As the treatment of EPI is a costly affair and should be continued lifelong, the commitment of the owner should be elaborated at the outset.
Treatment of EPI consists of pancreatic enzyme supplementation, dietary modification, antibiotics, and vitamins.
Exogenous Pancreatic Enzyme Supplementation
Generally powdered porcine pancreatic extracts of 2 teaspoons/20kg BW/meal for dogs is more than sufficient to manage the EPI (Kim, JW et al, 2005). Scientists opined that the powdered form of pancreatic extracts is readily absorbed in the system than the raw-chopped pancreas, and the enteric coated tablets or capsules.
Some of the commercially available enzyme capsules are:
Bleeding from oral cavity can be noticed in certain species of dogs during or shortly after consumption of meals containing pancreatic enzyme supplement. Reducing the dose of the pancreatic extracts can stop the oral bleeding.
The clinical signs of EPI is ameliorated with a highly digestible, low fat, and low-fiber diet. Some of the small animal gastroenterologists claim that providing low-fat diet to the EPI suffering dogs do not improve clinical symptoms. The patient situation may further improved with the dietary supplementation of medium-chained triglycerides oil (Dose-2 ml per meal every other day).
In spite of sufficient enzyme replacement, the absorption of fat will never normalized. Moreover, the fat will be a perfect platform for secondary bacterial overgrowth. Hence the early stage of treatment should include broad-spectrum antibiotics such as oxytetracycline (10 mg/kg PO). You can reduce the dose or even withdrawn once the secondary bacterial symptoms subsides.
There will be deficiency of vitamin E and vitamin B12 (cobalamin) in the dogs with EPI. Hence Oral vitamin- E supplementation, and vitamin K are required for treating the EPI in dogs. Dogs with EPI have been recommended with periodic injections of vitamin B12.
The affected dogs show response to treatment within a week of medication. Although there is an excellent response for the therapy, one dog in five simply won’t respond well. Some of the dogs won’t regain its original weight even after complete treatment.
Reasons for Treatment Failure
The main reason for treatment failure in EPI in dogs is the presence of higher quantity of small intestinal bacteria, which may lead to inflammatory small intestinl disease. In such cases, supportive therapy with corticosteriods (Prednisone) and/or nitroimidazole anti-infective agents (Metronidazole) may be indicated.
Apart from this, inadequate enzyme supplementation may lead to EPI treatment failure. As lipase is acid-sensitive enzyme, the supplementation of this enzyme must be followed by H2 blocker-type antacid (fomatidine) inclusion (cimetidine, ranitidine).
One study showed that the major cause of death in EPI was euthanasia because of treatment costs. Breeding should be avoided in exocrine pancreatic insufficiency affected dogs, and in German shepherds, their parents (considered carriers) and siblings (suspect carriers).
Nutrition is a significant issue for dogs with exocrine pancreatic insufficiency. The combination of poor intake due to pain and poor absorption carries a high risk of malnutrition.
Patients with EPI often must alter their food intake in order to optimize absorption of food and minimize pain associated with eating. Towards this goal, dogs may need to provide their diet to several small meals a day instead of two large meals. The diet should be high in carbohydrate and low in fat to minimize the enzymes needed for digestion.