EPI in Dogs

Exocrine Pancreatic Insufficiency

 


Symptoms     Causes    Diagnosis     Management     Breeds at Risk     Links     Quick-Start Guide


Please visit our sister site, Bloat in Dogs.  Knowing the symptoms and causes could save your dog's life.

 

Exocrine Pancreatic Insufficiency (EPI) is a potentially life-threatening disease in some dogs, yet most dog owners know very little about it and a lot of contradictory information has been published.  Even good veterinarians may not recognize EPI since it's not a common disease.  The good news is that many EPI dogs live long and happy lives because their EPI is being managed appropriately by their human family.  If you suspect your dog may have EPI (for example, has "cowpie" stools that won't clear up), the very best thing you can do is confirm the diagnosis immediately, so you can begin managing EPI as soon as possible.   

What is EPI?
EPI occurs when the part of the pancreas (acinar tissue) that produces digestive enzymes no longer functions properly.  As a result, the dog can't digest its food.  That's why an EPI dog will literally starve to death without proper treatment.   It's estimated that more than half the cases occur in German Shepherd Dogs (GSDs) or dogs that are closely related to GSDs, such as Shiloh Shepherds, but any breed (or mixed breed) can get EPI.  This page provides links to information on EPI and summarizes some of the key points we found in the sites we researched.  It's intended to help you successfully manage you dog's EPI.  It's also intended to provide a broad overview and basic understanding, and then point you to some resources that can help in greater depth.  Although we have researched the information carefully, we cannot attest to its accuracy. Please consult with your veterinarian for medical information.

EPI is sometimes also referred to as PAA (Pancreatic Acinar Atrophy), Pancreatic Hypoplasia, Malabsorption, or Malassimilation.  There is no cure, although for unknown reasons a very tiny percentage of dogs diagnosed with EPI return to normal after a number of months.  Some EPI dogs stabilize fairly quickly and are relatively easy to maintain; others have a very difficult road filled with constant challenges.  Set-backs can and do occur.   However, with proper care, many EPI dogs live long, full, and normal lives.

bullet Costs for managing EPI can be greatly reduced if you turn to the right resources. 
bullet Preparing food for your EPI dog isn't hard, just different and takes extra effort. 
bullet Many EPI dogs continue to do all the activities they did before, including agility, search & rescue, therapy, hiking, you-name-it!
bullet EPI, in and of itself, does not shorten a dog's lifespan.  The key is successful management.
bullet Other than your vet, your best source for EPI support, advice, and information is the K9-EPIGLOBAL Yahoo Group.  Membership is required (no cost), and a pre-condition is that your dog has received a positive diagnosis of EPI.  According to comments we've seen on quite a few different websites, it has been instrumental in vastly improving, and sometimes even saving the lives of EPI dogs.  Receiving a diagnosis of EPI can feel overwhelming and daunting. This group helps you deal with the many and varied challenges. 

SIBO & B12 Deficiency:  EPI's Nasty Companions

bullet SIBO (Small Intestinal Bacterial Overgrowth)
It's been said that 70% of dogs with EPI also develop a condition called "SIBO."
bullet Has some of the same symptoms as EPI
bullet Occurs when undigested food sits in the small intestine and is attacked by "bad" anaerobic bacteria 
bullet Some bad bacteria are always present, but are normally held in check by the "good" bacteria
bullet Since bad bacteria thrive on undigested food (especially starch, sugars, and grains), this causes an explosion in their growth
bullet Can result in permanent digestive problems and food allergies if not treated timely
bullet Results in nutrient malabsorption because the bad bacteria...
bullet Compete for calories and nutrients
bullet Produce toxins
bullet Damage small intestine's absorptive surfaces (mucosa)
bullet Cause symptoms in your dog that lead to...
bullet Reduced food intake (due to reduced appetite)
bullet Altered food intake (which can change the nutrient balance)
bullet Reduced immunity
bullet Also sometimes referred to as "Antibiotic-Responsive Diarrhea" (ARD)

 

bullet B12 Deficiency
It's been reported that about 50% of dogs with EPI lose the ability to process vitamin B12.
bullet B12 is necessary for many things
bullet Essential for digestion
bullet Deficiencies can lead to impaired cognitive function due to neurological complications
bullet An EPI dog that's deficient in B12 will have difficulty gaining weight, even when on enzymes
bullet An EPI dog is considered at high risk for B12 deficiency (if not immediately, then eventually)
bullet EPI dogs need mid to upper range levels of B12
bullet If a stabilized EPI dog is producing "good poop" but starts losing weight, ask your vet to test for B12 immediately  new
bullet Biggest long-term survival risk for EPI dogs is caused by untreated B12 deficiencies
 

This information is not intended to replace advice or guidance from veterinarians or other pet care professionals.  It is simply being shared as an aid to assist you with your own research on this very serious condition.

To support critical research on EPI in dogs, please contact Dr. Leigh Anne Clark of Clemson University.

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Symptoms

Typical symptoms often include some (but not necessarily all) of the following, according to the links below.  Unfortunately, even good veterinarians may not be very familiar with EPI because they don't see it often, so it's especially important that owners recognize the symptoms.   The sooner EPI is diagnosed, the better chance your dog has of avoiding serious side-effects and living a full and normal life.  It's recommended that any dog (especially a shepherd) that has chronic diarrhea and weight loss have a cTLI test.  If your dog has several of these symptoms (particularly some of the top five listed below), please strongly consider getting a cTLI test as soon as possible.

