This disease has many names (EPI, PAA, Malabsorption or Malassimilation), and is over represented in the GSD and the white shepherd descending from the GSD.
Hereditary in the white shepherd, it is determined to be an autosomal recessive. This is considered lucky as the disease can be bred away to diminish its presence within our breed.
Many vets do not recognise EPI when it is presented. They will run the gamut of tests for worms, IBS, allergies, etc. as they search for the cause of the problem.
Hereditary in the white shepherd, it is determined to be an autosomal recessive. This is considered lucky as the disease can be bred away to diminish its presence within our breed.
Many vets do not recognise EPI when it is presented. They will run the gamut of tests for worms, IBS, allergies, etc. as they search for the cause of the problem.
Anatomy
The pancreas is an elongated, tapered organ, tannish pink in colour, which resides in close proximity to the duodenum (the first section of the small intestine).
The tapered nature of the organ is often described as a 'head', 'body' and 'tail'.
It is covered with a thin connective tissue casing, which extends inward partitioning the gland into lobules. The bulk of the pancreas is made up of pancreatic exocrine cells and their associated ducts.
Within the exocrine tissue are millions of small cell clusters called the Islets of Langerhans.
These are the endocrine cells of the pancreas. They secrete insulin, glucagon and other hormones.
The pancreas is an elongated, tapered organ, tannish pink in colour, which resides in close proximity to the duodenum (the first section of the small intestine).
The tapered nature of the organ is often described as a 'head', 'body' and 'tail'.
It is covered with a thin connective tissue casing, which extends inward partitioning the gland into lobules. The bulk of the pancreas is made up of pancreatic exocrine cells and their associated ducts.
Within the exocrine tissue are millions of small cell clusters called the Islets of Langerhans.
These are the endocrine cells of the pancreas. They secrete insulin, glucagon and other hormones.
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Pathogenesis
Pancreatic acinar cell tissue located on the exocrine portion of the pancreas is responsible for creating and releasing pancreatic digestive enzymes.
These enzymes are vital to proper food digestion and the assimilation of nutrients. The three primary enzyme group types are protease, lipase and amylase.
Protease enzymes are necessary for proper protein breakdown and digestion. The two major pancreatic proteases are trypsin and chymotrypsin. These are created and kept in secretory vesicles (a closed membranous shell) as the inactive proenzymes trypsinogen and chymotrypsinogen.
Lipases are created and released for digesting fats, and amylases for carbohydrates.
PAA (pancreatic acinar atrophy) is responsible for the majority of cases of canine EPI.
The nutrients ingested by EPI affected dogs are not broken down into proper absorbable forms due to the lack of intraluminal enzyme activities.
Some dogs may also develop secondary changes to the intestinal mucosa. If secondary changes occur, it iwill impact on the genesis of malassimilation. The changes to the intestinal mucosa can include villous (villi is a tiny hair-like structures in the intestinal wall responsible for absorbing nutrients) atrophy, inflammatory cells and changes within the mucosal enzyme activities.
SIBO (small intestine bacterial overgrowth) is a common side problem of EPI and can be responsible for many mucosal changes.
Some thint the lack of pancreatic secretions containing possible antibiotic properties is the cause of EPI related SIBO.
Pancreatic acinar cell tissue located on the exocrine portion of the pancreas is responsible for creating and releasing pancreatic digestive enzymes.
These enzymes are vital to proper food digestion and the assimilation of nutrients. The three primary enzyme group types are protease, lipase and amylase.
Protease enzymes are necessary for proper protein breakdown and digestion. The two major pancreatic proteases are trypsin and chymotrypsin. These are created and kept in secretory vesicles (a closed membranous shell) as the inactive proenzymes trypsinogen and chymotrypsinogen.
Lipases are created and released for digesting fats, and amylases for carbohydrates.
PAA (pancreatic acinar atrophy) is responsible for the majority of cases of canine EPI.
The nutrients ingested by EPI affected dogs are not broken down into proper absorbable forms due to the lack of intraluminal enzyme activities.
Some dogs may also develop secondary changes to the intestinal mucosa. If secondary changes occur, it iwill impact on the genesis of malassimilation. The changes to the intestinal mucosa can include villous (villi is a tiny hair-like structures in the intestinal wall responsible for absorbing nutrients) atrophy, inflammatory cells and changes within the mucosal enzyme activities.
SIBO (small intestine bacterial overgrowth) is a common side problem of EPI and can be responsible for many mucosal changes.
Some thint the lack of pancreatic secretions containing possible antibiotic properties is the cause of EPI related SIBO.
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Dogs shown on the health pages do no have any diseases to our knowledge. They are purely to llustrate healthy dogs and puppies.
Diagnosis
The result of standard laboratory testing is normal (chemistry profiles, urinalysis, CBC, etc).
Dogs may exhibit a higher than normal serum ALT (a liver enzyme that plays a role in protein metabolism) activity due to disrupted small intestinal barriers and the resulting hepatic (liver) inflammation.
Many will also have hypocholesterolaemia (the presence of abnormally small amounts of cholesterol in the circulating blood).
Standard diagnostic testing, history examination, and physical examination will not be able to differentiate between small bowel disease and malassimilation from EPI at this point.
Further screening must be done.
The result of standard laboratory testing is normal (chemistry profiles, urinalysis, CBC, etc).
Dogs may exhibit a higher than normal serum ALT (a liver enzyme that plays a role in protein metabolism) activity due to disrupted small intestinal barriers and the resulting hepatic (liver) inflammation.
Many will also have hypocholesterolaemia (the presence of abnormally small amounts of cholesterol in the circulating blood).
