The standard of care for canine exocrine pancreatic insufficiency (EPI) is lifelong pancreatic enzyme replacement therapy (PERT) combined with a low-residue, moderate-fat diet, cobalamin supplementation when indicated, and management of concurrent dysbiosis or enteropathy in non-responders.Journal of the…+1
Diagnosis is confirmed by serum canine trypsin-like immunoreactivity (cTLI) at a cutoff of ≤2.5 µg/L, using a species-specific immunoassay that directly reflects functional pancreatic acinar mass.Journal of the…+1 Clinical EPI is classified at cTLI <2.0 µg/L, and subclinical EPI at 2.0–5.0 µg/L, against a reference interval of 5.2–35 µg/L.The Veterinary…+1
PERT is the primary treatment and is required for life. Commercially available products are of animal origin and contain pancreatin — an extract of porcine pancreas providing lipase, amylase, and protease.Journal of Vete… Enteric-coated and uncoated formulations are both used; no difference in fecal fat reduction has been demonstrated between them in dogs with EPI.Journal of Vete… Response to initial treatment is good in 60–64% of dogs, partial in 17–19%, and poor in 17–23%.Journal of Vete…
Dietary management targets a low-residue diet with moderate fat content in dogs.Journal of the… The 2021 AAHA Nutrition and Weight Management Guidelines recommend a low-fat diet for dogs with EPI, with the caveat that fat recommendations may depend on baseline intake and degree of hyperlipidemia.AAHA Clinical G… In most cases, no specific diet is required beyond appropriate enzyme supplementation, but additional fiber supplementation is warranted for persistent soft stool.AAHA Clinical G…
Cobalamin supplementation is indicated when serum cobalamin is low. More than 80% of dogs with EPI have abnormally low serum cobalamin, and low concentrations are associated with poor clinical response and outcome.Journal of Vete… Oral cyanocobalamin at 0.25–1.0 mg daily (dose selected by body weight) normalizes serum cobalamin — median concentrations rise from 188 ng/L to 1000 ng/L after a median of 41 days of supplementation — and is an effective alternative to parenteral administration.The Veterinary…
Lipid-soluble vitamin deficiencies are present in dogs with EPI despite PERT. Serum retinol is significantly lower in dogs with EPI (median 490 ng/mL) compared to healthy dogs (median 1203 ng/mL), and serum α-tocopherol is significantly lower in both EPI (median 11.51 µg/L) and subclinical EPI (median 12.66 µg/L) dogs versus healthy dogs (median 43.54 µg/L).Journal of Vete… The clinical relevance and therapeutic benefit of routine lipid-soluble vitamin supplementation has not yet been established.Journal of Vete…
Persistent clinical signs despite PERT should prompt evaluation for enteric microbiota dysbiosis and concurrent chronic enteropathy, both of which are recognized contributors to treatment failure.Journal of the… Ultrasonographic intestinal findings consistent with inflammatory bowel disease are present in 85% of dogs with EPI, supporting the high prevalence of concurrent enteropathy.Veterinary Scie…
Prognosis is generally good with high-quality medical therapy. Although EPI represents irreversible loss of acinar tissue in most cases, affected dogs typically gain weight quickly, pass normal feces, and achieve a normal lifespan with appropriate management.MSD Vet Manuals
Would you like guidance on managing the dog with EPI that has a partial or poor response to initial enzyme replacement?