Do you sit around pondering the problems surrounding EPI in your German Shepherd? Like most other owners, probably not. You may not have even heard of it. Nevertheless, untreated EPI can affect your German Shepherd’s quality of life.
EPI stands for exocrine pancreatic insufficiency. Classified as an exocrine as opposed to endocrine disease, EPI is the lack of enzyme production by the pancreas. Without enzymes, dogs fail to digest their food properly and thus do not obtain sufficient nutrients.
EPI German Shepherds often have healthy appetites, and their owners feed them plenty at mealtimes, but they look like they are starving.
We will discuss the symptoms of EPI, differential diagnoses, and effective treatments.
What does the pancreas do?
You likely already know about the pancreas and its essential functions in the digestion of food. In people, specifically, the organ has a significant role in starch and carbohydrate digestion. In dogs, like other mammals, the pancreas acts as an endocrine and exocrine organ.
The pancreas is responsible for blood sugar regulation through the hormone called insulin.
Our primary interest in the pancreas in EPI is, of course, its exocrine role. The pancreas secretes digestive enzymes into the small intestine to break down fats, carbohydrates, proteins with lipase, amylase, and protease, respectively.
Wild canids cannot break down starches to the extent domestic dogs can, so their pancreas has a more specialized role.
Exocrine enzymes are behind another major pancreatic disorder you may know about, pancreatitis. When the pancreas becomes inflamed, enzymes can leak and lead to further irritation and damage to surrounding abdominal structures.
Why do dogs get EPI?
There are three significant etiologies or causative factors for exocrine pancreatic insufficiency.
Health experts believe the most common reason for EPI in German Shepherds is pancreatic acinar atrophy or PAA.
Probably secondary to pancreatic lymph-based inflammation, acinar atrophy can lead to mild, moderate, or severe disease.
According to Dvm360.com, disruption of 90% of the pancreatic function must occur before signs develop.
PAA likely has a genetic basis. However, pancreatic acinar atrophy appears to involve multiple genes, so control is potentially difficult.
German Shepherds and Rough-Coated collies are the most common breeds affected by EPI secondary to pancreatic acinar atrophy. It may pass to German Shepherd puppies as a recessive gene.
Exocrine pancreatic insufficiency is potentially an immune-mediated process in both German Shepherds and Scotch Collies. EPI is also more common in Chow Chows, Cavalier King Charles Spaniels, and English Setters than other dog breeds.
We do not know for certain how much of a role chronic pancreatitis plays in canine EPI. Many German Shepherds with EPI secondary to chronic pancreatitis also have diabetes mellitus. For the Cavalier King Charles Spaniel, chronic pancreatitis is the primary cause of most cases of EPI.
Other less common causes of EPI in German Shepherds are pancreatic cancer and pancreatic hypoplasia, a rare congenital problem in puppies.
How likely is it your German Shepherd will develop EPI?
Exocrine pancreatic insufficiency usually develops in dogs six months to six years old, according to Ufaw.org.UK.
What are the signs your Shepherd may have EPI?
The fact that something is wrong with your beloved pet will be evident very quickly with EPI.
Weight loss is a classic and almost universal sign of EPI. Since EPI German Shepherds are not producing enzymes to break down their food, they cannot gain any nutritional value.
The body starves itself, and you will notice pronounced weight loss or failure to gain muscles or padding. Many dogs appear emaciated with prominent ribs, pelvis, and bones of the head and face.
A telltale sign of epi is that your dog eats normally but still appears to lose pounds. You may even feed extra meals to no avail. Puppies will fail to thrive, often having a dull coat.
Unlike many other illnesses, dogs with epi often eat like they are starving. A ravenous appetite also may spill into coprophagia or eating their feces.
You may also observe your dog has a desire to eat anything that is not nailed down, including foreign objects. Beyond a puppy’s behavior of putting everything in their mouths, you will note an epi German Shepherd has a fixation with eating.
Foul-Smelling Copious Stools
When a dog has exocrine pancreatic insufficiency, you will see evidence of the undigested waste. Epi dogs tend to have stools with high volume and a distinctive foul odor.
