Exocrine Pancreatic Insufficiency

Exocrine pancreatic insufficiency (EPI) is a type of malabsorption condition characterized by the decreased ability of the exocrine part of the pancreas to make digestive enzymes. Deficiency in digestive enzymes leads to poor digestion and small intestinal bacterial overgrowth. Affected dogs eat voraciously but lose weight and pass large quantities of gray stool. Chronic pancreatitis is a common cause of exocrine pancreatic insufficiency in humans and cats, but is rarely recognised in dogs, in which pancreatic acinar atrophy (PAA) is reportedly more common. PAA is a degenerative disease of digestive enzyme-producing acinar cells that leads to poor digestion. Chronic pancreatitis may be a more common cause of EPI in dogs, especially in the German Shepherd Dog, than previously assumed and may be under-recognised because of difficulties in diagnosis.

Diagnosis of exocrine pancreatic insufficiency is based on signs and laboratory tests, including blood tests and abdominal ultrasonography. The primary treatment of EPI is supplementing each meal with dry pancreatic extract and fat-soluble vitamins, especially vitamin E. Antibiotics and corticosteroids are used in some cases. Response to long-term enzyme treatment in dogs with EPI varies considerably, making it difficult to determine prognosis for individual patients. Response to initial treatment and survival are affected by signs and therapeutic methods. Long-term prognosis in canine EPI is favorable for dogs that survive the initial treatment period. Although it is possible to predict the long-term survival, severe cobalamin deficiency is associated with shorter survival. Therefore, cobalamin supplementation may be considered in some cases.


  1. Caring for Your Dog by Bruce Fogle, DVM, MRCVS
  2. Sonographic evaluation of the normal and abnormal pancreas.Hecht S, Henry G. Department of Small Animal Clinical Sciences, The University of Tennessee College of Veterinary Medicine, Knoxville, TN 37996-4544, USA.
  3. Prognostic factors in canine exocrine pancreatic insufficiency: prolonged survival is likely if clinical remission is achieved.Batchelor DJ, Noble PJ, Taylor RH, Cripps PJ, German AJ. Small Animal Hospital, Department of Veterinary Clinical Science, University of Liverpool, UK.
  4. Effects of diet on clinical signs of exocrine pancreatic insufficiency in dogs.Westermarck E, Wiberg ME. Department of Clinical Veterinary Sciences, Faculty of Veterinary Medicine, University of Helsinki, Finland.
  5. Exocrine pancreatic insufficiency as an end stage of pancreatitis in four dogs.Watson PJ. Department of Clinical Veterinary Medicine, University of Cambridge
  6. Effects of exocrine pancreatic insufficiency and replacement therapy on the bacterial flora of the duodenum in dogs.Simpson KW, Batt RM, Jones D, Morton DB. Department of Biomedical Services, University of Leicester, UK.
Exocrine Pancreatic Insufficiency dog disease

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