Exocrine Pancreatic Insufficiency - contd.
The main treatment for exocrine pancreatic insufficiency is the administration of enzyme replacements that are given with each meal. If the diagnosis of EPI is correct, and if sufficient enzyme supplement is provided, diarrhea will begin to resolve in a few days, followed by gradual weight gain in most dogs. It is very important to establish the diagnosis of EPI before starting pancreatic enzyme replacement therapy. Enzyme replacement can be expensive, and usually must be given for the rest of the patient's life. Some animals with diarrhea and a provisional diagnosis of EPI are treated with pancreatic enzyme replacements even when the diagnosis of EPI has not been confirmed. These animals may have resolution of their diarrhea for reasons other than enzyme replacement. If their response to treatment is incorrectly interpreted as confirming the existence of pancreatic insufficiency, they may be kept on an expensive and potentially unnecessary treatment for a long time.
Once an appropriate dose is found that controls the symptoms, the enzyme dose can be reduced until the lowest dose that maintains control is identified. The powder form of enzymes is generally more effective than tablets, although the latter are easier to administer.
Some animals do not respond appropriately to enzyme replacement alone. These patients may benefit from medications that augment enzyme replacement therapy. Certain drugs that block H-2 receptors in the stomach may increase enzyme replacement effectiveness by preventing breakdown of the enzymes in the stomach.
Some dogs seem to do better when they are fed a low fat, low fiber, highly digestible diet, but most dogs do not need specific dietary treatment for EPI. Oral vitamin E supplementation or intramuscular injections of vitamin B-12 may be administered to restore serum concentrations of these substances in dogs with EPI. Although such deficiencies have been documented in EPI, it is not known if they are significant. Rarely, dogs with these vitamin deficiencies that do not respond to enzyme replacement alone will do better when these deficiencies are corrected. Antibiotics may be helpful in some dogs if excessive bacterial growth in the intestines has occurred.
Although cats are treated less often for EPI, similar dietary and vitamin supplementation may be appropriately attempted in certain cats.
