Treatment of EPI and Pancreatitis in Dogs and Cats
发布时间：2023-09-18
Exocrine pancreatic insufficiency (EPI for short) is a digestive disorder. The pancreas is an organ in the body that has both exocrine and endocrine functions. When the pancreas does not secrete enough digestive enzymes (lipase, amylase, and protease) to support the body's normal digestive functions, it is unable to digest food and absorb nutrients, ultimately causing the dog or cat to starve to death. This is a wasting disease and the main pathological process leading to EPI is irreversible, incurable and dependent on exogenous pancreatic enzyme supplementation over time.
The most common cause of EPI in adult dogs is chronic atrophy of the pancreatic alveoli. Occurring primarily in dogs, EPI can occur in any breed, with German Shepherds, Collies, and English Setters being the breeds with a high incidence of pancreatic atrophy and EPI. Miniature Schnauzers are prone to chronic pancreatitis secondary to EPI. however, data from 2012 shows that German Shepherds are the high prevalent breed at about 50%, EPI in German Shepherds is a hereditary process known as atrophic lymphocytic pancreatitis, which can also eventually lead to chronic alveolar atrophy. Pancreatic hypoplasia and chronic pancreatitis may be rare causes of EPI in dogs, and are similar in cats.
Serum TLI is the most sensitive and specific test for EPI in dogs and cats when diagnosing EPI. The sensitivity and specificity of TLI in diagnosing EPI cases is almost 100%.
Dogs: less than 2.5ug/L
(Reference range 5~35ug/L)
Cat: Less than 8~10ug/L
(Reference range 17～49ug/L)
For diagnosis of EPI, animals should be fasted for more than 12h before the measurement of serum TLI concentration in order to avoid the "grey zone" value. The "grey zone" of TLI in dogs ranges from 2 to 5ug/L, and in cats, the "grey zone" of TLI ranges from 10 to 17ug/L.
Develops strong cravings for food and even starts eating his own poop or anything he can get his hands on;
Poop that is not formed and looks greasy, yellow or grey;
Pooping more often than before;
The presence of vomiting and diarrhoea;
A change in temperament, easily agitated;
Persistent thinning for which no cause can be found;
Note: Some dogs do not have any of these symptoms.
Treatment of exocrine pancreatic insufficiency can be supplemented with fresh pancreas from farm animals, fresh pancreas can be frozen and preserved but must be eaten raw, cooked pancreas has no therapeutic effect as the digestive enzymes within the pancreas have been completely inactivated. In addition to supplementing fresh animal pancreas you can also add enzymes (amylase, lipase, protease) to the affected dog's food to increase the digestion and absorption of nutrients.
However, ordinary enzyme preparations will have some shortcomings in the process of use:
①Digestive enzymes in direct contact with the mouth are likely to cause mucosal damage and oral bleeding;
② After the acidic environment of the stomach, the loss of activity of the components in the digestive enzymes is serious;
③ There are large differences in the ability of pancreatic enzymes from different animal sources to decompose things, so they mes according to the composition of the food in order to produce a good pro-digestive effect.
Enteric-coated encapsulated pancreatic enzymes are needed to help tolerate stomach acid and ensure effective action.
In addition to enzyme supplements or fresh animal pancreas, vitamin B12 and folic acid need to be supplemented regularly:
In the extracellular fluid, B12 transport depends on three carriers: binding to corin (or R protein or transcobalamin I), intragastric factor and transcobalamin (or transcobalamin II). These proteins are homologous; each is associated with a vitamin B12 molecule.
In the acidic environment of the stomach, dietary B12 is released and combined with bound colchicine (HC, Kd ~ 0.01 pM), which protects B12 from degradation. In the duodenum, HC is digested by trypsin, releasing vitamin B12.
Therefore, in dogs and cats with pancreatic dysfunction that do not secrete trypsin normally, vitamin B12 ingested by the normal route is not successfully absorbed in the small intestine. This is where the role of WeNzyme comes into play. Enteric-coated capsules encapsulating vitamin B12 can reach the small intestine directly, and after the capsules are digested, the vitamin B12 content can be absorbed directly.
