets and capsules can be improved by crushing or opening the capsule to sprinkle the active ingredient over the meal.

The starting dose of the powdered replacer is usual 1 – 1.5 teaspoons per 100g of food, mixed well.

Best results are obtained by feeding little and often, such as three meals a day [4].

The effectiveness of pancreatic replacements is reduced if the dog is taking an antacid medication, so the latter are best avoided.

Dogs with EPI often have long term vitamin B deficiency and injections of vitamin B12 (cobalamin) every 2 – 4 weeks are recommended [5].

Can a Diet Help with EPI?

Diet for Maldigestion Disorder in Dogs or EPIDogs with EPI lack the enzymes to break down fat; therefore it is best to feed a fat restricted or low fat diet, with the aim of giving the digestive system less work to do [34].

A highly-digestible fat-restricted diet is advisable. However, fat makes food tasty so a low-fat diet can be less appealing to eat. Add meat or fish stocks to food to make it more palatable.

If preparing a home-cooked diet look for lean, white meats such as chicken, turkey, rabbit, cod, or coley. Avoid fatty foods such as burgers, mince-meat, and marbled red meats.

For a home-cooked diet look for highly digestible sources of carbohydrate such as white rice, white pasta, tapioca, or boiled potatoes.

Beans and pulses are highly fermentable and poorly digestible, so avoid diets which list soya amongst the top ingredients.

A home-cooked diet may be deficient in vital minerals and vitamins, so add a good supplement to the meal following the manufacturer’s directions as to how much to add [6].

The cooking process makes foods easier to digest so avoid a raw diet if your dog has EPI as it is giving the dog’s digestive system extra work to do [6].

Commercial highly-digestible diets are available, and these have the advantage of being nutritionally balanced with added vitamins and minerals. Suitable diets include Hills ID and Purina EN.

A regular commercial dog food has a digestibility factor of around 70 – 90%, but this information is rarely listed on the pack. A highly digestible diets scores around 85-90%, so if you are unclear about your chosen diet, contact the manufacturer who can supply the necessary information.

Consider giving your dog a daily probiotic supplement designed for canines (such as Purina Fortiflora.) Populating the gut with the correct type of bacteria helps reduce the chances of unhealthy bacteria overgrowing and causing SIBO (Small intestinal bacterial overgrowth).

With care and dedication the owner of a dog with EPI to keep their dog fit and well. But right after diagnosis, be aware of the cost implications of long term pancreatic replacers and be sure this is something you can commit to.

References

  1. Batt RM. Exocrine pancreatic insufficiency. Vet Clin North Am Small Anim Pract. 1993 May;23(3):595-608.
  2. Wiberg ME1, Saari SA, Westermarck E. Exocrine pancreatic atrophy in German Shepherd Dogs and Rough-coated Collies: an end result of lymphocytic pancreatitis. Vet Pathol. 1999 Nov;36(6):530-41.
  3. Pidgeon G, Strombeck DR. Evaluation of treatment for pancreatic exocrine insufficiency in dogs with ligated pancreatic ducts. Am J Vet Res. 1982 Mar;43(3):461-4.
  4. Westermarck E1, Junttila JT, Wiberg ME. Role of low dietary fat in the treatment of dogs with exocrine pancreatic insufficiency. Am J Vet Res. 1995 May;56(5):600-5.
  5. Ruaux CG. Cobalamin in companion animals: diagnostic marker, deficiency states and therapeutic implications. Vet J. 2013 May;196(2):145-52. doi: 10.1016/j.tvjl.2013.01.025. Epub 2013 Mar 18.
  6. Westermarck E1, Wiberg ME. Effects of diet on clinical signs of exocrine pancreatic insufficiency in dogs. J Am Vet Med Assoc. 2006 Jan 15;228(2):225-9.