WHAT IS EPI? IS IT COMMON?

Written by my buddy Jason Sigler, a dog trainer who experienced this first hand.

​It’s Common But it’s not Normal.
Several years ago, I had a German Shepherd (GSD) that I adopted from a rescue. He was intelligent, strong, and a bit of a jerk, but he had all of the necessary drives I wanted in a demo dog as far as training was concerned. At the time I had never had a GSD, but had always wanted one. And now I did. He was two-years old when I adopted him and he seemed to be pretty slim. My immediate thought was that he’d be putting on weight soon as I use a lot of treats when training. Over the course of a few weeks I noticed that he had very soft, greasy looking bowel movements. I asked my mentor about it, and she told me that loose stool is completely normal in GSDs. Being a novice trainer and she being the resident subject matter expert on all things GSD I didn’t give it another thought.
So, three months later I was graduating from dog training school with Gibbs, my GSD. The adoption was finalized and he was now the newest addition to my family. Prior to traveling across country with him I decided to have my Veterinarian look at him for a full physical, just to make sure that he was physically healthy. The Doctor called me the following the day and informed me that Gibbs had Exocrine Pancreatic Insufficiency (EPI).
The doctor went on to tell me that the first tell-tail sign of EPI is loose, greasy stool. I told him that I was told loose stool like that of Gibbs’ was completely normal for GSDs. The doctor then laid some knowledge on me by saying, “loose stool like Gibbs’ is very common in GSDs but it’s not normal.”

So, what is EPI?
EPI is the inability of the acinar cells of the exocrine pancreas to produce and secrete enzymes necessary for the proper digestion of food. In other words, the pancreas stops producing the enzymes needed to absorb nutrients from the food they eat.
EPI is sometimes referred to as Pancreatic Hypoplasia or Pancreatic Acinar Atrophy (PAA). EPI can also be the secondary condition of a chronic illness, such as chronic pancreatitis. Without these enzymes, the digestive tract is unable to absorb nutrients from the food, which causes further health complications if not managed appropriately. Because the food is not being fully digested and nutrients aren’t getting absorbed despite eating copious amounts of food; the dog is constantly hungry, malnourished and can literally starve to death. Without proper treatment, dogs with EPI can die a painful death from malnourishment, starvation and in severe cases multiple organ failure.
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Due to EPI; organ, immune, nervous and all other body systems become compromised to one degree or another. A lack of nutrients often results in temperament changes which may present themselves as one or more variations of aggression (in Gibbs’ case it was resource guarding and predatory aggression). It is an overwhelming, maddening disease that is misdiagnosed more often than not. What makes this disease so difficult to diagnose is that symptoms don’t usually show until 80% and 95% of the exocrine pancreas acinar cells are destroyed. And, not all dogs display any or all of the symptoms at all. Any breed can have EPI, but the most common are GSDs.
What does EPI look like?
EPI can manifest anytime in a dog’s life, from a young pup to an elderly dog, with the severity and symptoms of the disease varying from dog to dog.
Common symptoms include but not limited to:
Insatiable appetite.
Stools are very soft (loose) and appear greasy.
The amount of stool passed will appear to be the same as the amount of food consumed.
Increased rumbling sounds from the abdomen.
Increased amounts of flatulence.
Gradual wasting away despite a voracious appetite.
Some display a personality change.
 
So, if I suspect it, how do I test for it?
The only way to positively confirm EPI is with a TLI (Trypsin-Like Immunoreactivity) blood test.
Because GSDs and their crossbreeds make up the majority of diagnosed EPI cases, anytime a gastrointestinal upset persist with a GSD, it is strongly recommended that you have them tested for EPI.
What is the treatment for EPI?
Every dog is different and will require a different treatment protocols for effective management. Be prepared for a long stressful road to stabilization. Be aware too that this road will not only put a strain on your emotions, but will also place considerable tension on finances as well.
FOOD
Most, but not all, dogs with EPI require a grain-free food with mild protein that is easier for the body to digest with what little digestive enzymes they have naturally.
ENZYMES
A dog with EPI will require enzyme replacements in EVERY meal. I had the best results with Pancrezyme. However, it was very expensive. At the time depending on the Veterinary clinic you purchased it from it cost $110.00 - $130.00 per jar and one jar lasted about three weeks. It worked out to around $4,500 a year in just the replacement enzymes alone.  Raw fresh beef, pork or lamb pancreas can be used as a natural enzyme replacement, but depending on your geographic location it can be near impossible to find a meat market that carries it.
Having a dog with EPI is an absolute nightmare. That doesn’t mean it’s impossible to live with. It can be managed. If the dog is positive for EPI don’t let anyone fool you into believing that simply feeding your dog probiotics will solve the problem because it won’t. Remember that the root problem with EPI is that your dog lacks the digestive enzymes necessary to properly absorb nutrients from the food they eat. Therefore, if you give the them probiotics they still won’t get any benefits from them if they cannot absorb them. They go in probiotics – they come out probiotics. The key to management is in the Enzyme replacement.
Sure, it’s very common for GSDs to have large, greasy, soft stools…. But it is not normal.