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What Is Exocrine Pancreatic Insufficiency?

Proper digestion of food and its nutrients requires the systematic breakdown of ingested food to microscopic molecules that are easier for the body to absorb. The exocrine function of the pancreas plays a vital role in this process by secreting enzymes that assist in the deterioration of large food molecules. A condition known as Exocrine Pancreatic Insufficiency (EPI) results when the pancreas’ exocrine function fails, leading to numerous health problems when the body does not receive the nutrients it needs.

  1. Pancreatic Exocrine Function

    • Ingestion of food initiates the exocrine functions of the pancreas. Exocrine acinar cells secrete digestive enzymes that begin to break food down into smaller particles, making them easier to digest and absorb when they reach the small intestine. These enzymes include pancreatic proteases, amylases, lipases and nucleases that digest proteins, carbohydrates, lipids (fats) and nucleic acids, respectively. Damaged acinar cells lead to a deficiency or absence of these enzymes, causing food to remain in macromolecule form. The loss of digestive enzymes leads to malabsorption of necessary nutrients.

    EPI in Humans

    • The main causes of EPI in humans include cystic fibrosis, pancreatic cancer, trauma to the pancreas and chronic pancreatitis. Acinar cells have a significant functional reserve, as enzyme secretions remain sufficient until about 90 percent of acinar cells are damaged. This phenomenon means that an individual can have EPI for years before displaying any indications of the disease.

    EPI in Dogs and Cats

    • EPI most commonly occurs in dogs and cats, though much more often in dogs. The deterioration of acinar cells, a condition called acinar cell atrophy, causes EPI in dogs, while chronic pancreatitis is usually the cause in cats. Like humans, dogs and cats can have EPI for years before showing clinical symptoms. Certain breeds of dogs, including German Shepherds, develop EPI more often than other breeds because of a genetic predisposition to the disease.

    Signs and Symptoms

    • Humans and animals exhibit similar signs and symptoms of EPI. These include polyphagia (compulsive hunger) and diarrhea. In animals, vomiting may occur as well. Stools are often loose, frequent and contain an excess amount of fat, a condition called steatorrhea. Maldigestion and malabsorption of food also leads to weight loss and vitamin deficiencies, which can lead to a number of other conditions as the body does not have the proper nutrients to carry out necessary processes.

    Treatment

    • Pancreatic enzyme supplements make up the most common EPI treatment for both humans and animals. Usually given in powder form to animals and pill form to humans, the supplements contain extracted pancreatic proteases, amylases, lipases and nucleases. In humans, the supplemental amylases and proteases effectively digest carbohydrates and proteins, respectively; however, the lipases do not break down fats as efficiently, and malabsorption of fat still occurs. The reason for this phenomenon is currently being researched. For animals, a second, though rarer, treatment involves feeding dogs and cats about one to three ounces of fresh, raw bovine pancreas, in which enzymatic activity lasts for months when stored properly.

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