Page 619 - Clinical Small Animal Internal Medicine

54 Exocrine Pancreatic Insufficiency in Dogs and Cats 587

is not indicated for the diagnosis of EPI in dogs and cats. Pancreatic Enzyme Supplementation
VetBooks.ir While it is believed that more than 90% of the pancreatic Pancreatic enzyme supplementation is the cornerstone
parenchyma needs to be destroyed in order for clinical
of EPI treatment in the vast majority of cases. There are
signs of EPI to develop, it is almost impossible to accu-
rately determine the extent of pancreatic atrophy either several different types of products that can be used for
the management of EPI in animals and differences in
grossly or histopathologically, and thus whether acinar efficacy may exist among them. Options generally
cell loss is leading to EPI. The utility of histopathology is include enteric‐coated preparations, uncoated enzyme
limited to determination of the underlying cause of EPI powder (as powder or in capsules), and raw pancreas.
(PAA or pancreatitis). Even then, in dog breeds that have Most commercially available products contain pancre-
been shown to be predisposed to EPI due to acinar atro- atic enzymes and proenzymes that are derived from por-
phy (i.e., German shepherds, rough‐coated collies), his- cine pancreas (in the form of dried extracts), while raw
topathology is redundant. Therefore, histopathology pancreas (which also contains pancreatic enzymes and
should only be used in atypical cases where the cause of proenzymes) is usually obtained from cattle or pigs.
EPI needs to be determined.
Only a small proportion of the orally administered
pancreatic enzymes remains functionally intact by the
Treatment time they reach the small intestine. It has been reported
that up to 85% of pancreatic enzyme activity can be lost
in the stomach due to the acid pH and/or the action of
The vast majority of animals with EPI require lifelong gastric pepsins. Therefore, enteric‐coated preparations
treatment with pancreatic enzyme supplementation, have been developed to protect the enzymes from degra-
with or without other treatments. Although pancreatic dation in the stomach. There has been considerable dis-
enzymes are essential for digestion, alternative pathways cussion regarding the comparative efficacy of different
for digestion of some nutrients do exist and therefore products for the treatment of EPI. To add to the confu-
rare animals may compensate for the loss of pancreatic sion, results of available studies have been conflicting.
enzymes and display only minimal clinical signs without An early study suggested that enteric‐coated prepara-
treatment. tions were less effective than uncoated preparations,
Table 54.1 summarizes the treatment options for dogs
and cats with EPI. while a more recent study suggested that there was no

Table 54.1 Treatment options for dogs and cats with exocrine pancreative insufficiency (EPI)

Dosage regimen

Medication Dog Cat Comments

Pancreatic enzymes
Powder 1–2 teaspoon per 0.5–1 tsp per meal Mix with food just prior to feeding (powder) or
10 kg in each meal give with food (enteric‐coated formulations)
Enteric‐coated Titrate to the minimum effective dose when
formulations clinical signs are in remission
Raw pancreas 50–100 g per meal, 30–90 g per meal, Rarely, may cause oral bleeding and irritation. In
mixed with food mixed with food these cases dose reduction is indicated
Antibacterials
Tylosin 10–25 mg/kg q12h 10–25 mg/kg q12h Treat for a minimum of 4 weeks
Metronidazole 10–15 mg/kg q12h 10–25 mg/kg q12h The benefits of antibacterial treatment are
uncertain in cats with EPI
Vitamin supplements
Cobalamin (in the form 250–1000 μg, SC, weekly 250 μg, SC, weekly for Measure serum cobalamin concentrations every
or cyanocobalamin or for 6–8 weeks or orally, 6–8 weeks, or orally, 3–6 months after initial supplementation and treat
hydroxycobalamin) daily for 8 weeks daily for 8 weeks as necessary with additional supplementation
Acid suppression Not generally indicated
medications