Shepherds with epi will present with weeks of diarrhea that will not go away. Often the stool has a characteristic cow-patty consistency with a greasy sheen from the undigested fats.
How do you know for sure your German Shepherd has epi?
You can only be certain whether or not your dog has epi by taking her to a veterinarian for a definitive diagnosis.
Your veterinarian will perform a blood test to check for canine trypsin-like immunoreactivity. He or she will likely also measure for vitamin B12 deficiency with a Cobalamin/Folate test.
Tests for EPI involve specialized instruments. Your veterinarian will probably have to send the blood sample to a remote laboratory, and you may have to wait a couple of days for the results.
Illness in dogs or people is similar to a puzzle or a treasure hunt. Complex disease processes may share symptoms, and obtaining a diagnosis requires compiling several bits of information from tests, patient history, signalment, and signs.
Signalment refers to breed, age, and other characteristics that influence the prevalence of certain conditions. For example, we would readily attribute demodectic mange to a three-month-old Pit Bull puppy but not usually a two-year-old Irish Setter.
Differential diagnoses are diseases with similar symptoms as the disorder in question. A health practitioner utilizes tests and other clues to rule a differential diagnosis in or out, confirming or discarding the suspected disease.
The following diseases, like EPI, present with weight loss, diarrhea, or increased appetite.
- Small intestinal malabsorption
- Intestinal worms
- Addison’s disease
- Chronic pancreatitis
Small Intestinal Malabsorption
The small intestinal disease is probably the most difficult health issue to differentiate from EPI. First, the symptoms of the two processes are quite similar.
Second, German Shepherds can experience both EPI and small intestinal disease concurrently. Occasionally, small intestinal diseases, like bacterial overgrowth, are a result of EPI.
German Shepherds are prone to small intestinal diseases like inflammatory bowel and food sensitivity. Your veterinarian must perform specific tests to differentiate primary small bowel malabsorption and EPI.
Often, primary small bowel disease does not produce the huge volumes of feces that EPI does. Also, the appetite may decrease when a disease affects the small intestine, especially if the liver or gallbladder plays a role.
Sometimes your vet can perform a lipid test on the feces. However, most distinctions between EPI and small bowel disease occur only after a trypsin-like immunoreactivity analysis.
Treatment for EPI usually addresses secondary small bowel malabsorption, especially bacterial overgrowth. Primary small bowel disease requires a diagnosis of the underlying cause and then subsequent treatment.
Intestinal worms often cause weight loss and diarrhea. You see worms most commonly in young puppies. Your veterinarian can easily rule worm in or out with an examination of a fecal sample.
Facilities perform repeated fecal examinations if necessary. Although puppies lose weight and are unthrifty from worms, it will not be as drastic as in EPI. Diarrhea tends to be scant and may have blood in it.
A disease whereby dogs do not have the appropriate hormones to deal with stress, Addison’s can on the surface look similar to EPI.
However, Addisonians show more intermittent signs, often show vomiting that accompanies diarrhea, and have other signs atypical of EPI like lethargy, dehydration, and collapse.
Addison’s Shepherds will not have dramatic weight loss or the high-volume diarrhea of EPI dogs.
Although starving German Shepherds look much like EPI dogs, the diagnosis will be obvious from the history. Moreover, if you rescue a German Shepherd from starvation, for example, you will not see voluminous diarrhea because there is no food intake.
Chronic pancreatitis can be difficult to differentiate from EPI because both diseases have origins in the same organ.
Moreover, chronic pancreatitis is sometimes a cause of EPI. However, pancreatitis can also cause vomiting, inappetence, lethargy, abdominal pain, and vomiting.
Is there a cure for EPI?
There is no cure for EPI, but the treatment is very satisfying. German Shepherds with a diagnosis of EPI live a full and healthy life. When you begin treatment, you must adjust dosages for each individual.
Once your enzymes are at appropriate levels for your dog, you should expect smooth and predictable results of weight gain and the resolution of diarrhea.
Treatment for EPI usually involves a three-pronged attack.
The chance your dog will spontaneously recover from EPI is exceedingly low. Rare cases exist where a candid with pancreatic insufficiency secondary to acute pancreatitis eventually regained enzymatic function. EPI is almost always a lifelong commitment to enzyme supplementation.
