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Exocrine Pancreatic Insufficiency, EPI (Underactive Pancreas) in Dogs

Occurrence: rarer
Location of illness: Abdomen/pelvis

Author: Dr. med. vet. Gisa Löwe | Last modified: 06.11.2025

Exocrine Pancreatic InsufficiencyInsufficiency refers to the inadequate function or performance of an organ or system. This can include, for example, heart failure, kidney failure, or venous insufficiency. (EPI) is a condition in dogs where the pancreasThe pancreas is an organ that produces digestive enzymes and hormones, including insulin. It plays an important role in digestion and blood sugar regulation. does not produce enough digestive enzymesEnzymes are biological catalysts that accelerate specific chemical reactions in the body without being consumed. They play a crucial role in virtually all physiological processes., leading to inadequate digestion and absorptionAbsorption refers to the uptake of substances by living cells or tissues. In the context of veterinary medicine, it often refers to the absorption of nutrients, drugs, or toxins from the digestive tract into the bloodstream. of nutrients.

The most important facts at a glance

Exocrine Pancreatic Insufficiency (EPI) is a condition in dogs where the pancreas does not produce enough digestive enzymes, which impairs the digestion of food. The most common cause is pancreatic atrophyAtrophy is the process of tissue, organ, or muscle reduction or wasting, often resulting from disease, disuse, or malnutrition., a genetic condition that occurs mainly in breeds such as the German Shepherd. Symptoms of EPI include Weight loss, DiarrheaDiarrhea refers to the condition of frequent, watery bowel movements, which can be a sign of infections, digestive disorders, or other health problems., and fatty stools. DiagnosisA diagnosis is the identification of a disease or condition by its symptoms and/or results from diagnostic tests. It is the first step in the management and treatment of patients. is made through clinical symptoms, blood tests such as the TLI test, and stool tests. Treatment consists of the lifelong administration of enzyme replacement preparations and often a special diet to support digestion and avoid deficiencies. Early diagnosisA diagnosis is the identification of a disease or condition by its symptoms and/or results from diagnostic tests. It is the first step in the management and treatment of patients. and treatment are crucial to prevent serious health problems and maintain the dog’s quality of life. Preventive measures include the selectionSelection refers to the process of natural or artificial selection of specific individuals for reproduction, based on desired genetic traits. In breeding, this is applied to promote specific characteristics in dogs and cats. of genetically healthy breeding animals and regular veterinary examinations. Research focuses on genetic and molecular foundations, the improvement of enzyme replacement therapies, and the role of nutrition as well as the intestinalIntestinal refers to the intestine, the part of the digestive tract that extends from the stomach to the anus. Intestinal diseases affect the small and/or large intestine. microbiome. Innovative approaches such as stem cell research potentially offer new treatment options, while more advanced diagnostic methods are being developed to enable earlier and more accurate detection of EPI.

Causes

The pancreasThe pancreas is an organ that produces digestive enzymes and hormones, including insulin. It plays an important role in digestion and blood sugar regulation. has two main functions: the production of insulininsulin is a hormone produced by the pancreas. It regulates blood sugar levels by promoting the entry of glucose into cells. insulin deficiency or impaired insulin action are key features of diabetes mellitus. to regulate blood sugar levels (endocrine function) and the production of digestive enzymesEnzymes are biological catalysts that accelerate specific chemical reactions in the body without being consumed. They play a crucial role in virtually all physiological processes. (exocrine function). In EPI, the exocrine function is impaired because the pancreasThe pancreas is an organ that produces digestive enzymes and hormones, including insulin. It plays an important role in digestion and blood sugar regulation. does not produce enough enzymesEnzymes are biological catalysts that accelerate specific chemical reactions in the body without being consumed. They play a crucial role in virtually all physiological processes. such as amylaseAmylase is an enzyme that plays a role in carbohydrate digestion by breaking down starch and glycogen into simpler sugars. It is mainly produced in the salivary glands and pancreas., lipaseLipase is an enzyme primarily produced by the pancreas and plays a vital role in the digestion of fats in the small intestine. Elevated lipase levels in the blood may indicate pancreatitis., and protease, which are necessary for the digestion of carbohydrates, fats, and proteins.

