Exocrine Pancreatic Insufficiency (EPI) in Dogs and Cats

EPI is a condition in which your pet’s pancreas is unable to make enough digestive enzymes to break down the food they eat. This means that your pet cannot digest and absorb nutrients from their food, causing them to become malnourished.  

Your pet may also show other clinical signs depending on the underlying cause of EPI.

What are the causes of EPI?

The most common cause of EPI is a lack of the cells that make digestive enzymes. Cells can be lacking due to wasting away (atrophy), damage from inflammation, a blockage of the pancreatic duct, or other causes. In most cases, there are no digestive enzymes at all; however, in rare cases, just one enzyme may be missing in your pet.

Any dog or cat can develop EPI. Some dog breeds may be more likely to develop EPI than others, including young German Shepherds, Rough-Coated Collies, and Eurasiers. Cavalier King Charles Spaniels may be predisposed to EPI following chronic inflammation of the pancreas, also known as pancreatitis. Domestic shorthair cats may also be more likely to have EPI. 

What tests are required?

After getting a complete history and performing screening tests to rule out other problems, a simple blood test can be used to diagnose EPI. This test is called trypsin-like immunoreactivity (TLI) and its concentration is low in dogs or cats with EPI. Your veterinarian may also evaluate your pet’s feces (poop) for the presence of fat and to rule out parasites. The TLI test is recommended to be performed along with measurement of cobalamin (B12) which is a vitamin that is commonly low in pets with this disease. 

What is the treatment for EPI?

Daily pancreatic enzyme supplementation is the standard treatment for EPI. Your vet will prescribe these supplements, which you will then add to your pet’s food to help ensure they get the enzymes they need. Supplements usually come as a powder, capsule or tablet. Side effects of enzyme supplementation are rare but may include bleeding of the mouth. When this happens, some veterinarians will prescribe raw, chopped beef or pork pancreas for your pet to eat. 

Your vet may also recommend that you change your pet’s diet. Typically, novel protein or hydrolyzed diets are prescribed. Novel protein diets use protein sources your pet hasn’t seen before such as kangaroo, venison, alligator, etc. Hydrolyzed diets are made so that the proteins themselves are so small that they are unlikely to cause an adverse food reaction. Cobalamin (B-12) supplementation is also commonly prescribed in both dogs and cats with EPI. 

If your pet does not respond to standard treatment, your veterinarian may try a different brand or formulation of pancreatic enzymes or may alter the dose until they find the best treatment for your pet. Occasionally other medications (gastroprotectants, probiotics, or antibiotics) may also be used to improve your pet’s response. Your veterinarian may also look for more evidence of other diseases, such as intestinal problems, which could occur at the same time as EPI and may cause similar symptoms.

Most pets with EPI have a good quality of life and a normal life expectancy with ongoing treatment. Your pet should get regular check-ups to ensure the treatment is working and that they are getting the nutrition they need throughout their life.

Edited by:
Paige Mackey, DVM, MPH, DACVIM (SAIM)
June 2022