EPI-affected dogs need a diet that is easily digested and absorbed, with small, frequent meals. Eggs, cheese and lean meat are preferred as protein sources, while rice and barley are preferred as carbohydrate sources. Dietary fibre should not be too high and should be less than 2% DM. Fat content can be as high as 19% and provide up to 49% of the body's calorie requirements.
Pancreatitis is a disease of the pancreas caused by the auto-digestive action of trypsin. The pancreas is a mixed secretory gland, with two main functions: exocrine and endocrine.
The main component of exocrine secretion is pancreatic fluid, which contains alkaline bicarbonate and various digestive enzymes, and its function is to neutralise gastric acid and digest sugar, protein and fat.
The main components of endocrine secretion are insulin and glucagon, followed by growth hormone release inhibiting hormone, intestinal vasoactive peptide, gastrin and so on. If insulin is deficient, less glucose enters the tissue cells. The decomposition and xenobiosis of hepatic glycogen is enhanced; glucose released into the blood by the liver is greatly increased, and blood glucose level rises and exceeds the renal glucose threshold and is discharged from the urine, manifesting as diabetes mellitus, pancreatitis.
Clinical signs of pancreatitis in dogs are variable and lack specificity, the more common ones include: vomiting, loss of appetite, abdominal pain, depression, dehydration, pain reflexes on palpation of the anterior abdomen, diarrhoea (sometimes haemorrhagic), fever (because of inflammatory reaction), weakness, and even shock, among others.
Pancreatitis can be classified as acute or chronic. More dogs and cats actually develop pancreatitis, but fewer show clinical signs, and most often the lesions are found at post-mortem autopsy. The incidence is higher in dogs than in cats. Acute pancreatitis is characterised by sudden severe abdominal pain, shock and peritonitis.
For acute pancreatitis, fluids and administration of antibiotics are necessary. Fasting should be done in the early stages of the disease because food in the duodenum stimulates the pancreas to produce more pancreatic enzymes, which can exacerbate the inflammation that is already present.
There is debate as to how nutrition is obtained during rescue of dogs with acute pancreatitis. Clinical data show that sick dogs using both infusional and enteral nutrition have a significantly higher survival rate than dogs relying only on infusional nutrition. For enteral nutrition, a jejunostomy tube can be used to inject fluid directly into the jejunum.
Pancreatitis dogs can be supplemented with probiotics, which can improve the intestinal mucosal barrier and inhibit infections. WeNzyme contains Enterococcus faecalis, which is able to adequately stimulate GAIT (gut-associated lymphoid tissue) and provide systemic or localised immunity.
Dogs with pancreatitis are often low in Vitamin B12 and therefore require regular supplementation. WeNzyme also contains Vitamin B12 and Folic Acid (B9), which in enteropathies such as EPI are usually accompanied by a reduction in the absorption of Cobalamin (B12) and Folic Acid (B9), highlighting the importance of supplementing them.
Dogs with pancreatitis can start eating as soon as the vomiting stops, and the food must be a liquid diet that is easily digested and absorbed. Since some amino acids stimulate the release of pancreatic enzymes, affected dogs should not be fed diets that are too high in protein.
Name：Guagua
Age: 1 year 11 months
Breed: Border Collie
Diagnosis: Exocrine pancreatic insufficiency (EPI)
Half a month after the treatment, it can be seen that the dog's faeces can already be shaped and the colour is back to normal, indicating that the various digestive enzymes in the animal's body have been effectively supplemented. Since the pathological process of pancreatic exocrine insufficiency is irreversible, the dog needs to take pancreatic enzyme supplements for a long time, together with a dietary programme.
After half a month of pancreatic enzyme feeding, the dog's appetite returned to normal and the shape and colour of the stools returned to normal.
As there is no cure for EPI, it is necessary for the animal and the owner to take WeNzyme supplements for a long period of time and plan the diet. We hope that the situation will continue to improve.
Thanks to Chengdu Harmonic Beikang Pet Hospital for providing the case.