The most common cause of EPI in dogs is pancreatic atrophyAtrophy is the process of tissue, organ, or muscle reduction or wasting, often resulting from disease, disuse, or malnutrition., a genetic condition that occurs mainly in certain breeds such as the German Shepherd and the Rough-haired Dachshund. This condition leads to a progressiveProgressive describes a condition or disease that worsens over time. This term is often used to characterize the course of an illness that causes increasingly severe symptoms or damage. destructionDestruction means "demolition." In medicine, it refers to the destruction of cells, tissues, organs, or body parts. The growth of malignant Tumors is also usually accompanied by destruction of the surrounding tissue. of the pancreatic cells that produce enzymesEnzymes are biological catalysts that accelerate specific chemical reactions in the body without being consumed. They play a crucial role in virtually all physiological processes.. Another cause can be chronicChronic refers to a condition or disease that is long-lasting or permanent. Chronic diseases often develop slowly and can lead to persistent or recurring health problems over time. pancreatitis, an inflammation of the pancreasThe pancreas is an organ that produces digestive enzymes and hormones, including insulin. It plays an important role in digestion and blood sugar regulation. that leads to damage and scarring of the tissue.

Rarer causes of EPI include pancreatic tumors or a sudden interruption of the blood supply to the pancreasThe pancreas is an organ that produces digestive enzymes and hormones, including insulin. It plays an important role in digestion and blood sugar regulation., which can lead to acuteAcute refers to a condition that occurs suddenly and is usually of short duration. In a medical context, it describes symptoms or illnesses that can quickly become serious and require immediate attention. damage to the organ. Certain surgical procedures or traumaA trauma refers to a physical injury or damage caused by external force. Traumas can range from simple cuts to severe multiple injuries. can also impair the function of the pancreasThe pancreas is an organ that produces digestive enzymes and hormones, including insulin. It plays an important role in digestion and blood sugar regulation..

Symptoms

Very common symptoms:

Common symptoms:

Rare symptoms:

The most common symptoms of EPI in dogs include chronicChronic refers to a condition or disease that is long-lasting or permanent. Chronic diseases often develop slowly and can lead to persistent or recurring health problems over time. DiarrheaDiarrhea refers to the condition of frequent, watery bowel movements, which can be a sign of infections, digestive disorders, or other health problems., voluminous and fatty stools (steatorrheaSteatorrhea refers to the presence of excess fat in the stool, indicating malabsorption or digestive disorders. It can be caused by diseases of the pancreas, intestines, or liver.), Weight loss despite normal or increased appetite, and Flatulence. These symptoms result from inadequate digestion and absorptionAbsorption refers to the uptake of substances by living cells or tissues. In the context of veterinary medicine, it often refers to the absorption of nutrients, drugs, or toxins from the digestive tract into the bloodstream. of nutrients.

Affected dogs often also show signs of malnutrition, such as a dull coat, poor skin condition, and general weakness. In some cases, Vomiting and AbdominalThe term “abdominal” refers to anything that concerns the belly or the abdomen. It is an adjectival expression used to describe the location, symptoms, or conditions that occur in the abdominal area. pain may also occur. Due to poor nutrient absorptionAbsorption refers to the uptake of substances by living cells or tissues. In the context of veterinary medicine, it often refers to the absorption of nutrients, drugs, or toxins from the digestive tract into the bloodstream., dogs with EPI are more susceptible to infections and other health problems.