bullet "Cowpie" stools
bullet This is one of the most common symptoms of EPI & may be the first sign the owner sees 
bullet Often they are yellow, orange, gray, or pale-colored 
bullet Diarrhea that won't go away
bullet "Cow-patty" seems to be most common form
bullet See photo (scroll to pg 26)
bullet Sometimes appearance is compared to pudding or soft-serve ice cream
bullet Watery or very loose diarrhea also occurs with some frequency
bullet Often this version is due to SIBO
bullet Diarrhea doesn't go away, no matter what you or your vet try
bullet Many, many EPI dogs were initially assumed to have Giardia or some other condition
bullet Can be a symptom of EPI, SIBO, and/or B12 deficiency
bullet Rapid weight loss
bullet Normally occurs since the dog is literally starving to death
bullet If your dog has long hair or thick fur, this might not be immediately obvious in the beginning
bullet It's not unusual for a 100 lb dog to lose 1/2 lb a day
bullet SIBO can also cause some weight loss
bullet B12 deficiency will also cause weight loss
bullet Ravenous appetite (polyphagia)
bullet Usually occurs since the dog is starving
bullet Some dogs may lose their appetite instead
bullet Loss of appetite is associated with SIBO and/or B12 deficiency (both often accompany EPI)
bullet Ironically, SIBO can instead cause increased appetite in some dogs
bullet Voluminous & frequent stools which may have a fluffy, pulpy, putty-like, or watery appearance
bullet Much greater quantity of stools than normal and may occur several times a day.
bullet Food is passing through your dog's body without being used
bullet Often 3 or more bowel movements per day
bullet Texture is not compact.
bullet Surfaces lack the "wrinkled" appearance of normal dog stool
bullet Gas (burping, flatulence, etc.)
bullet Often seen with EPI (before enzyme treatment begins)
bullet Very common early symptom of SIBO
bullet Higher risk of Bloat due to gas
bullet Greasy or oily-looking stools and/or particularly foul-smelling stools
bullet Caused by inability to to digest fats (steatorrhea)
bullet May appear to have a transparent sheath covering
bullet May cause some staining of fur
bullet Can be symptom of both EPI and SIBO
bullet Dry, dull, or brittle coat
bullet Possibly excessive shedding too
bullet Gurgling and loud digestive sounds in the tummy (borborygmus)
bullet Typical early symptom of SIBO, which often accompanies EPI 
bullet Abdominal discomfort
bullet Symptom of SIBO which often accompanies EPI
bullet Vomiting, regurgitation, throwing up, or wet burps
bullet Symptom of SIBO so often seen in dogs with EPI
bullet May be mostly liquid (often brown)
bullet Eating stools / feces (coprophagia)
bullet Quite a few EPI dogs do this. Many stop once they begin enzyme supplementation. 
bullet Lots of dogs that never develop EPI do this too.
bullet May accompany SIBO due to malabsorption.
bullet Eating non-food items (pica)
bullet Some EPI dogs will eat sticks, stones, paper, dirt, their toys, etc.
bullet Pica can also be a sign of SIBO
bullet Temperament changes showing fear and/or aggression
bullet Some EPI dogs understandably become temporarily aggressive because they're starving to death.  This no doubt makes them feel afraid and desperate.
bullet B12 deficiencies can affect cognitive functions
bullet SIBO creates on-going abdominal discomfort which may aggravate behavior issues
bullet Failure to gain weight or failure to thrive, malaise (even when on enzymes)
bullet Symptom of B12 deficiency, which often accompanies EPI 
bullet Could also be a symptom of SIBO, particularly if SIBO has been long-term and damaged the gut
bullet Elevated "ALT" and/or decreased cholesterol in a typical blood test
bullet A typical blood test CANNOT diagnose EPI; however, some dogs have elevated ALT and/or decreased cholesterol prior to their EPI diagnosis.
bullet ALT stands for "Alanine Aminotransferase" (sometimes called SGPT).  Elevated ALT can indicate liver issues.
bullet May also have decreased serum tocophereol (vitamin E) and and decreased serum vitamin A
bullet May have prolonged bleeding times due to malabsorption of fat-soluble vitamin K
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Causes

EPI

Both genetic and environmental factors are believed to probably cause EPI.

bullet It's believed that EPI probably has a genetic origin, as well as environmental.
bullet Researchers strongly believe EPI has a genetic component, but the exact mode of inheritance is not known.
bullet Prior research suggested that EPI was inherited in an "autosomal recessive" manner (i.e., both parents had to be carriers for a dog to get EPI); however, it's no longer believed that both parents must be carriers in this manner.
bullet Latest research by Dr Leigh Anne Clark and her Research Associate, Dr Kate Tsai of Clemson University yielded exciting new findings to help understand the causes of EPI.   New
bullet The study found that autoimmune reactions which can destroy digestion-related parts of the pancreas play a key role.    New
bullet These autoimmune reactions were found to have a relationship to a certain chromosome and a particular gene.   New
bullet The "alleles" associated with this particular gene appear to be significant.    New
bullet Dogs that had one particular allele associated with this gene had an increased EPI risk.   New
bullet Dogs that other alleles associated with this gene appeared to have more protection from EPI.  New
bullet Summary of Dr. Clark's project:   New
bullet  Dog Leukocyte Antigen 88 Typing in German Shepherd Dogs Having Pancreatic Insufficiency   New
bullet The best way to ensure EPI is not passed on to future generations is through careful breeding.
bullet Don't breed dogs diagnosed with EPI.
bullet Don't repeat matings that produced any EPI pups. The sire and/or dam of any EPI puppy is almost certainly a carrier.
bullet Dogs with parents, siblings, or other close relatives who have produced an EPI puppy may be carriers themselves.
Illness
bullet Certain illnesses, such as chronic pancreatitis, can lead to EPI.
bullet Although pancreatic tumors (such as insulinoma) are not common, pancreatic surgery related to a tumor can lead to EPI symptoms.  New
bullet Results of a cTLI test may or may not be normal.
bullet Support for insulinoma is available at the InsulinomaDog Yahoo Group.
bullet When EPI occurs in senior or geriatric dogs, it's generally believed that there's probably some underlying medical condition.


B12 Deficiency

bullet Intrinsic Factor.  A dog's ability to absorb B12 requires something called "intrinsic factor."
bullet A dog's pancreas produces intrinsic factor, thus the increased likelihood of B12 deficiency in EPI dogs.
bullet Intrinsic factor binds to and protects B12 from being destroyed during digestion.
bullet Your dog may be consuming plenty of B12, but it can't process what it consumes because its pancreas is no longer producing adequate intrinsic factor. 
bullet SIBO.  SIBO's bad bacteria use B12, which can cause B12 deficiencies.
bullet H2-receptor blockers.  B12 deficiencies can also be caused by chronic use of H2-receptor blockers (e.g., cimetidine, ranitidine, famotidine) because an acidic environment is needed to absorb B12.


SIBO

bullet Could be due to a variety of different reasons, such as...
bullet Malabsorption / malnutrition due to inadequate digestive enzymes (e.g., EPI), or other reasons
bullet Can leave undigested food ("substrate") in small intestine on which bad bacteria thrive
bullet Decreased output of pancreatic antimicrobial factors caused by EPI
bullet Can lead to overrun in bad bacteria
bullet Decreased mucosal immunity and damage to intestinal mucosa
bullet Inadequate intestinal motility (movement of food through the gastrointestinal (GI) tract)
bullet Obstructions
bullet Inadequate acids due to acid-suppressing medications or other causes
bullet Anatomical problems due to surgery, disease, or other causes
bullet Immune deficiencies (such as Immunoglobulin A (IgA))
bullet Certain breeds, such as German Shepherds, may be more prone.
bullet Other
bullet Believed to be caused by colonic bacteria invading small intestine
bullet Contributing Factors
bullet Starches and sugars (including grains), since SIBO bacteria thrive on these
bullet Antibiotics, since these kill off friendly bacteria
bullet Stress
bullet German Shepherds and dogs closely related to GSDs may be more predisposed
bullet Some reports also mention Chinese Shar Peis

 

 

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Diagnosis

If you think your dog may have EPI,  ask your veterinarian for two blood tests: cTLI & Cobalamin/Folate. 

