EPI in Cats ... Exocrine Pancreatic Insufficiency
Exocrine pancreatic insufficiency (EPI) is the inability of the pancreas to secrete necessary digestive enzymes, Amylase to digest starches, Lipase to digest fats, and Protease & Trypsin to digest protein. When these enzymes are not available to help digest nutrients, nutrients from food cannot be used by the body. The body in essence starts to starve.
EPI traditionally was thought to be rare in cats, however with introduction of the fTLI serum measurement, EPI in cats is now reported much more frequently. The most common cause of EPI in cats is chronic pancreatitis. Lesser possible causes are pancreatic acinar atrophy, aplasia or hypoplasia. However there are other conditions, not true EPI,
that have the same clinical signs and require the same treatment as EPI. Some examples are pancreatic duct obstruction, a pancreatic fluke infestation, damage via abdominal surgery, and lack of intestinal enteropeptidase (needed to activate enzymes).
"The functional reserve of the pancreas is considerable, however true EPI only develops when the exocrine secretory capacity is reduced to less than 10 - 15% of normal of it's function. At this point residual pancreatic function together with extra-pancreatic mechanisms of digestion cannot support adequate nutrient digestion so weight loss, diarrhea, and other clinical signs ensue". (http://vetmed.tamu.edu/gilab/service/assays/tli)
Possible EPI Signs
- Gradual wasting away
- Semi-loose yellow/gray/tan stinky feces
- Watery diarrhea
- Poor hair-coat
- Decreased appetite
- Increased appetite
Cats with EPI often have concurrent conditions such as IBD, Diabetes, Pancreatitis, or Hepatic Lipidosis.
A trypsin-like immunoreativity (fTLI) blood test www.cvm.tamu.edu/gilab/assays/TLI.shtml
shows the cat’s ability to produce the needed digestive enzymes. Values equal to or below 8.0 are diagnostic for EPI in a cat. Values between 8.0 and 12.0 may or may not be EPI and it is then suggested to retest in a month/+. A cat must be food-fasted at least 12 hours prior to the blood test. The fTLI test costs approximately $125+. It is cost efficient to run the B12 (Cobalamin) blood test at the same time as the fTLI test.
Vets may call the TAMU GI lab: 1-979-862-2861 for an EPI consultation.
Treatment of EPI may be regulated after some trial and error in finding the right balance of Enzymes, Diet, B12, and Antibiotics (if needed for SID previously known as SIBO). Powdered porcine enzymes (most reliable), or raw pancreas may be used with every
meal. Some will do well on tablets if crushed into a powder. Enzymes are usually required for life measured per volume of food and the individual cat’s needs. Food with enzymes should be served at room temperature. Heat temperatures 130/+ degrees Farehnheit will destroy the enzymes. Cold inhibits enzymes activity. With the powdered enzymes (add enough liquid to moisten) incubation for 20 minutes is not required, but it helps avoid possible mouth sores and some EPI patients fare better with incubation. Some enzyme products are: Pancrezyme, Viokase, or for a cost savings there are generic USA Pancreatin 6x or 8x at Enzyme Diane http://www.enzymediane.com/ .
Almost all cats with EPI have decreased vitamin B12 levels. TAMU suggest subcutaneous injection of 250µg cyanocobalamin (B12) serum per injection depending on weight, weekly for 6 weeks, 1 dose after 30 days, retest 30 days after last dose. When the B12 regimen is completed an the re-tested B12 levels are in normal range B12 injections should be continued on a maintenance basis, starting with monthly injections, increase frequency if needed.
Malabsorption of fat-soluble vitamins (A,D,E,& K) may occur. Fat soluble vitamin dosing should be determined by a vet to avoid over-dosing. If coagulopathy happens, it should be treated by a vet with vitamin K. Because of it’s antioxidant function monitored vitamin E supplementation may be helpful with cats that do not respond to enzymes and supportive management or with EPI cats that are dealing with other concurrent conditions.
It was previously thought that cats did not get SID (small intestinal dysbiosis) but that theory is rapidly changing. SID is now considered as a possibility and is being treat with success in cats. Currently Tylan is the preferred drug of choice for SID. Standard dosage is typically 2.5 to 5mg per pound but should be determined by the vet depending on individual cases. Tylan is given twice daily.
Dietary changes are usually beneficial, high digestibility is essential. Fat restriction is not advisable (unless required by a concurrent health condition) as cats need relatively high doses of fat. Fats also promotes better digestibility with the enzymes and aides poor body conditions. Carbohydrates should be kept to a minimum. Some will fare better on low fiber foods, others may benefit from limited amounts of fermentable fiber.
The best diet and percentage of fats and carbs used will depend on the individual cat. commercial kibble, canned, raw, home-prepared or hydrolyzed/prescription diets may be used. If there are concurrent health conditions, consideration should be given to the other health concern first.To ascertain what works best for your EPI cat, start keeping an EPI Log. Record everything given, brand name, amount, dosing technique, etc. After initial implementation of the EPI protocol, if things are not progressing accordingly, make changes 1 at a time, wait 3-5 days to determine if results are positive or not before implementing the next trial change.
Working with enzymes