The pancreas produces several different enzymes which are secreted into the gut in order to help with the digestive process. These enzymes facilitate the break down of food so that it may be absorbed and used by the body. The three main types of enzymes secreted by the pancreas are proteases which break down proteins, lipase which breaks down fats and amylase which breaks down carbohydrates/ starch. If these enzymes are not produced in sufficient amounts to adequately break down the proteins, fats and carbohydrates in the diet then signs of pancreatic insufficiency will arise.
The signs of pancreatic insufficiency may vary according to the underlying cause and extent of the problem. A dog with this problem may show some or all of the following signs: normal or increased appetite, coprophagia (eating faeces), pica (eating abnormal things), weight loss, flatulence, borborygmus (rumbling, gurgling gut sounds) and diarrhoea. The volume and frequency of faeces usually increases with pancreatic insufficiency and stools may be soft or loose. The faeces may also be pale in colour and have a rancid smell due to the presence of undigested fats. Your dog may still appear to be bright and active despite these signs. In some cases the pancreatic insufficiency may be due to repeated episodes of pancreatitis in which case there may be a history of intermittent vomiting and diarrhoea with or without a loss of appetite.
The most common form of pancreatic insufficiency is caused by the atrophy of the acinar glands which produce the digestive enzymes; this is known as pancreatic acinar atrophy. In this condition the glands degenerate or die and are no longer able to produce enzymes in sufficient amounts to digest the food in the gut properly. This type of pancreatic disease is often found in young adult dogs with German Shepherds being particularly affected. Some dogs have more severe atrophy of the glands than others and it is unclear why it occurs, although there may be some inherited genetic factor in the case of German Shepherds. Dogs with this condition may have a history of intermittent intestinal problems before the more chronic signs develop. Chronic pancreatitis is another cause of pancreatic insufficiency in the dog. This tends to affect older animals. Pets with chronic pancreatitis may also have signs of diabetes mellitus. The causes of chronic pancreatitis are not fully understood and many causes have been suggested. These include nutritional factors, viruses, bacteria, trauma or an inflammatory process in the pancreas which damage or destroy the acinar glands within the pancreas. The acinar glands become unable to produce the enzymes which are needed to digest the food in the gut and signs of pancreatic insufficiency result. It is necessary to treat the primary cause of the pancreatitis in this situation otherwise the damage to the organ will continue. Other causes of pancreatic insufficiency are pancreatic neoplasia (cancer) and acute pancreatitis. These serious conditions are painful and produce severe signs of illness.
In order to make a diagnosis of pancreatic insufficiency it is usually necessary to perform a blood test. The concentrations of trypsinogen (the precursor of the enzyme trypsin) in the blood can give a reliable indication of pancreatic insufficiency if they are abnormally low. This test is known as a serum trypsin-like immunoreactivity or TLI test. Other tests may also give an indication of concurrent intestinal diseases which may be associated with pancreatic insufficiency. Usually all necessary tests can be performed on the same blood sample.
Treatment of pancreatic insufficiency is usually required for the life of the pet. A special diet which is low in both fats and fibre will help in this condition. The diet should be very easily digested. Hills i/d is a very good food for dogs with pancreatic insufficiency. In many dogs however, a special diet may not be strictly necessary and they do well if the pancreatic enzymes they are lacking are replaced. This is done by feeding them the enzymes which are given at the same time as their food. Tryplase capsules are often used for this purpose. They contain amylase, lipase and protease enzymes to help break down the food within the gut. The dose required must be individually tailored to the pet so that normal faeces are produced. The dose will vary according to how much food your pet eats; approximately 1 capsule is required to digest the protein, fat and starch in 100g of normal dog food. Dogs will need between 2 to 5 capsules per day and if the pet is fed twice daily then the dose should be split between the feeds. Pancrex-vet powder is another product which is often used as the name suggests it comes in a powder form rather than as capsules but other than that it is much the same. These products are usually safe and effective but an upset stomach may result from an overdose. Your vet may also recommend that your dog is given injections of vitamin B12 which is not absorbed well if your dog has pancreatic insufficiency. Vitamin E is also sometimes supplemented and antibiotics may be necessary if there is a bacterial overgrowth in the gut as a result of this disorder.
For most dogs with exocrine pancreatic insufficiency or EPI due to pancreatic acinar atrophy the prognosis is generally good. Supplementation with pancreatic enzymes will generally be required for the life of the pet and there may be episodes of diarrhoea caused by bacterial overgrowth in the gut which can usually be treated with antibiotics. In dogs with chronic pacreatitis the prognosis may depend upon other complicating factors such as diabetes mellitus being adequately controlled.