bullet These are not routine blood tests, so you need to ask for them by name.
bullet Ideally the blood for both tests should be drawn at the same time so you won't lose valuable time beginning treatment.
bullet Getting both tests at once is strongly recommended by Texas A&M University (TAMU)
bullet If your vet submits the samples directly to TAMU for analysis rather than going through an intermediary lab:
bullet  TAMU will consult directly with your vet about the meaning of the test results and possible management approaches
bullet You'll receive the test results faster

 

bullet cTLI Test
bullet Purpose.  Tests dogs for EPI
bullet Dog must be fasted for a minimum of 12 hours before the blood is drawn
bullet Be sure your vet draws enough blood or this will be a problem.  (See requirements)
bullet Taking enzymes won't affect test results, so if your dog is already on enzymes, no need to stop them prior to testing
bullet Results:
bullet Normal range for cTLI:  5.7 - 45.2 µg/L
bullet Values below 2.5 µg/L are diagnostic for EPI
bullet Values between 3.5 and 5.7 µg/L are rarely if ever associated with signs of EPI
bullet May reflect subclinical pancreatic problems
bullet Could eventually lead to EPI
bullet For results in this range, TAMU recommends retesting after one month (See guidance)
bullet cTLI stands for "Canine Trypsin-Like Immunoreactivity"
bullet Measures the amount of trypsinogen and trypsin in the blood (normally released by the pancreas in healthy dogs)
bullet If your dog wasn't fasted for a minimum of 12 hours, the cTLI score may be higher than it should be.

 

bullet Cobalamin/Folate Test
bullet Purpose.  Tests for vitamin B12 (cobalamin) deficiency and SIBO
bullet Dog must be fasted for a minimum of 12 hours before the blood is drawn
bullet Be sure your vet draws enough blood or this will be a problem.  (See requirements.)
bullet Results:
bullet Normal range for Cobalamin (B12):  252 - 908 ng/L
bullet Low values.
bullet Indicate B12 deficiency
bullet Often associated with SIBO (bacteria bind to B12)
bullet Could be temporary (e.g., caused by SIBO and/or on-going diarrhea)
bullet May be permanent since the pancreas is involved in the processing of B12
bullet Normal values.  If your dog has been diagnosed with EPI but is within normal cobalamin (B12) ranges, you should retest periodically since B12 takes a fairly long time to deplete. 
bullet B12 is critical to the body, so you don't want to take chances with this.
bullet It's not unusual for EPI dogs with normal B12 values to become deficient months, or even years later; so periodic testing is strongly advised.
bullet High values.  No known significance.  (See TAMU)
bullet Normal range for Folate (tests for SIBO):  7.7 - 24.4 µg/L
bullet High values.  Suggest SIBO, because bad bacteria produce folate.
bullet If the bad bacteria have migrated up from the colon to the "proximal" part of the small intestine (which is where the body absorbs folate), test results will be "high."
bullet Note:  The proximal small intestine is in closest proximity to the stomach.
bullet Normal values.  SIBO often exists even when test results are within normal range, so pay close attention to your dog's symptoms (TAMU, WSU, WSAVA, AVMA, CVJ)
bullet If the bad bacteria are in the "distal" part of the small intestine (which can't absorb folate), test results will be "normal" because the folate produced by the bad bacteria is simply excreted in feces.
bullet Note:  The distal small intestine is more distant from the stomach (it's is closer to the colon).
bullet Low values.  Not indicative of SIBO; however, may indicate other problems (e.g., disease affecting the
proximal small intestine since that's where folate is absorbed).
bullet Reading results together can be particularly helpful
bullet Cobalamin and folate
bullet Cobalamin, folate, and cTLI

 

bullet Tests That Don't Diagnose
bullet  Regular blood tests do not diagnose EPI, SIBO, or B12 deficiencies
bullet Complete Blood Count (CBC) results are often normal in EPI dogs.
bullet Some EPI dogs may have elevated ALT and/or decreased cholesterol levels, but this doesn't diagnose EPI.
bullet Even blood protein levels (for example, albumin "ALB") are surprisingly well maintained in EPI dogs.
bullet Regular blood tests can be useful in ruling out other medical conditions.
bullet Colonic or fecal cultures can't diagnose SIBO because they don't necessarily reflect what's happening in the small intestine.
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Management

Exocrine Pancreatic Insufficiency (EPI)  ::  Cobalamin (B12) Deficiency  ::  Small Intestinal Bacterial Overgrowth (SIBO)

 

Managing Exocrine Pancreatic Insufficiency (EPI)
Enzymes   ::   Diet

Success in managing EPI is primarily judged by if your dog produces normal stools.  What is "normal" can vary from dog to dog, but for most dogs it means the consistency is firm (not hard), the appearance is wrinkled (not smooth), and the color is some shade of brown.  Regaining lost weight is also highly desirable.  Eliminating or reducing other symptoms usually will happen if these two things occur.  Many sources say that one in five dogs doesn't respond to the enzymes; however, our research suggests that's just not true.  It seems that most EPI dogs respond well to the enzymes as long as EPI is properly managed, plus any B12 deficiency and SIBO (if a B12 deficiency and/or SIBO exist) are also properly managed.  If there are other health problems, obviously the chance for complications increases.  This website gives only a general overview on how to manage EPI.  Since every dog is different, you can learn what has worked for others and get advice for particular stumbling blocks you encounter on K9-EPIGLOBAL or EPI4DOGS.