Diagnosis

The diagnosisA diagnosis is the identification of a disease or condition by its symptoms and/or results from diagnostic tests. It is the first step in the management and treatment of patients. of EPI is based on a combination of clinical symptoms, blood tests, and function tests. The most commonly used test is the SerumSerum is the liquid part of the blood that remains after coagulation. It does not contain blood cells or coagulation factors, but many other proteins, antibody and electrolytes. Serum is used in diagnostics for a variety of blood tests. Trypsin-like Immunoreactivity (TLI) test, which measures the amount of trypsin and trypsinogen in the blood, enzymesEnzymes are biological catalysts that accelerate specific chemical reactions in the body without being consumed. They play a crucial role in virtually all physiological processes. that are produced by the pancreasThe pancreas is an organ that produces digestive enzymes and hormones, including insulin. It plays an important role in digestion and blood sugar regulation.. Low values indicate EPI.

In addition, stool tests can be performed to determine the amount of undigested food components in the stool. An increased fat content in the stool is a typical sign of EPI. In some cases, imaging techniques such as ultrasoundUltrasound refers to sound waves that are above the hearing threshold of the human ear. In medicine, ultrasound is used for diagnostic imaging procedures to visualize internal organs, tissues, and blood flow. or X-rayX-ray is an imaging technique that uses X-rays to create images of the inside of the body. It is often used to diagnose bone fractures, lung diseases, and other conditions. can also be used to detect changes in the pancreas.

Therapy

The treatment of EPI in dogs mainly consists of the lifelong administration of enzyme replacement preparations. These preparations contain pancreatic enzymesEnzymes are biological catalysts that accelerate specific chemical reactions in the body without being consumed. They play a crucial role in virtually all physiological processes. that compensate for the insufficient production of the pancreasThe pancreas is an organ that produces digestive enzymes and hormones, including insulin. It plays an important role in digestion and blood sugar regulation. and support digestion. They are usually given with meals.

A special diet may also be necessary to support digestion and improve nutrient absorptionAbsorption refers to the uptake of substances by living cells or tissues. In the context of veterinary medicine, it often refers to the absorption of nutrients, drugs, or toxins from the digestive tract into the bloodstream.. A highly digestible, low-fat diet is often recommended to relieve symptoms and maximize nutrient absorptionAbsorption refers to the uptake of substances by living cells or tissues. In the context of veterinary medicine, it often refers to the absorption of nutrients, drugs, or toxins from the digestive tract into the bloodstream.. In some cases, vitaminVitamins are organic compounds that are necessary in small amounts for the normal growth, development, and physiological function of the body. Vitamins must mostly be obtained through food, as the body cannot produce them or not in sufficient quantities. and mineral supplements may also be required to correct deficiencies.

In addition to drug therapy and dietary changes, it is important to carry out regular veterinary check-ups to monitor the dog’s health and adjust the treatment if necessary.

Prognosis and follow-up care

With appropriate treatment and care, the prognosisThe prognosis is the prediction of the likely course and outcome of a disease based on the general state of health, the nature of the disease, and the response to treatment. It can provide information on how a disease is expected to develop. for dogs with EPI is generally good. Many dogs respond well to enzyme therapyTherapy refers to the treatment of diseases or disorders with the aim of alleviating symptoms, promoting healing, or improving quality of life. Therapies can be medicinal, surgical, or through other medical interventions. and can lead a relatively normal life. However, it is important to continue treatment consistently and regularly monitor the dog’s health.

If left untreated, however, EPI can lead to serious health problems, including extreme malnutrition and a significant impairment of quality of life. Therefore, early diagnosisA diagnosis is the identification of a disease or condition by its symptoms and/or results from diagnostic tests. It is the first step in the management and treatment of patients. and treatment are crucial.

Prevention

Although there is no sure way to prevent EPI, certain measures can reduce the risk. This includes the selectionSelection refers to the process of natural or artificial selection of specific individuals for reproduction, based on desired genetic traits. In breeding, this is applied to promote specific characteristics in dogs and cats. of genetically healthy breeding animals, especially in breeds that are predisposed to EPI. A balanced diet and regular veterinary examinations can also help to support the health of the pancreasThe pancreas is an organ that produces digestive enzymes and hormones, including insulin. It plays an important role in digestion and blood sugar regulation..

