Vetnuus | August 2024 37 The exocrine pancreas plays an essential role in the digestion and absorption of nutrients. Pancreatic acini absorb, synthesize and secrete enzymes such as lipase, trypsin and amylase that digest fats, proteins and carbohydrates respectively. Pancreatic duct cells secrete bicarbonate that maintains an optimal pH for digestive and absorptive processes, as well as the intrinsic factor: that enables the absorption of cobalamin (Vit B12). The exocrine pancreas also produces peptides and defensins that regulate the upper GI flora and play a role in the maintenance of the intestinal mucosa and glucose homeostasis. Exocrine pancreatic insufficiency (EPI) is characterised by the loss of functional pancreatic mass, leading to the loss of digestive ability of the GI tract. Juvenile pancreatic acinar atrophy (PAA) is the most common cause of exocrine pancreatic insufficiency (EPI). Dogs under 5 years of age diagnosed with EPI are typically suffering from PAA, whereas older animals likely have a higher incidence of pancreatitisinduced degeneration1. A tentative diagnosis of exocrine pancreatic insufficiency (EPI) is made based on compatible historical and clinical findings and by ruling out parasitic, infectious, metabolic and anatomical causes of small bowel diarrhoea. Chronic, voluminous, putrid-smelling, cow-pat diarrhoea with weight loss and a ravenous appetite in predisposed breeds such as German shepherds or Rough Coated Collies should provoke suspicion of EPI. These symptoms are all directly attributed to decreased intraduodenal concentrations of pancreatic enzymes, bicarbonate and various other factors with the resultant malassimilation of fats, carbohydrates and proteins. Subnormal serum concentrations of trypsin-like immunoreactivity (TLI) in combination with clinical signs are definitively diagnostic for EPI2. Primary treatment of EPI involves oral administration of exogenous pancreatic enzymes (1tsp per 10kg body mass with each meal is sufficient) 3. Premixing the enzymes in with the base diet is not necessary 3. Tablets and capsules are not as effective as powder3. Powdered enzyme preparations should be coated to resist gastric acid effects. Once patients have fully responded and gained back their original body weight, the amount of enzyme can be decreased to the lowest effective dose, titrated based on stool consistency and body condition3. Approximately 80% of dogs with EPI are cobalamin deficient3. Should this be the case, oral cobalamin supplementation should be added to the treatment regimen3. Minced raw porcine pancreas (fresh or frozen) can be a very effective treatment and in some cases works better than the powdered extract. However, it can be very difficult to source and can become financially straining. Fat is considered the most difficult nutrient to assimilate, and lipase activity is the limiting step in its digestion. A commercial low-fat or moderate-calorie intestinal formulation that incorporates all of the intentions to reduce pancreatic overload is prescribed in these cases. A highly digestible, fat-adapted diet will increase the percentage of dry matter digested and reduce faecal mass and water content in EPI4. A diet that is low in fibre should be provided. This is because fibre is indigestible, dilutes the energy density and hinders pancreatic enzyme activity. Rice is a highly digestible carbohydrate source and is the primary starch in most commercial intestinal formulations. Some data has shown that some German Shepherds suffered concurrent IBD and did not enjoy a complete response unless a hypoallergenic diet was prescribed. If dietary sensitivity is suspected then an antigen-restricted or protein hydrosylate diet may be employed5 Antibiotic therapy may be required if the patient is not responding to oral enzyme therapy. Antibiotic-responsive diarrhoea may be the issue in these cases3. The nutritional management of this condition is the cornerstone in the treatment and maintenance of longevity in the EPI patient. Although literature pertaining to the condition has been controversial, therapeutic enzyme supplementation remains the key feature in most publications. Alteration of the maintenance diet to one that is highly digestible may greatly improve the patient’s quality of life and contribute significantly to their response to treatment as a whole. References 1: Hall EJ, Bond PM, Butt RM et al – A survey of the diagnosis and treatment of canine exocrine pancreatic insufficiency. J Small Anim Pract 1991; 32: 613-619. 2: Westermarck E, Wiberg M - Exocrine pancreatic insufficiency in dogs. Vet Clin North Am Small Anim Pract. 2003; 33(5): 1165-79. 3: Cote, E. (2011). Retrieved May 10, 2016, from www.clinicalvetadvisor2.com: http://clinicalvetadvisor2.com/bc_content.php?id=258&text=exocrine pancreatic 4: Pidgeon, G. (1982) Effect of diet on exocrine pancreatic insufficiency in dogs. Journal of American Veterinary Medical Association 181, 232-235 5: Burchell, R. (2016, May 10). Dr.(M. Harman, Interviewer) v The role of nutrition in the management of Exocrine Pancreatic Insufficiency Dr Debby Bain
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