bullet Enzymes
bullet Absolutely necessary to manage EPI
bullet Necessary, because your dog's pancreas can no longer produce enzymes needed for digestion
bullet Will enable your dog to regain health
bullet Must be given for the rest of your dog's life whenever your dog is fed
bullet Enzyme types....  
bullet Porcine powder Porcine (pig) pancreatic enzyme powder is the main method used manage EPI.
bullet Commercially available and easy to use
bullet Many brands available (e.g., Viokase-V, Pancreatin 6X, Bio Case V, etc.)
bullet Most dogs do equally well on any brand
bullet Normal Strength Enzymes.  Amounts of the three digestive enzymes (Lipase, Protease, Amylase) are approximately the same in many brands
bullet Lipase digests fat
bullet Protease digests protein
bullet Amylase digests starch
bullet Some brands (e.g., Viokase-V), typically require a vet's prescription; however, not all brands require a prescription.
bullet Special Strength Enzymes.  Some enzymes are available in special strengths (e.g., Pancreatin 4X and 8X). 
bullet Pancreatin 4X, often available in health food stores or drug stores, is relatively weak.
bullet Pancreatin 8X is stronger than the standard Pancreatin 6X but can be more practical for dogs needing higher doses.
bullet Enzyme Diane is a great source for high-quality enzyme powder at very affordable prices. 
bullet She sells samples of different strengths so you can determine what works best for you.
bullet As the "mom" of an EPI dog herself, she understands the need for reasonably-priced enzymes and participates in several EPI discussion forums.
bullet We recommend wearing a surgical-type mask (available at hardware stores or medical supply stores) when working with powdered enzymes, particularly for those with asthma or other respiratory concerns.
bullet Porcine pills.  Powdered enzymes are generally considered to be much more effective than pills.
bullet A few dogs refuse to eat food mixed with dissolved powdered enzymes so must take pills instead
bullet Fresh pancreas.  Fresh beef or pig pancreas can be excellent; however, availability may be difficult
bullet Plant-based enzymes. These are considered least effective for managing EPI.
bullet Some plant-based enzymes, for example ProZyme, may be beneficial as a supplement to add later on (see "Food" discussion below). 
bullet If your dog is allergic to meat (particularly pork), plant-based enzymes may be necessary.
bullet We do not endorse any particular brand, and every dog is different so what works well for one may not work for another.  Owners of several EPI dogs that cannot tolerate porcine enzymes have reported some success with the plant-based enzyme product, Total-Zymes.
bullet Plant-based enzymes are available without prescription from many pet-product dealers.
bullet Enzyme Preparation....
bullet MethodMix enzymes well with warm water and room-temperature food
bullet Ensure enzymes are thoroughly dissolved so they...
bullet Are activated by the warm water
bullet Completely blend with the food particles
bullet Don't cause ulceration and bleeding of the dog's mouth and throat
bullet Add enough warm water so mixture has consistency of mush, oatmeal, or even thick soup
bullet Exact amount of water isn't important
bullet Remember, digestion takes place in the bowl, not in your dog
bullet What the enzymes can't touch, won't be digested
bullet Undigested food doesn't benefit your dog and may contribute to SIBO
bullet Quantity.  It's generally recommended to start with 1 tsp enzyme powder to one cup of food.  (1 tsp refers to normal-strength enzymes; not 4X or 8X special-strengths.)
bullet After 3-5 days, if your dog's stools are still soft, you'll need to adjust the amount up or down slightly until you find the right dosage. 
bullet If you need to adjust the enzyme dosage, it's generally recommended to adjust the enzyme quantity by 1/8 tsp at a time, and then try that dosage for 3-5 days.
bullet Finding the right enzyme-to-food ratio for your dog is trial-and-error.
bullet Each dog is different, so there's no formula.
bullet Food with higher percentage of moisture than kibble (e.g., raw and canned) needs less enzymes per cup.
bullet If you grind kibble, the 1 tsp/1 cup ratio is based on whole kibble, so adjust accordingly.
bullet Weighing 1 whole cup of kibble, and then using the same weight of ground kibble works well.
bullet Take careful notes so you'll know what works and what doesn't.
bullet Some sources say large dogs need more enzymes, but this seems variable.
bullet Once your dog is stabilized, it's often possible to slowly reduce the amount of enzymes.
bullet With time, you may need to adjust enzyme quantity again, for example...
bullet If you change what you're feeding your dog
bullet If your dog's cTLI number continues to decrease
bullet Temperature.  Enzymes are activated by moisture and by warmth.
bullet Mix enzymes with warm water and food, then let the mixture soak ("preincubate") at room temperature for an adequate amount of time.
bullet Don't add enzymes to cold food.
bullet Preincubating anywhere from 86 -130 degrees F (30--55 degrees C) should be fine.
bullet Ideally the mixture will be similar to your dog's body temperature.
bullet After the food/enzyme/water mixture has adequately preincubated, it's fine to store it in the fridge until mealtime.
bullet Cold slows enzymes down significantly, but doesn't stop or destroy them.
bullet To serve, you may want to consider warming the food first.
bullet Many do this by soaking the bowl of food in another bowl of very warm water.
bullet Caution:  Excessive heat (e.g., boiling water or cooking/baking/microwaving) destroys enzymes that are still active.
bullet Time.  Let the food/enzyme mixture soak a minimum of 30 minutes.
bullet Soaking longer works better for many dogs. One-hour soaks work well for many.
bullet Soaking gives the enzymes time to "digest" the food, because your dog can't.
bullet Inadequately soaked enzymes can cause painful sores or bleeding in your dog's mouth and throat.
bullet Inadequately soaked enzymes are still caustic
bullet May cause your dog to avoid food due to pain
bullet Enzyme Storage....  
bullet Enzymes must be stored in a cool, dry location in a sealed container (such as Tupperware) or they won't work.
bullet Moisture activates the enzymes so it's absolutely essential to keep them moisture-free.
bullet Storing enzymes in an air-tight container is critical.  (If air can seep in, so can moisture.)
bullet If you store in the fridge or freezer, watch for condensation as that can destroy enzymes.
bullet Excessive heat destroys the enzymes, so pick a cool location.

 