Standard diagnostic testing, history examination, and physical examination will not be able to differentiate between small bowel disease and malassimilation from EPI at this point.
Further screening must be done.
Treatment
EPI is treated with enzyme replacement given with each meal. If the diagnosis of EPI is accurate, and if sufficient enzyme supplementation is provided, diarrhea and other symptoms will begin to resolve in a matter of days, followed by gradual weight gain.
It is important to confirm the diagnosis of EPI before starting pancreatic enzyme replacement.
Once an appropriate dose of enzyme replacement is found that controls the symptoms, the enzyme dose can be reduced until the lowest dose that maintains control is found. Powder form enzyme is generally more effective than tablets, although you may find the tablets easier to administer.
Some animals do not respond to enzyme replacement alone. These animals may benefit from medications that enhance/augment enzyme replacement. Certain drugs
EPI is treated with enzyme replacement given with each meal. If the diagnosis of EPI is accurate, and if sufficient enzyme supplementation is provided, diarrhea and other symptoms will begin to resolve in a matter of days, followed by gradual weight gain.
It is important to confirm the diagnosis of EPI before starting pancreatic enzyme replacement.
Once an appropriate dose of enzyme replacement is found that controls the symptoms, the enzyme dose can be reduced until the lowest dose that maintains control is found. Powder form enzyme is generally more effective than tablets, although you may find the tablets easier to administer.
Some animals do not respond to enzyme replacement alone. These animals may benefit from medications that enhance/augment enzyme replacement. Certain drugs
The information on this page has been taken from an article originally written by Sher Belonus published on the White Shepherd Genetics website. The website is well worth visiting for lots of information on genetic diseases in white shepherds.
Clinical Features
It was once believed that a solitary severe case of acute pancreatitis or repeated bouts of mild, chronic pancreatitis could result in a progressive loss of pancreatic acinar tissue.
Recent studies now conclude that this form of EPI is uncommon and that the bulk of EPI cases presented are heritable (GSD) or of an adult onset nature (idiopathic, non-breed specific).
Dogs affected by the heritable form are usually young when symptoms manifest (around 2 or below). Dogs affected by the idiopathic form are typically mature or into their geriatric phase of life ,and may or may not have exhibited a history of chronic pancreatitis.
When the disease reaches its peak and 90% or more of the pancreatic acinar ability is lost; the dog will present with the clinical signs of nutrient malassimilation. Up until that time, the dog will appear normal.
Owners typically present undiagnosed dogs with EPI to a vet for a chronic weight loss history though the dog may be a ravenous eater with a large appetite. No matter how much the dog eats it continues to drop weight. Quite literally, the dog could eat copious amounts morning, noon and night and yet starve to death. The dog may also exhibit an increase in thirst.
The character of the fecal excretions can be normal, soft and of a cow-patty nature, or watery. The EPI affected dog will often go off a normal bowel movement schedule having bowel movements frequently throughout the day and night.
Gastric distress such as stomach gurgling, continual flatulence, and burping are typical and may also manifest.
Some owners describe their dogs experiencing pica (eating of inedible things such as dirt, wood, et.) and coprophagia (stool eating). EPI affected dogs exhibiting pica and coprophagia are not doing so for behavioral reasons. The dog is merely desperate to ingest nutrients from any source.
Poor skin and coat conditions are common with the coat being brittle, dry and lack lustre.
Staining of the perineal region may occur while the dog is experiencing steatorrhea (fecal matter that is frothy, foul smelling and floats because of a high fat content).
It was once believed that a solitary severe case of acute pancreatitis or repeated bouts of mild, chronic pancreatitis could result in a progressive loss of pancreatic acinar tissue.
Recent studies now conclude that this form of EPI is uncommon and that the bulk of EPI cases presented are heritable (GSD) or of an adult onset nature (idiopathic, non-breed specific).
Dogs affected by the heritable form are usually young when symptoms manifest (around 2 or below). Dogs affected by the idiopathic form are typically mature or into their geriatric phase of life ,and may or may not have exhibited a history of chronic pancreatitis.
When the disease reaches its peak and 90% or more of the pancreatic acinar ability is lost; the dog will present with the clinical signs of nutrient malassimilation. Up until that time, the dog will appear normal.
Owners typically present undiagnosed dogs with EPI to a vet for a chronic weight loss history though the dog may be a ravenous eater with a large appetite. No matter how much the dog eats it continues to drop weight. Quite literally, the dog could eat copious amounts morning, noon and night and yet starve to death. The dog may also exhibit an increase in thirst.
The character of the fecal excretions can be normal, soft and of a cow-patty nature, or watery. The EPI affected dog will often go off a normal bowel movement schedule having bowel movements frequently throughout the day and night.
Gastric distress such as stomach gurgling, continual flatulence, and burping are typical and may also manifest.
Some owners describe their dogs experiencing pica (eating of inedible things such as dirt, wood, et.) and coprophagia (stool eating). EPI affected dogs exhibiting pica and coprophagia are not doing so for behavioral reasons. The dog is merely desperate to ingest nutrients from any source.
Poor skin and coat conditions are common with the coat being brittle, dry and lack lustre.
Staining of the perineal region may occur while the dog is experiencing steatorrhea (fecal matter that is frothy, foul smelling and floats because of a high fat content).
Prognosis
Treatment of EPI is necessary for life, though there have been cases documented of spontaneous remission.
Most dogs with EPI due to pancreatic acinar atrophy respond well to enzyme replacement, and have a very good long-term prognosis for living normal, full lives.
Treatment of EPI is necessary for life, though there have been cases documented of spontaneous remission.
Most dogs with EPI due to pancreatic acinar atrophy respond well to enzyme replacement, and have a very good long-term prognosis for living normal, full lives.
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