Diagnosis of exocrine Pancreatic Insufficiency

Diagnosis of exocrine Pancreatic Insufficiency

Your veterinarian will examine the pet for the existence of the signs and symptoms of exocrine pancreatic insufficiency. The diagnosis of the EPIis mainly depends on the symptoms of EPI evinced on the patients that include nausea, vomiting, steatorrhea (oily stools), intractable pain and involuntary weight loss.

Pancreatic biopsy only confirms the EPI. Though, indirect tests are employed to preclude the need for surgery. A number of tests have been used:

  • 24 hour fat balance study
  • Oral fat tolerance test
  • Benzoyl-tyrosyl para-amino benzoic acid (BT-PABA) test
  • Fecal proteolytic activity (“fecal trypsin”)


Due to the high rate of spurious results and the development of better results, these tests are considered as obsolete. Unfortunately, these tests frequently are misleading or unhelpful because many of the results are equivocal.

Intially the diagnosis of this condition utilizes inaccurate fecal tests. Introduction of the serum Trypsin-like Immunoreactivity test (cTLI) by radioimmunoassay paves way for confirmative diagnosis of this condition.

Trypsin-like Immunoreactivity Test

The dog must be fasted for a day prior to blood collection. In healthy animals, no trypsin is available in the bloodstream in order to circumvent digestion of one’s own body. The Pancreas stores this enzyme trypsin. A dog with EPI will never show serum TLI in the blood stream. The results will be obtained within few days. The reference range for dogs TLI is >5 to 35 µg/l. In EPI, values are typically <2.5µg/l.

Fecal Protease Test

In this test the fecal sample is subjected to detect the presence of enzymes of protein digestion. The animal need not be fasted prior to collection, but three days successive samples are necessary to obtain reliable result since there is incredible inconsistency of the enzymatic activity in the stools over the day. For getting accurate results some of the vets provide soybeans to pets to help kindle the liberation of pancreatic digestion enzymes.

Fecal Elastase Test

Another digestive enzyme that plays an important role in digestion is ELASTASE. This test is being used for dogs only. Single day stools sample is more than sufficient for performing this test by ELISA.

In case of positive elastase test, the dog is ruled out of EPI, but we can’t confirm that once it shows negative (10 ?g/g). Since the elastase test is canine-specific, there is no cross-reaction even if the dog is on replacement therapy. A disadvantage of fecal elastase test is that normal dogs also can occasionally show low results.

Radio-Immuno Assay

Recently a technique called radioimmunoassy has been developed and validated for the diagnosis of exocrine pancreatic disorders.This measures canine pancreatic lipase immunoreactivity (PLI). The PLI test is more specific and sensitive than TLI test.

Differential Diagnosis

The small intestinal disorders that cause maldigestion or malabsorption includes—

  • Changes of the intestinal brush border enzyme activities
  • Short bowel syndrome
  • Diffuse small intestinal malignancies
  • Lymphangiectasia
  • Small intestinal villus atrophy
  • Inflammatory bowel disease
  • Intestinal parasites

Once you have diagnosed your dog with EPI, this is a high time to get an opinion about the disease at the earliest possible time…

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