Your veterinarian will prescribe or recommend enzymes for your German Shepherd in the form of powder, tablets, or capsules. The powder is by far the most effective formulation.
If you subscribe to holistic or all-natural treatments, you can talk to your veterinarian about providing enzymes via fresh frozen pig pancreas.
According to Epi4dogs.com, you can also use beef or lamb. A fresh-frozen pancreas complements raw diets especially well.
Cooking raw pancreas destroys enzymatic action, but the uncooked meat can be susceptible to bacterial contamination. The feeding recommendation is three to four ounces of the minced or blender-processed pancreas.
Whether the powder you use is prescription or over-the-counter, you will achieve the best results if you add warm water to activate the enzymes. Then the directions call for you to mix the enzymes with your dog’s food.
Typical amounts are a half to full teaspoon of enzyme powder for every cup of food. You customize the amount gradually according to how your dog progresses.
Eventually, you will decrease doses to use the minimal effective amount to maintain weight. Dogs who have too high of dosage may experience oral bleeding.
Aside from supplementing her enzymes, you will also need to modify your Shepherd’s diet. Many dogs do best with a raw diet or at least one that is free of grains.
By selecting for specific macronutrient ratios, you decrease your dog’s risk of acid imbalances that can exacerbate an inflamed bowel. You also want to support your German Shepherd’s immune system.
According to All Shepherd Rescue, the balance you want is 20 to 25% protein and 10 to 15% fats. You can choose from prescription diets or hand-selected meals from high-quality health-minded brands.
Your goal is to moderate protein and limit fats compared to what many premium dog foods offer. You will also pay attention to fiber intake, limiting that to 1 or 2%.
You can feed a homemade or raw diet as well. Coordinate with your vet or a nutritionist to ensure balance and the fulfillment of vitamin and mineral requirements.
Treating EPI Complications
The most common secondary effects of EPI that you may have to treat are vitamin B12 deficiency, inflammatory small bowel disease, and bacterial overgrowth.
Usually, your dog’s inflamed small intestines and bacterial overgrowth go hand-in-hand. Bacterial overgrowth is an explosion of “bad” microbes, which cause the acidity of the gut to change. pH changes encourage inflammation and further proliferation of nonbeneficial bacteria.
Diet modification helps, but your German Shepherd may also benefit from longterm antibiotics that target harmful bacteria. Such antibiotics include Flagyl or Metronidazole and Oxytetracycline.
Dogs can suffer from vitamin E and K deficiencies, but the most critical shortages are typically vitamin B12. The intrinsic factor in the pancreas provides vitamin B12 but does not function correctly in over 50% of dogs with EPI.
Moreover, if your German Shepherd does produce the vitamin, he may not be able to absorb it because of inflammation or bacterial overgrowth in the small intestine.
Administering oral vitamin B12 does not change your pet’s ability to absorb it, so most EPI Shepherds who require supplementation must receive weekly vitamin B12 injections.
Eventually, the frequency may change to every other week and then monthly. Your veterinarian may be able to train you to give injections at home. A lab test confirms whether your pet needs vitamin B12 supplementation.
Vitamin B12 is vital for your German Shepherd to gain weight and maintain healthy intestinal and brain function. It takes a long time for vitamin b12 to reach critically low levels and it is a challenging task to get it back up once it plummets.
So what I’ve top facts can you take away about EPI in German Shepherds?
- Not common – 1% of German Shepherds acquire it, but the German Shepherd is the most overrepresented breed
- Not curable but highly treatable – Enzyme supplementation and intestinal support are for life
- Must confirm the diagnosis with a specific test
- Do not take lightly – EPI will cause your dog to starve to death
- With treatment, EPI does not shorten your dog’s life nor affect the quality of life. Your German Shepherd can work, play, and serve as your loyal companion.
Rather than show videos of emaciated German Shepherds, we end on a positive note with a German Shepherd returning to normal weight and life after an EPI diagnosis.
Caretakers of rescue dogs must be ever-vigilant as it is easy to confuse exocrine pancreatic insufficiency with starvation when a dog first comes to a shelter.