🧬 Exocrine Pancreatic Insufficiency in Dogs and Cats – A 2025 Vet's Guide to Enzyme Therapy, Nutrition & B-12 Support

By Dr Duncan Houston, BVSc

🔍 What Is Exocrine Pancreatic Insufficiency (EPI)?

EPI is a condition where the exocrine pancreas fails to produce enough digestive enzymes to properly break down and absorb food. Without these enzymes, dogs and cats can’t digest nutrients, leading to weight loss, greasy diarrhea, malnutrition, and vitamin deficiencies. 🧪🍽️

📌 What the Pancreas Normally Does

The pancreas has two jobs:

• Endocrine function – controls blood sugar (e.g., insulin)
• Exocrine function – produces digestive enzymes for fats, proteins, and carbs

In EPI, the exocrine function is impaired. Without digestive enzymes, food can't be broken down, absorbed, or utilized—leading to malnutrition despite a normal or even increased appetite. 🐾

🚨 Symptoms of EPI in Pets

• ⚖️ Sudden or progressive weight loss
• 💩 Greasy, foul-smelling diarrhea
• 🐕 Ravenous appetite (polyphagia)
• 🧴 Dull, flaky coat
• 🩸 Vitamin B12 (cobalamin) deficiency

🐕 Causes of EPI in Dogs

Most canine EPI is due to pancreatic acinar atrophy, where the exocrine tissue shrinks and stops producing enzymes. It is likely genetic, especially in:

• German Shepherds (70%) 🐶
• Rough Collies (20%)
• Juvenile Greyhounds (rare)

🐈 Causes of EPI in Cats

In cats, EPI usually results from chronic pancreatitis. Rarely, it may be caused by a pancreatic fluke infection from eating grasshoppers, although this is very uncommon. 🐱

🧪 Diagnosing EPI

Definitive diagnosis requires specialized testing:

1. 💉 Trypsin-Like Immunoreactivity (TLI)

This is the gold standard. A single fasted blood sample is taken to check for pancreatic enzymes. If TLI is very low, EPI is confirmed.

2. 💩 Fecal Elastase Test (dogs only)

Checks for enzyme levels in stool. Can rule out EPI when positive, but not reliable when negative. ✅❌

3. 💩 Fecal Protease Test

Older test using three fecal samples. Less accurate than TLI but sometimes used as a secondary method.

💊 Treatment of EPI

🔬 Enzyme Replacement Therapy

Daily supplementation with powdered digestive enzymes is the cornerstone of treatment. These help break down food even if much of the powder is destroyed in the stomach.

• Preferred form: Powders (Viokase-V, Pancrezyme, PanaKare) 💊
• Less effective: Tablets (do not always dissolve well)
• If palatability is an issue: Enzyme powder can be encapsulated by a compounding pharmacy

⏱️ Incubation Myth

It’s a myth that enzymes need to be pre-incubated in food. Simply mix thoroughly into the meal. If mouth ulcers occur, incubation (6–24 hours) may help reduce irritation. ❌

🍖 Raw Pancreas

Feeding raw pancreas (beef or lamb) is an alternative, though it comes with risks of parasites and bacteria. Cooking destroys the enzymes, so only raw or frozen raw should be used. ⚠️

🥗 Diet

• High-digestibility, low-fiber diets are preferred for weight gain and nutrient absorption
• Prescription diets are helpful but many pets do well with enzymes added to their regular food

💉 Vitamin B12 (Cobalamin)

Many EPI pets, especially cats, suffer from B12 deficiency due to bacterial overgrowth or poor absorption. Supplementation is essential:

• 💉 Injectable B12 for cats (often lifelong)
• 🧴 Oral B12 is now available for dogs and cats

🌿 Folate Deficiency (cats)

Folate supplementation is often needed in the first month of therapy. Check blood levels regularly. 🧪

🧬 Secondary Issues: Bacterial Overgrowth

When enzymes are low, undigested food feeds bacteria in the gut. This causes bacterial overgrowth (SIBO), which worsens malnutrition and steals nutrients. Treatment involves:

• 🍽️ Enzyme therapy
• 💉 Vitamin B12
• 🍽️ Digestible, low-fiber diet

🔄 What If Your Pet Isn’t Improving?

Most pets improve within a week. If not:

• 🔄 Increase enzyme dose
• 🧪 Check enzyme freshness and brand
• 💉 Start or continue B12 injections
• ⏱️ Consider food incubation
• 📋 Try a prescription diet

If symptoms persist, discuss testing for co-existing diseases with your vet. 🧠

📆 Long-Term Prognosis

With proper enzyme and B12 therapy, most dogs and cats live normal, happy lives. However, treatment is lifelong, and symptoms will return if enzymes are stopped. ✅

About 20% of dogs may not gain full weight, but their energy and quality of life still improve greatly. 🐕✨

📲 Ask A Vet for Support With EPI

Managing EPI involves lifelong enzyme therapy, monitoring, and nutritional support. Need help understanding test results, choosing a diet, or adjusting enzyme doses?

Download the Ask A Vet App or visit AskAVet.com for one-on-one veterinary support whenever you need it. 🐾📱

✅ Key Takeaways

• 🧬 EPI = insufficient digestive enzymes from the pancreas
• 🐕 Caused by genetic atrophy in dogs; pancreatitis in cats
• 💉 TLI blood test is most accurate for diagnosis
• 🍽️ Daily enzyme powder is the main treatment
• 💊 B12 and folate support are essential, especially for cats
• ⚠️ Lifelong therapy is needed to prevent recurrence

💬 Final Words from Dr Duncan Houston

EPI can be daunting at first, but with consistency and care, your pet can thrive. Once the right enzyme dose, diet, and supplements are dialed in, most pets experience dramatic improvements. 🐶🐱💚

For more guidance and community support, chat with a vet anytime on the Ask A Vet App or visit AskAVet.com. You and your pet aren’t alone on this journey. 🐾📱