bullet Diet
bullet Food basics....
bullet Start simple.  Just food and enzymes. 
bullet Pick a food with a single protein source
bullet Don't mix raw, cooked, canned, and kibble.  Pick just one.
bullet Measure food exactly (by cup or by weight)
bullet No treats whatsoever.  It's hard to do, but truly necessary.
bullet Guidelines.  Pick a food that's:
bullet Less than 12% Fat
bullet Less than 4% fiber. 
bullet Fiber inhibits the activity of pancreatic enzymes
bullet Grain-free (e.g., no wheat, rice, oats, etc.). 
bullet Few EPI dogs tolerate grains well.
bullet Kibble.  If you're feeding kibble, switch to one that meets the guidelines above (for example, Natural Balance grain-free Limited Ingredient Diets).
bullet It's safest to start with a food that's within the guidelines since that works for almost all EPI dogs.
bullet Later you may be able to change to a food that's outside the recommended guidelines.
bullet Raw.  If you feed raw, you'll need to alter the bone content to accommodate EPI needs.
bullet Advantages.  Some dogs are unable to fully stabilize until they switch to raw feeding.
bullet Raw food has its own enzymes which can aid digestion.
bullet Raw diets may require fewer added enzymes than kibble diets.
bullet If you've never fed raw before, you may want to start with a pre-made raw (for example, Nature's Variety).
bullet A number of EPI dogs have reported excellent results with this, even when nothing else has worked well (but see "Bone Content" paragraph below regarding 50/50 adjustments to make).
bullet Some sources say a raw diet is preferable for many EPI dogs, but many EPI dogs are fed kibble and do just fine on it.
bullet Bone Content.  Feeding raw to an EPI dog is different than standard raw diets.
bullet EPI dogs can only tolerate about half the bone content as regular raw diets.
bullet If you feed raw (including pre-made raw), mix it 50/50 with de-boned meat such as ground turkey.
bullet Grinding.  Grind kibble or raw food in a food processor, blender, or grinder.
bullet Grind before mixing food with enzymes and warm water
bullet Ensures all parts of food are exposed to the enzymes
bullet Can pre-soak kibble in water until it's soggy instead of grinding (so enzymes can reach all parts)
bullet Note:  If your kibble gets entirely soft and mushy (no hard parts) after incubating, there is no need to grind or pre-mush.
bullet Food that doesn't come in direct contact with enzymes probably won't be digested and may contribute to SIBO.
bullet Prepared, pre-ground raw (such as Nature's Variety) usually doesn't require additional grinding.
bullet Frequency.   Feed smaller meals more often, especially in the beginning.
bullet Easier on your dog's digestive system
bullet Start with 3-4 meals daily
bullet Once your dog's target weight is reached, you can probably go to two meals daily.
bullet Later on....  
Once your dog is stabilized on a food-to-enzyme ratio and is producing good stools regularly, you may experiment by slowly adding one supplement at a time, then waiting 4-7 days, to learn what your dog can tolerate and what helps your dog. 
bullet The "3-S" Change System:  Slow-Small-Single
bullet Make changes very slowly
bullet Make changes in small increments. 
bullet Make just a single change at a time.
bullet because....
bullet Avoids upsetting your dog's already-sensitive GI system.
bullet Reduces likelihood of gas, which could put your dog at increased risk of bloat.
bullet Allows you to truly understand the effect of each change.
bullet Allows time for your dog to adjust to the change before you assess its impact.
bullet Allows you to immediately discontinue anything that creates obvious problems for your dog, without giving your dog a large dose of it.
bullet Probiotic.  A probiotic supplement will help bring back and maintain the friendly bacteria in your dog's digestive system.
bullet Start slowly using only a small fraction of the recommended dose initially, then increase gradually.
bullet Friendly gut bacteria are essential for long-term success.
bullet They limit harmful bacteria
bullet They enhance immunity
bullet Consider starting with lactobacilli and/or bifidobacteria (particularly lactobacillus acidophilus)
bullet Especially critical if you're dog has had antibiotics
bullet Antibiotics destroy both good and bad bacteria
bullet Yogurt may not be the best choice
bullet It's a weak probiotic at best, and many dogs have difficulty digesting it.
bullet The forms of bacteria generally used in yogurt don't naturally occur in the GI tract of dogs
bullet Each dog is different, so we don't  recommend any particular brand.  Brands which owners have reported worked well for their EPI dogs include Allerdophilus, NOW Acidophilus & Bifidus, and Primal Defense.
bullet Some probiotics (such as Allerdophilus) may be taken with food; others (such as Primal Defense) are best taken on an empty stomach.  A few (such as Intestinal Care DF) must be refrigerated.  Check labels for details.
bullet Prebiotic.  A prebiotic supplement promotes friendly bacteria and helps them thrive
bullet Decreases bad bacteria
bullet Improves mucosal and gastrointestinal health
bullet Some examples of prebiotics are beet pulp, FOS (fructo-oligosaccharides), inulin, and arabinogalactans (AG)
bullet Fish oils.  Consider adding to meals (easily digested; very beneficial)
bullet Start with a tiny amount and increase very slowly
bullet Cod liver oil, particularly in winter (has Vitamin D)
bullet Dogs make Vitamin D in their fur when sunlight hits it, so they have less Vitamin D in winter.
bullet Omega 3 Wild Salmon oil is fine the rest of the year
bullet Coconut Oil.  Consider adding to meals a small amount of coconut oil, which is a Medium-Chain Triglyceride (MCT)
bullet More easily absorbed by the body than other fats
bullet Can be particularly useful in pancreatic insufficiency situations
bullet May provide other health benefits, including antimicrobial (contains both lauric and capryilic acid)
bullet Has been reported to help fight yeast
bullet Start with a extremely tiny amount and work up to 1 tsp daily (or less frequently)
bullet May cause gas for some dogs
bullet Available from health food stores (get it in glass jars)
bullet Vitamins.  Some dogs may benefit by the addition of vitamins.  Some vitamins which have been mentioned as particularly beneficial to EPI dogs are listed below.  (Each dog is different, so these may not be advisable for all, and/or others may be desirable.)
bullet Vitamin B12.  See discussion below.
bullet Vitamin E
bullet Zinc.  EPI has been associated with a high risk for zinc deficiency.
bullet One study of human EPI patients showed that only a small daily dose (15 mg or less) was needed.
bullet Zinc helps fight infection and enhance immunity
bullet Diiarrhea and malabsorption can cause zinc deficiencies.
bullet Zinc deficiency can result in  loss of appetite.
bullet Vitamin K deficiency is rare
bullet Plant-based enzymes.  Consider adding a plant-based enzyme supplement (e.g., Prozyme, Total-Zymes, etc.), since they may enhance health and put weight on your dog
bullet Increasing Fat.  You may wish to experiment slowly with other foods, including one that has a slightly higher fat content
bullet EPI dogs, once stabilized, can often manage a higher amount of fat
bullet Can be beneficial for EPI dogs (but probably not those with SIBO)
bullet Mixing raw.  You may wish to experiment with mixing a small amount of raw meat (not more than 20%) with kibble
bullet Treats.  If you want to try treats...
bullet Some EPI dogs can manage a small amount of carefully selected treats.  Unfortunately, many EPI dogs cannot.
bullet Dogs on raw diets seem to have better luck working in occasional, small treats
bullet Experiment very, very carefully with tiny low-fat meat treats, for example...
bullet Dehydrated liver bits
bullet Dehydrated "cookies" made from enzyme-treated/preincubated ground kibble
bullet Meat that has been ground and preincubated with enzymes
bullet Many have had success in substituting non-food rewards
bullet Playtime, toys, car rides, walks - - the ideas for rewards are endless....
bullet Incubating supplements.
bullet Some supplements should be incubated, because they require digestion
bullet Example:  Kelp, fish oils, coconut oils
bullet Some supplements should not be incubated, or they will be destroyed
bullet Example:  Probiotics (such as acidophilus)
bullet For some supplements, it doesn't seem to matter
bullet Example:  L-Glutamine
bullet Whether or not a supplement should be incubated can be confusing.  A general rule of thumb is that if it's a food-like substance which likely contains carbohydrates, fats, or proteins, it should be incubated.  Some supplements may contain fillers or extra ingredients that require incubation, so read labels closely.   Good advice on this topic is available from the K9-EPIGLOBAL Yahoo Group.
bullet Bottom line:  Each EPI dog is different.  What works well for one may not work at all for another.
bullet Make changes slowly.
bullet You can't judge by the first couple days, since there may be an adjustment period.
bullet Don't make a new change until you know what results your last change is consistently producing.
bullet Remember that food transit time through a dog varies, but normally takes at least a day, so when you're on "poop patrol," what you see probably reflects what your dog ate a day or two earlier.
bullet Make changes one at a time.
bullet Keep notes.  That way you can refer back to the details of what worked and what didn't.

