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  • Author or Editor: Maria E. Wiberg x
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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 immunosuppressive drugs.

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)

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in Journal of the American Veterinary Medical Association


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.

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in Journal of the American Veterinary Medical Association


To study response to long-term enzyme replacement treatment in dogs with exocrine pancreatic insufficiency (EPI).


Cross-sectional study.


76 German Shepherd Dogs or rough-coated Collies with EPI and 145 clinically normal dogs of the same breeds.


Questionnaires were sent to owners of dogs with EPI and owners of clinically normal dogs. Dogs with EPI had been given dietary enzyme supplements for at least 4 months. Relative frequency distributions of gastrointestinal tract and dermatologic signs, prevalences of typical signs of EPI (eg, weight loss, ravenous appetite, yellow and pulpy feces, high fecal volume), feeding regimens, and dietary intolerances were compared between dogs with EPI and clinically normal dogs.


Gastrointestinal tract signs considered typical for dogs with EPI were almost completely controlled with dietary enzyme supplements in half of the dogs with EPI, and their general health was similar to that of clinically normal dogs. A poor treatment response was found in a fifth of dogs with EPI that had several signs that were typical of EPI. Signs most often persisting were high fecal volume, yellow and pulpy feces, and flatulence. Dermatologic problems were common, especially in German Shepherd Dogs with EPI. Treatment response was irrespective of breed. Nonenteric-coated enzyme supplements, powdered enzyme, and raw chopped pancreas were equally effective in controlling clinical signs. Although dietary sensitivities were common, use of adjunctive dietary treatment was minimal. Antibiotics were occasionally administered to half of the dogs with EPI.

Clinical Implications

Results of this study indicate that, with basically similar treatment regimens, response to long-term enzyme treatment in dogs with EPI varied considerably. (J Am Vet Med Assoc 1998;213:86-90)

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in Journal of the American Veterinary Medical Association


The main objective of the study reported here was to determine whether signs typical of exocrine pancreatic insufficiency (epi) are alleviated when affected dogs are fed a diet with low fat content, compared with feeding ordinary commercial dog food or food prepared by the owner. The most cost-effective amount of enzyme supplement also was estimated. The study consisted of 6 test periods. Duration of the first and third periods was 4 weeks, and that of the others was 2 weeks. During the first 2 periods, the dogs were fed their original diet. The amount of enzyme supplement was reduced by half between the first and the second period. During the last 4 periods, the dogs were fed only the low-fat diet, and amount of the enzyme supplement was reduced stepwise. During the entire study, owners were asked to assess daily the severity of 9 signs typical of epi. A new index was established by adding the daily scores of each individual epi sign. This index was designated the epi index and was used as a measure of the general well-being of the dog. When the mean epi indexes of the original diet periods were compared with those of the corresponding low-fat diet periods, there were no statistically significant differences by use of Tukey's test or the paired t-test. There was considerable variability between dogs, however. The fat content of the original diet did not correlate with the difference in epi signs when the dogs were fed the low-fat diet. According to our study, feeding a low-fat diet to dogs with epi did not significantly alleviate clinical signs of the disease.

Decreasing the enzyme supplementation by 50% of the recommended dose did not significantly increase severity of the cumulative epi score. Decreasing the enzyme supplement by three-fourths of the recommended dose was excessive, and the severity of the clinical signs increased significantly (P < 0.05). The cost of the low-fat diet, compared with that of the original diet, was high.

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in American Journal of Veterinary Research