Exocrine pancreatic insufficiency (EPI)

Treatment of exocrine pancreatic insufficiency (EPI) is based 
on supplementation of the deficient pancreatic enzymes.

Some textbooks advocate extracorporeal predigestion, a 
notion that deters many pet owners amd may in many 
cases result in animals with EPI being put down. In fact, 
Studies ^1,2,3 in dogs have shown that preincubation of 
the feed, supplementation with bile salts, or concomitant 
antacid treatment is unnecessary for obtaining good 
results in most cases. Dividing rations of feed into 
multiple small meals also appears to be unnecessary.

With commercial pancreatic extracts, make sure you do 
not use capsules, tablets, or enteric coated preparations 
(such as are common in human medicine). Powder is the 
most effective dosage form ^1,2,3. Mix the powder with the 
feed immediately before feeding the animal. You may need 
to slightly moisten dry feed so that extract adheres properly.

The starting dose should be large enough to guarantee 
an effect, as the effective dose varies greatly from animal 
to animal ^1,3. Clinical improvement can be seen in 24 – 48 
hours, as evident by the volume and consistency of the 
feces. Polyphagia stops within a few days, and body weight 
returns to normal in a matter of weeks. The dose can then 
be reduces to the minimun effective level, as indicated by 
normalization of the feces.

Resistance to treatment may be due to proliferation of 
bacteria in the small bowel. This can be treated with 
metronidazole and other agents.