 

Managing Cobalamin (B12) Deficiency

If your EPI dog has been diagnosed with a B12 deficiency, you'll need to restore the B12 in order for your dog to regain health.  A recent study showed that not properly treating a B12 deficiency results in a poor prognosis for the dog.

bullet B12 Protocol.  An initial series of B12 subcutaneous injections is necessary.
bullet B12 is a water-soluble vitamin and any excess is readily disposed by the body, so B12 injections should be seriously considered for any dog testing below the normal range.
bullet Retest a month after the last B12 injection to determine if the B12 problem has been resolved or if regular injections should continue.
bullet This is often referred to as the "TAMU (Texas A&M University) B12 Protocol."
bullet Home Injections.  B12 subcutaneous shots can usually be given at home by the dog's owner after being taught how, even by owners with no medical training. 
bullet B12 injection materials can be purchased relatively inexpensively.
bullet Please consult with your veterinarian for guidance.
bullet What to avoid.  Please note that TAMU does not recommend the use of injectable multi-vitamin or B-complex formulations because they:
bullet Have much lower amounts of B12
bullet Often cause pain at the injection site
bullet Oral Supplements.
bullet Oral B12 supplements are ineffective for correcting a B12 deficiency.
bullet Exception:   "Intrinsic factor" supplementation
bullet We know of only two B12 supplements that also include intrinsic factor, and they have worked well for a number of EPI dogs with B12 deficiencies when given daily.
bullet The products are Metagenics Intrinsi B12/Folate TM and and Wonder Laboratories TRINFAC-B TM.  They are commercially available from several internet vitamin companies, as well as from health care practitioners.  Updated
bullet Dogs using these supplements should be tested periodically to ensure their B12 levels are adequate.
bullet For more information, please visit K9-EPIGLOBAL Yahoo Group.
bullet Important Cautions:  If your dog has a B12 deficiency, it's essential to consult with your veterinarian.
bullet Do not switch from subcutaneous injections to supplements without closely working with your vet. 
bullet Virtually all dogs with B12 deficiencies must get the "B12 Protocol" series of subcutaneous injections, even if you decide to try intrinsic factor supplementation later.
bullet Serious B12 deficiencies can be fatal if not properly managed.

 

Managing Small Intestinal Bacterial Overgrowth (SIBO)

If your dog has been diagnosed with SIBO (or if you and your vet determine your dog probably has SIBO based on observation of symptoms), you'll need to beat this nasty, insidious disease for your dog to recover.

Eliminating SIBO:    Reestablishing a healthy environment in the gut is the ideal long-range solution.

bullet Remove SIBO bacteria using tylosin, metronidazole, or other prescribed antibiotic, as recommended by your vet.
bullet 6-week treatment with Tylan (tylosin) and/or Flagyl (metronidazole) antibiotics is usually recommended.
bullet Shorter treatments may be not be enough for stronger bacteria.
bullet Recommended dosages for both tylosin and metronidazole are normally weight-based. (pgs 205-206 of link)
bullet If SIBO is present, your dog should show some response to the antibiotics within a week.
bullet If your dog has a bacteria that doesn't respond to tylosin or metronidazole, another antibiotic (perhaps amoxicillin or oxytetracycline) may be needed.
bullet Owners often report best success when probiotics are used along with antibiotics.
bullet Give 4 hours apart from the antibiotic so they won't be destroyed
bullet Increase probiotics when antibiotics are decreased or discontinued
bullet Tylosin.  Has both antibiotic and anti-inflammatory properties and is often recommended.
bullet Described as the "antibiotic agent of choice" for treating SIBO.
bullet Tylan powder dosage should be based on the dog's weight, as prescribed by your veterinarian (pg 205 of link)
bullet For example...
bullet An owner of a 30-lb dog reported success using 1/8 tsp twice daily for at least 6 weeks
bullet An owner of a 60-lb dog reported success using 1/4 tsp twice daily for at least 6 weeks
bullet An owner of a 90-lb dog reported success using 3/8 tsp twice daily for at least 6 weeks
bullet An owner of a 120-lb dog reported success using 1/2 tsp twice daily for at least 6 weeks
bullet It's very important to check with your veterinarian on all medicine doses and before giving any medication, as your dog's circumstances my vary from others. 
bullet We highly recommend your vet be made aware of  the dosage recommendations in Dr. Steiner's book, Small Animal Gastroenterology, since he and TAMU are world-renowned experts in this area. (pg 205 of link)
bullet Recent studies suggest tylosin is only bactericidal at appropriate weight-based doses (pg 205 of link)
bullet Extremely bitter, so many owners put the powder in gel or veggie caps (available from health food stores)
bullet Some dogs may need to continue with daily tylosin if symptoms won't resolve after the initial treatment.
bullet Owners often report best success with increasing probiotics and adding prebiotics.
bullet SIBO may recur from time-to-time, in which case many owners turn again to Tylan.
bullet May return if your dog eats something it shouldn't.
bullet A very few dogs must remain on small doses of tylosin permanently.
bullet Doses are normally reduced slowly so long-term maintenance is at  the lowest dose possible.
bullet Giving probiotics regularly should decrease the amount of tylosin needed.
bullet Tylan is available on the web or may be purchased through your vet.
bullet MetronidazoleHas both antibiotic and anti-inflammatory properties.
bullet Has been reported to occasionally have side-effects, including neurological.
bullet Side effects aren't generally associated with short courses of treatment.
bullet Signs may begin 7-12 days following the start of treatment, but could start at any time.
bullet Must be obtained by prescription from your vet.
bullet Consult with your veterinarian for guidance.
bullet Repair any damage to the gut and its mucosa that SIBO has caused.
bullet Can lead to allergies (especially protein allergies) and other, more serious problems
bullet Associated with "Leaky Gut Syndrome"
bullet L-Glutamine can be very beneficial
bullet Preserves intestinal barrier function
bullet Increases "brush border" enzyme activity
bullet Promotes protein synthesis
bullet Aids recovery from intestinal injury
bullet Helps the body resist bad bacteria, stimulates the immune system, and generally helps GI functions
bullet Consider including a prebiotic such a FOS (fructo-oligosaccharides), which stimulates Short Chain Fatty Acids (SCFAs) that help heal the intestine's mucosa.
bullet This has proved to be a key factor in helping some EPI dogs overcome SIBO and keep it from returning.
bullet Other supplements which may be beneficial:
bullet N-Acetyl-Glucosamine (NAG).
bullet Mix with food prior to incubation before feeding to an EPI dog.
bullet Note:  Contains shellfish so should be avoided by dogs with such allergies.
bullet Deglycyrrhizinated Licorice (DGL)
bullet Powder from the capsule should be mixed with food prior to incubation before feeding to an EPI dog.
bullet Note:  In DGL, licorice extract has been specially de-glycyrrhizinated to avoid side effects.
bullet See  K9-EPIGLOBAL Yahoo Group for details on repair techniques that have helped others.
bullet Replace inadequate digestive enzymes with the right amount of digestive enzymes.
bullet Prevents undigested food ("substrate") in the gut which feeds the bad bacteria
bullet See discussion on enzymes above.
bullet Reinoculate the gut with friendly bacteria from probiotics (e.g., acidophilus).
bullet Consider starting with one that includes lactobacilli and/or bifidobacteria.
bullet Lactobacillus is particularly beneficial to the small intestine.
bullet Start at a low dose and increase slowly so you won't upset your dog's gut.
bullet Can help counteract negative effects of stress on the gut.
bullet Consider a dairy-free version
bullet SIBO can harm the intestinal lining which produces the lactase needed to digest dairy products, so a dairy-free probiotic may be a wise choice.
bullet Yogurt is not a good choice (see reasons above)
bullet Start giving probiotics while giving antibiotics, so you can build up the friendly bacteria.
bullet Give probiotics at least two hours (preferably four hours) away from antibiotics or they'll be destroyed.
bullet Discolored "poop" (especially yellow, orange, or green) is often a sign that friendly bacteria are lacking.
bullet Continue probiotics indefinitely to help prevent recurrence of SIBO.
bullet Consider including a prebiotic (such as FOS) since these stimulate the growth of friendly bacteria.
bullet Provide Nutritional SupportConsidered essential to long-term management of SIBO.
bullet Feed a highly digestible diet while fighting SIBO
bullet Reduces undigested food left in the small intestine so bad bacteria can't feed on it
bullet Undigested food causes gas, tummy rumblings, and/or diarrhea
bullet Often due to malabsorbed carbohydrates or proteins
bullet Reducing carbohydrates (especially fiber) and trying a different protein source may be helpful
bullet "Hypoallergenic" diets are often recommended
bullet Feed a grain-free diet low in starch and sugars
bullet SIBO bacteria thrive on these
bullet Grains convert to sugars in the digestive tract
bullet Feed a low-fat diet while fighting SIBO
bullet Increased fat metabolism can result in inflammation of the GI tract and promote diarrhea
bullet Avoid dairy products
bullet Most dogs don't do well on dairy products
bullet SIBO can damage the gut's "brush border membrane" which produces lactase (necessary to digest dairy)
bullet If dairy can't be digested, the bad bacteria feed on it
bullet Include a small amount of fish oils (e.g., wild salmon oil and/or cod liver oil)
bullet Contributes to membrane health and has an anti-inflammatory effect
bullet SIBO may result in...
bullet Deficiencies in certain fat-soluble vitamins (A, D, E)
bullet Vitamin K deficiency is rare in SIBO
bullet B-12 deficiencies (since bad bacteria use it)
bullet Greater intolerances to carbohydrates (if gut's "brush border enzyme activity" is reduced by SIBO)
bullet Undigested carbohydrates become food for bad bacteria.
bullet Dietary elimination trials may be needed if allergies are contributing to gut problems.
bullet Common dog-food proteins such as chicken can be culprits.
bullet Various supplements such as L-Glutamine may be very helpful (see K9-EPIGLOBAL Yahoo Group for details).