Main effects: Release of pancreatic enzymes (lipase, amylase, protease), Enterococcus faecalis, Vitamin B12 and folic acid through enteric capsule during digestion to safeguard the effect of pancreatic enzymes. Improves the efficiency of enzyme use, promotes digestion and enhances appetite. Provides perfect pancreatic support for dogs and cats.
Main ingredients: pancreatic enzymes (lipase, amylase, protease); vitamin B12 and folic acid (VB9); Enterococcus faecalis.
Product features: Enteric capsule technology to ensure the effective amount, containing VB12 and VB9, to supplement the state of dogs and cats suffering from EPI, easy to lack of VB12 and VB9, capsule packaging, easy to feed.
Avoiding the direct contact between pancreatic enzymes and the mouth.
Prevent the destruction of enzyme activity by stomach acid.
The capsule is dissolved and absorbed in the small intestine and releases the enzyme, and the digestive enzyme exerts the maximum activity of the enzyme during digestion and absorption in the duodenum.
The Catalogue of Feed Additive Species (2013) specifies Enterococcus faecalis as a strain that can be added to feeds, which can form a biofilm in the animal's intestinal tract that adheres to the mucous membrane of the animal's intestinal tract, and develops, grows and reproduces.
Enterococcus faecalis is able to soften fibres in feed and improve feed conversion.
Enterococcus faecalis produces a wide range of antimicrobial substances, which have a good inhibitory effect on pathogenic bacteria such as Salmonella, Escherichia coli and Staphylococcus aureus. Studies have shown that Enterococcus faecalis is able to produce volvomycin, which can effectively inhibit the growth and reproduction of Listeria monocytogenes and Staphylococcus aureus, as well as spoilage microorganisms.
At the beginning of EPI treatment, it is recommended to increase the feeding amount to 1.5 times of the body's normal needs to help the pet to regain weight quickly, but to eat less and more often, it is recommended to feed 3-4 meals per day, with intervals of 2 hours or more.
After the EPI condition has recovered, gradually reduce to feeding 2 meals per day.
If symptoms such as diarrhoea persist after feeding your pet a fully digestible, medium-fat diet, consider feeding a hydrolysed food and watch for allergies to certain food ingredients.
Quoted from: https://www.petdhw.com/show-9151.html
Dietary modification is an adjunct to EPI treatment and one with a high degree of uncertainty.
Adjusting the fibre in the diet has a more pronounced therapeutic effect on EPI, and it is recommended to choose a low-fibre food (<4%). However, this is not absolute and some pets show more adaptation to foods containing small amounts of cereal fibre. Foods such as grains, vegetables and fruits contain fibre, both soluble and insoluble types of fibre. Soluble fibre slows down digestion and allows nutrients to be absorbed more completely, whereas insoluble fibre shortens the time it takes for food to pass through the digestive system.
Therefore, it is important to try foods with different fibre types and content under the guidance of your vet to find the right type of food for your pet, which will help improve the condition of your pet's loose stools.
Fat intake is not in conflict with the treatment of EPI in pets. EPI pets are generally adapted to foods with a fat content of less than 12%, and an appropriate increase in fat intake is recommended in order to help pets regain weight. However, if the pet suffers from other diseases that require restriction of fat intake, the fat content of the food should be strictly controlled.
For example, for pets with EPI complicated by DM (diabetes mellitus), fat in the diet may greatly increase blood glucose levels, which is very detrimental to the DM condition, so it is important to limit the fat content of the food to ensure that blood glucose levels are normal.
Depending on the specific case, a combination of WeNzyme and Diabecy can be used to control abnormal blood glucose levels due to pancreatic insufficiency.
For diabetes: Diabecy is a supplement for dogs and cats that supports the physiological regulation of blood sugar (glucose in the blood).
It contains an innovative, research-based, imported natural ingredient called "Patented Bioactive Peptide" that inhibits alpha-glucosidase activity and reduces blood sugar fluctuations.
Diabecy
Pet diabetes treatment;
Improves metabolism and insulin sensitivity;
Regulates postprandial blood sugar levels, natural and safe.