Objective—To study progression of autoimmunemediated
atrophic lymphocytic pancreatitis from the
subclinical to the clinical phase (exocrine pancreatic
insufficiency [EPI]) and determine whether progression
of the disease could be halted by treatment with
Design—Randomized controlled trial.
Animals—20 dogs with subclinical EPI.
Procedure—Diagnosis of subclinical EPI was determined
on the basis of repeatedly low serum trypsin like-immunoreactivity
(TLI) in dogs with no signs of EPI.
Laparotomy was performed on 12 dogs with partial acinar
atrophy and atrophic lymphocytic pancreatitis. A
treatment group (7 dogs) received an immunosuppressive
drug (azathioprine) for 9 to 18 months, and a nontreatment
group (13) received no medication.
Results—During the subclinical phase, serum TLI
was repeatedly low (< 5.0 µg/L). Although a few dogs
had nonspecific gastrointestinal tract signs, they did
not need diet supplementation with enzymes. While
receiving immunosuppressive medication, treated
dogs had no clinical signs of EPI, but within 2 to 6
months after treatment was stopped, 2 dogs had
signs of EPI, and diet supplementation with enzymes
was started. Five of the 13 untreated dogs needed
diet supplementation with enzymes within 6 to 46
months. During follow-up of 1 to 6 years, 3 of the 7
treated dogs and 8 of the 13 untreated dogs did not
need continuous diet supplementation with enzymes.
Conclusions and Clinical Relevance—Progression of
atrophic lymphocytic pancreatitis varied widely. The subclinical
phase may last for years and sometimes for life.
The value of early treatment with an immunosuppressive
drug was questionable and, because of the slow
natural progression of the disease, cannot be recommended.
(J Am Vet Med Assoc 2002;220:1183–1187)
Objective—To assess the effects of dietary modification on clinical signs of exocrine pancreatic insufficiency (EPI) in dogs.
Design—Blinded randomized crossover study.
Animals—21 dogs with EPI.
Procedure—Dogs were fed the diet they received at home for 2 weeks. Thereafter, they received 3 special diets (a high-fat diet, a high-fiber diet, and a highly digestible low-residue diet) for 3 weeks each. Owners scored dogs daily for the last 2 weeks of each 3-week period for severity of 6 clinical signs including appetite, defecation frequency, consistency of feces, borborygmus, flatulence, and coprophagia. An EPI index was calculated for each dog by adding the daily scores for each clinical sign.
Results—Significant differences in daily EPI indices among diets were observed in 20 dogs. The original diet appeared to be the most suitable in 8 dogs, whereas the high-fat diet was most suitable in 5 dogs, the high-fiber diet was most suitable in 4 dogs, and the low-residue diet was most suitable in 2 dogs. In 1 dog, the lowest EPI index score was the same during the original diet and the high-fat diet feeding periods. One dog did not complete the feeding period for the high-fiber diet. Differences in mean EPI indices among diets were not significant.
Conclusions and Clinical Relevance—Results indicated that responses to different diets varied among individual dogs. Because responses to the feeding regimens were unpredictable, it is suggested that feeding regimens be individually formulated for dogs with EPI.