 

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Breeds At Greatest Risk

It's estimated that over 50% (and possibly as many as 75%) of EPI cases occur in the following breeds:

bullet German Shepherds
bullet Shiloh Shepherds
bullet German Shepherd mixes

Some sources have reported higher-than-expected rates in the following breeds also:

bullet Rough-Coated Collies
bullet Terrier breeds
bullet Cavalier King Charles Spaniels
bullet Chow Chows
bullet English Setters

The rest of the cases occur in all the other breeds.  No breed is immune.  In fact, EPI is now being reported in breeds where it has never been seen previously as well as in non-Shepherd mixed breeds.

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Links

A word of caution:   There's a lot of contradictory and incorrect information published on EPI (including in some of the links below).   If your dog is diagnosed with EPI, your best source for information (other than your vet) is the K9-EPIGLOBAL Yahoo Group, which has been helping EPI dogs for many years.  Many websites speak highly of its tremendous value to participants and say it has a wealth of information (none of which is referenced or reproduced here).  We have no vested interest in promoting membership to that group.  We simply make that recommendation because we believe it to be true.  A new site, EPI * Exocrine Pancreatic Insufficiency:  Managing EPI (EPI4Dogs) is also very helpful.

bullet Canine Serum Trypsin-Like Immunoreactivity  (TLI) - Texas A&M University (TAMU)
Complete information and details on the cTLI Test
bullet Cobalamin:  Diagnostic use and therapeutic considerations - Texas A&M University (TAMU)
B12 deficiency, therapy, doses, and recommendations
bullet Texas A&M University (TAMU) Requirements for Sample Submissions
Very important information to know before having blood drawn for the cTLI Test and the Cobalamin/Folate Test
bullet Exocrine Pancreatic Insufficiency
Merck Veterinary Manual description
bullet Exocrine Pancreatic Insufficiency
World Small Animal Veterinary Association article with good overview of EPI.
bullet Exocrine Pacreatic Insufficiency
Overview with pictures.
bullet EPI Overview - Q&A
Simple, clear, concise overview.
bullet Exocrine Pancreatic Insufficiency
Explanation, with emphasis on relationship to SIBO
bullet Feeding Tips (Managing EPI)
Excellent and detailed description of how to feed an EPI dog
bullet Effects of diet on clinical signs of EPI in dogs
Interesting study demonstrating scientifically that each EPI dog is indeed different
bullet Treatment of EPI
Brief summary of what to do
bullet Digestive Enzyme Supplements for EPI
Top-quality, low-cost enzyme supplements from "Enzyme Diane" for dogs diagnosed with EPI
bullet Dog leukocyte antigen 88 typing Study, Dr Leigh Anne Clark, PhD     New
Summary of American Kennel Club (AKC) Canine Health Foundation Grant to study EPI in 2011
bullet Inheritance of pancreatic acinar atrophy in German Shepherd Dogs
AMVA/TAMU study in 2002 concluding autosomal recessive inheritance is strongly suggested
bullet Linkage analysis and gene expression profile of pancreatic acinar atrophy in the German Shepherd Dog
Study in 2005 by TAMU and others concluding genes are causative for PAA; however, the genes/linkages are not known.
bullet Exocrine Pancreatic Atrophy in German Shepherd Dogs and Rough-coated Collies
Study of low cTLI results preceding onset of clinical EPI
bullet Exocrine Pancreatic Insufficiency:  White Shepherd Genetics Project
Overview of condition and treatment
bullet Canine Exocrine Pancreatic Insufficiency Treated with Porcine Pancreatic Extract
Journal of Veterinary Science article on treating a Maltese dog
bullet Controlling Canine EPI FAQs (Cheetah's site)
Helpful FAQs with especially helpful information on using raw pancreas
bullet Pancreatic Atrophy   
Shows surgical photos of a healthy pancreas and an atrophied pancreas.
bullet Serum lipase activities and pancreatic lipase immunoreactivity concentrations in dogs with EPI
AMVA/TAMU study
bullet TLI, folate, and cobalamin (B12)  tests:  what they mean  New
Good explanation of the tests.  Includes drawings to help explain how functions work.
bullet SIBO and EPI
Good discussion of how SIBO and EPI are related
bullet Bacterial Overgrowth in Dogs-More Common Than You Think
Excellent article by a recognized expert explaining SIBO
bullet Impact of SIBO on Nutritional Status
Clear and well-written article that's quite enlightening and thought-provoking
bullet Small Intestinal Bacterial Overgrowth (SIBO)
Very comprehensive point paper with clear explanations
bullet Small Intestinal Bacterial Overgrowth:  Chronic Diseases of the Small Intestine
Interesting discussion on SIBO and relation to IgA deficiency
bullet What is Small Intestinal Bacterial Overgrowth?
Description of SIBO
bullet Malabsorption and Bacterial Overgrowth
Overview of SIBO with comparisons to EPI
bullet Effect of treatment on bacterial flora of dogs with EPI
Interesting study showing prevalence of SIBO in dogs with EPI, and effectiveness of Tylosin as a treatment
bullet Bacterial Overgrowth
Good summary of possible causes.  Mentions predisposition in GSDs.
bullet Bacterial Overgrowth Syndrome    New
Interesting overview with helpful details.
bullet Bacterial Enteropathogens in Dogs
Scientific paper which includes a discussion of SIBO
bullet Comparison of Tests of SIBO and ARD in Dogs
Questions if SIBO and ARD are the same thing
bullet IBD and Food Allergies:  over-rated or under-diagnosed?