Early detection and treatment of diseases that can lead to EPI, such as chronicChronic refers to a condition or disease that is long-lasting or permanent. Chronic diseases often develop slowly and can lead to persistent or recurring health problems over time. pancreatitis, can also be helpful. At the first sign of digestive problems, it is important to seek the advice of a veterinarian to quickly identify and treat any underlying problems.

Outlook on current research

Exocrine Pancreatic Insufficiency (EPI) is a condition that occurs in dogs when the pancreasThe pancreas is an organ that produces digestive enzymes and hormones, including insulin. It plays an important role in digestion and blood sugar regulation. does not produce enough digestive enzymesEnzymes are biological catalysts that accelerate specific chemical reactions in the body without being consumed. They play a crucial role in virtually all physiological processes.. These enzymesEnzymes are biological catalysts that accelerate specific chemical reactions in the body without being consumed. They play a crucial role in virtually all physiological processes. are necessary to properly digest food in the small intestineThe intestine is the medical term for the gut, including the small intestine (intestinum tenue) and the large intestine (intestinum crassum). It plays a central role in the digestion and absorption of nutrients.. Current research approaches focus on the genetic and molecular basis of EPI to develop new diagnostic methods and treatment strategies. For example, scientists are investigating the genetic markers associated with the disease, especially in dog breeds such as the German Shepherd, which have a higher prevalence of EPI.

Another focus of research is on improving enzyme replacement therapies, which are currently the main treatment method for EPI. Researchers are working to optimize the effectiveness and tolerability of these enzyme preparations. This could be achieved through the development of new formulations or by increasing the stability and bioavailability of the enzymesEnzymes are biological catalysts that accelerate specific chemical reactions in the body without being consumed. They play a crucial role in virtually all physiological processes.. The role of nutrition is also being intensively researched, as the right food can significantly alleviate the symptoms of EPI. Studies are investigating how different diets affect digestion and nutrient absorptionAbsorption refers to the uptake of substances by living cells or tissues. In the context of veterinary medicine, it often refers to the absorption of nutrients, drugs, or toxins from the digestive tract into the bloodstream. in dogs with EPI.

Innovative approaches in stem cell research also offer potential for the treatment of EPI. Scientists are exploring the possibility of regenerating pancreatic cells through stem cell therapyTherapy refers to the treatment of diseases or disorders with the aim of alleviating symptoms, promoting healing, or improving quality of life. Therapies can be medicinal, surgical, or through other medical interventions. and thus restoring enzyme production. This research is still in an early stage, but shows promising results in preclinical studies. In the long term, this could represent a revolutionary treatment option that makes it possible to address the underlying cause of EPI instead of just treating the symptoms.

Another promising area of research is the role of the microbiome in the gut of dogs with EPI. It is believed that a disturbed intestinalIntestinal refers to the intestine, the part of the digestive tract that extends from the stomach to the anus. Intestinal diseases affect the small and/or large intestine. flora can worsen the symptoms of EPI. Researchers are investigating how probiotics and prebiotics could be used to balance the gut microbiome and thus improve the digestion and health of affected dogs. These approaches could be used in combination with existing therapies to enable a more comprehensive treatment of the disease.

Finally, scientists are working to develop more advanced diagnostic methods that enable earlier and more accurate detection of EPI. While current tests, such as the serumSerum is the liquid part of the blood that remains after coagulation. It does not contain blood cells or coagulation factors, but many other proteins, antibody and electrolytes. Serum is used in diagnostics for a variety of blood tests. TLI test, are effective, researchers are looking for less invasiveInvasive describes medical procedures or pathogens that enter the body or penetrate tissue. In medicine, invasive procedures can range from minimally invasive techniques to open surgery. and faster methods, possibly through the use of biomarkers in the blood or stool. Early diagnosisA diagnosis is the identification of a disease or condition by its symptoms and/or results from diagnostic tests. It is the first step in the management and treatment of patients. could significantly improve the prognosisThe prognosis is the prediction of the likely course and outcome of a disease based on the general state of health, the nature of the disease, and the response to treatment. It can provide information on how a disease is expected to develop. for affected dogs, as treatment can begin earlier.

