Exocrine Pancreatic Insufficiency

Dear Dr. Jody: Our one-year old German shepherd, “Hemi”, has had intermittent soft stool since he was a puppy. We have tried him on many different varieties of food and cannot find one that works well for him. Despite having a great appetite, he has always been very thin and has recently even lost some weight. We have had him dewormed several times. What might we be missing? 

As you can imagine, there are countless causes of diarrhea in dogs. In order to arrive at a diagnosis, several different diagnostic tests may be required. After your veterinarian performs a complete physical exam, it will be important to submit a sample of stool to the laboratory for analysis. Most veterinary clinics have the capability of running limited types of stool samples in-house to rule out common parasites, but larger laboratories can more easily detect the trickier organisms such as Cryptosporidium, Isospora, Giardia, and Clostridium. Many of these pathogens are easy to treat with appropriate medication. 

In the event that Hemi’s fecal analysis does not provide a diagnosis, your veterinarian may want to test Hemi for exocrine pancreatic insufficiency (EPI). EPI is a defect in pancreatic enzyme secretion that makes it very difficult or impossible for a dog to digest certain nutrients. The result is chronic diarrhea, marked weight loss (or an inability to gain weight) and decreased muscle mass. German shepherds are by far the most common breed affected by EPI. 

The pancreas is an extremely important structure. This flat little organ is tucked up next to the stomach. When it detects the presence of an ingested meal, it secretes its enzymes into the upper small intestine via a tiny duct. These enzymes then work to dismantle nutrients such as proteins, fats, and, to a lesser degree, carbohydrates so that they can be absorbed through the intestinal wall and travel to various parts of the body through the nutrient-carrying bloodstream. When the enzyme-secreting parts of the pancreas do not work well, the body has no way of breaking apart these nutrients in order to absorb them and use them. These unabsorbed nutrients travel through the dog’s entire digestive system and into the stool without being absorbed and used by the dog. The presence of these nutrients within the intestines can feed opportunistic bacteria in the gut, leading to small intestinal bacterial overgrowth (SIBO) and a worsening of existing diarrhea. Because dogs that are not absorbing their proteins and fats appropriately are also at risk for imbalances in other nutrients such as cobalamin (vitamin B12) and folic acid, these vitamins and minerals need to be measured in dogs diagnosed with EPI. 

The good news is that EPI is manageable. The bad news is that there is no “cure”; rather, EPI requires treatment to be given with every meal for the rest of the dog’s life. Veterinary formulated pancreatic enzymes are mixed with each meal before feeding the meal to the dog. These supplemental enzymes will break down the fats and proteins in the dog’s food so that he can readily absorb these nutrients. 

Owners frequently comment at how quickly their dog responds to the treatment. These dogs enjoy improvement in their muscle mass, stool quality, coat quality, and overall energy. If you have been struggling to manage chronic intestinal upset in your dog, please do not hesitate to contact your veterinarian immediately.