Very interesting British Veterinary Association (BVA) slide presentation which includes discussion of SIBO and ARD
bullet Holistic Approaches to Inflammatory Bowel Disease
Holistic approaches to fighting bad bacteria in the gut (Remove, Repair, Replace, Reinoculate)
bullet The Canine Gastrointestinal Tract:  Small Intestine
Excellent description of small intestine, including how digestion works and related problems, such as SIBO.
bullet Textbook of Small Animal Gastroenterology, by Jörg M. Steiner (ed.)
In our opinion, the very best information available on EPI, SIBO, and B12 deficiencies (e.g., see page 205 for SIBO).
bullet Textbook of Small Animal Medicine, by John K. Dunn
Small Intestinal Disease chapter, section on SIBO, pg 425.
bullet Diseases of the Small Intestine Causing Vomiting or Diarrhea
Overview, with helpful chart on interpreting B12 and Folate test results
bullet Chronic Diarrhea
Very informative article by Dr. Jörg Steiner that includes discussion of EPI, SIBO, and B12 deficiency
bullet Diarrhea
Description of possible causes
bullet Stool Colors - - What they signify   New
Excellent explanation of what yellow, orange, green, grey, and brown stools mean
bullet Vomiting
Addresses vomiting in dogs and cats
bullet The Vomiting Dog - Diagnosis
Describes how to develop a plan to determine why a dog is vomiting
bullet Biochemical Changes in the Mucosa of Dogs with EPI
Interesting discussion of EPI can affect intestinal mucosa.  (Note: An older study, so watch for newer data.)
bullet Examples of diagnosing gastro-intestinal problems
Interesting examples of the diagnostic process for 2 example cases (small bowel diarrhea & hypoalbuminemia)
bullet Ugly Bugs - - Balancing the Gut Flora for Health
Describes the importance of probiotics in companion animals. Explains how SIBO can thrive when friendly gut flora are lacking.
bullet Effect of the Macrolide Antibacterial Drug, Tylosin
Describes benefits of tylosin in a study on rats
bullet Serum Vitamin B12 and Folate Assays
Interpretations of Cobalamin/Folate Test result meanings (from book Veterinary Hematology and Clinical Chemistry)
bullet Vitamin B12 Dietary Supplement Fact Sheet   
Detailed information about what B12 is, sources of B12, and why it's necessary.
bullet Folate and B12 deficiencies
Discusses the scientific relationship between B12 and folate
bullet Role of Pancreas in the Absorption and Malabsorption of Cobalamin (Vitamin B12) in Dogs  New
Study by Roger Batt and others regarding B12's relationship to EPI in dogs
bullet Hemantinics:  B12 and Folic Acid
Explains important role of B12 and folic acid in animals
bullet Giving Subcutaneous Fluids to a Dog
Please consult with your vet first! This WSU site has instructions with photos that can help serve as a reminder of your vet's directions.
bullet Effects of Medium-Chain Triglycerides on well-being of dogs with EPI
AMVA/TAMU study
bullet Absorption of medium and long chain triglycerides: factors influencing their hydrolysis and transport
Study by Harvard University showing MCTs can be particularly useful in pancreatic insufficiency
bullet Medium-Chain Triglycerides:  Monograph
Overview of MCTs from a scientific perspective
bullet Responses of dogs to dietary Omega-3 fatty acids
AMVA/TAMU study on benefits of omega-3 fatty acids from fish oil and other marine sources
bullet Oral ulceration and bleeding associated with pancreatic enzyme supplementation
Study showing preincubating enzymes longer than 20 minutes can help prevent ulceration and bleeding
bullet Enzymes
Scientific explanation of how enzymes work
bullet Associations between dietary factors and pancreatitis in dogs
AMVA/TAMU study.  Addresses factors other than diet also.
bullet Pancreatitis In Dogs And Cats
An easy-to-understand explanation of this condition
bullet Serum TLI in Cats and Dogs
Technical report by Dr. David A. Williams describing this test
bullet Understanding Lab Test Results
Easy-to-understand explanations of how to read your pet's lab test results
bullet Gastrointestinal Function Tests in Dogs and Cats
Good explanation of how to interpret test results
bullet The Role of Fibre in Pet Foods
Explains how fiber inhibits activity of pancreatic enzymes for pets
bullet Chronic Intestinal Inflammation and Intestinal Disease in Dogs
Discusses SIBO, including the the role of prebiotics and probiotics.
bullet Canine Inflammatory Bowel Disease (IBD)  New
Explains that IBD is chronic and to diagnose a condition as IBD, bacterial infections first must be ruled out.
bullet Sketches of pancreas and digestive system in dogs New
Clearly labeled drawings which show details of the canine digestive tract.
bullet Funding & Resources for EPI Dogs (F.R.E.D.)
Help for EPI dogs who are in need
bullet EPI Research Fund
Your donations, no matter how small, will be greatly appreciated.
bullet For the Love of Dogs:  EPI Research Fund-Raising Wines
Whether you're buying for yourself or as a gift, this is a gift that gives twice.  (It's a good wine, too!)
bullet Travelling Trails, Tales and Tails of EPI Wine
Fun blog with great photos showing places where "For the Love of Dogs" wine (for EPI Research) has been seen
bullet EPI in German Shepherd Dogs
TAMU research on EPI in GSDs and the challenges EPI dogs face
bullet Transmission Genetics of PAA in the GSD & Development of DNA-based tools
By Dr Leigh Anne Clark, Texas A&M University
bullet EPI Research at Texas A&M University (TAMU)
Brief summary of EPI research by TAMU

 

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