Reviewing EPI in Cats

diarrhea in cats, EPI in cats

Yes, it can happen
The following is an excerpts from a real answer from the pet parent of a 12-13 yr DSH cat that was been diagnosed as a diabetic 3 years ago. Her diabetes is well-regulated, but she has loose and very pungent stools. Hyperthyroidism was ruled out, and the below is a portion of the discussion about Exocine Pancreatic Insufficiency (EPI), which her vet suspected but had yet to be diagnosed.

Exocrine pancreatic insufficiency (EPI) is a disorder in which the pancreas does not produce an adequate amount of digestive enzymes. This deficiency results in maldigestion (poor digestion) and malabsorption (poor absorption). EPI is rare in cats, but it does exist.

Clinical signs include weight loss, ravenous appetite, poor haircoat, and very thin body condition.

The most common cause of EPI in a cat is chronic pancreatitis. Many cats with EPI also have concurrent IBD.

Testing is by running a serum TLI. This is the only accurate test, and there isn’t a point in spending your money on the others. The TLI test is a simple and reliable way of confirming the diagnosis of EPI; however; it is essential to use an assay specific for feline TLI since there is no cross reactivity between canine and feline TLI. Performing the test to rule it in or out of course is best. You may want to ask your vet how much it costs, as it may not be more expensive than the enzymes your vet is using, depending on the brand.

Most cats with EPI can be successfully treated by dietary supplementation with pancreatic enzymes. Dried extracts of bovine or porcine pancreas are available (e.g. Viokase or Pancrezyme). The powder is more effective than tablets or capsules.

chronic diarrhea in cats, online vet reviews

Exocrine Pancreatic Insufficiency

Even though pancreatic enzyme supplementation causes the clinical signs to subside in almost all patients, it has been shown in human beings and dogs with EPI that nutrient absorption, and particularly fat absorption are not normalized by enzyme supplementation.  This is thought to be due to the acidity of the stomach leading to irreversible damage of the pancreatic lipase contained in the supplement.  If fat absorption is a problem, your vet can give you some acid blockers that are relatively cheap.

Diet is also important.  The literature suggests that a diet low in insoluble or non-fermentable fiber should be fed.  Response to enzyme supplementation alone may not be satisfactory in some feline patients with EPI.  Cats with EPI are often best managed on a hypoallergenic intestinal type diet as there is a high incidence of concurrent inflammatory bowel disease.

Some cats do not respond to enzyme supplementation and cobalamin application. These patients likely have concurrent small intestinal disease. In cats with EPI, inflammatory bowel disease can occur concurrently.

I do want to mention two other things that could be going on: cancer in the bowel and a blockage. I do think it is less likely (especially the blockage), but I do want to tell you all the options I consider are relevant. Many older cats are affected by intestinal neoplasia, often lymphoma or pancreatic cancer to name a couple, but given how long this has been going on, I put it lower on my differential list. I do have to put it out there, as is possible unfortunately.

It takes approximately two weeks for the enzymes to start helping. It is important to make sure she is eating them as many cats reportedly “hate” the taste of the powder and may be more easily dosed using solid dosage forms (enteric-coated tablets or compounded capsules made from powder or crushed tablets). Some cats will also eat food mixed with one brand of veterinary power, and refuse another.

It is not an easy diagnosis to arrive at, especially since it is so rare in cats and at the back of the mind of vets.  The good news is that can usually be well-controlled.

Best regards,

Dr. Laci

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