Frequently asked questions (FAQs)

What is Exocrine Pancreatic InsufficiencyInsufficiency refers to the inadequate function or performance of an organ or system. This can include, for example, heart failure, kidney failure, or venous insufficiency. (EPI) in dogs? EPI is a condition in which a dog’s pancreasThe pancreas is an organ that produces digestive enzymes and hormones, including insulin. It plays an important role in digestion and blood sugar regulation. does not produce enough digestive enzymesEnzymes are biological catalysts that accelerate specific chemical reactions in the body without being consumed. They play a crucial role in virtually all physiological processes.. These enzymesEnzymes are biological catalysts that accelerate specific chemical reactions in the body without being consumed. They play a crucial role in virtually all physiological processes. are crucial for the proper digestion of nutrients in the small intestineThe intestine is the medical term for the gut, including the small intestine (intestinum tenue) and the large intestine (intestinum crassum). It plays a central role in the digestion and absorption of nutrients.. Without them, the dog cannot absorb enough nutrients from its food, which can lead to Weight loss, DiarrheaDiarrhea refers to the condition of frequent, watery bowel movements, which can be a sign of infections, digestive disorders, or other health problems., and other health problems.
What symptoms does a dog with EPI show? The most common symptoms of EPI in dogs are chronicChronic refers to a condition or disease that is long-lasting or permanent. Chronic diseases often develop slowly and can lead to persistent or recurring health problems over time. DiarrheaDiarrhea refers to the condition of frequent, watery bowel movements, which can be a sign of infections, digestive disorders, or other health problems., Weight loss despite normal or increased appetite, poor coat condition, and frequent defecation. The stool is often voluminous, pale, and greasy. In severe cases, the dog may also show signs of malnutrition or vitaminVitamins are organic compounds that are necessary in small amounts for the normal growth, development, and physiological function of the body. Vitamins must mostly be obtained through food, as the body cannot produce them or not in sufficient quantities. deficiencyDeficiency means a lack or absence of a necessary substance required for normal bodily functions or health, such as vitamins, minerals, or hormones..
How is EPI diagnosed in dogs? EPI is usually diagnosed by a blood testA blood test is a laboratory procedure in which blood is drawn and analyzed to obtain information about the body's health. It can include various parameters such as blood sugar, blood count, liver and kidney values. known as the Trypsin-like Immunoreactivity (TLI) test. This test measures the concentration of trypsinogen, a precursor enzyme produced by the pancreasThe pancreas is an organ that produces digestive enzymes and hormones, including insulin. It plays an important role in digestion and blood sugar regulation.. Low values are indicative of EPI. Additional tests such as stool tests can also be performed to support the diagnosisA diagnosis is the identification of a disease or condition by its symptoms and/or results from diagnostic tests. It is the first step in the management and treatment of patients..
Can EPI be cured? Currently, there is no cure for EPI, but the condition can be effectively managed with appropriate enzyme replacement therapyTherapy refers to the treatment of diseases or disorders with the aim of alleviating symptoms, promoting healing, or improving quality of life. Therapies can be medicinal, surgical, or through other medical interventions. and dietary adjustments. Most dogs with EPI lead a normal life if they regularly take enzyme supplements and maintain an appropriate diet.
What treatment options are available for EPI in dogs? The main treatment for EPI is enzyme replacement therapyTherapy refers to the treatment of diseases or disorders with the aim of alleviating symptoms, promoting healing, or improving quality of life. Therapies can be medicinal, surgical, or through other medical interventions.. This involves adding pancreatic enzymesEnzymes are biological catalysts that accelerate specific chemical reactions in the body without being consumed. They play a crucial role in virtually all physiological processes. to the dog’s food to aid digestion. In addition, special diets with easily digestible nutrients and low-fat ingredients may be recommended. In some cases, vitaminVitamins are organic compounds that are necessary in small amounts for the normal growth, development, and physiological function of the body. Vitamins must mostly be obtained through food, as the body cannot produce them or not in sufficient quantities. and mineral supplements may also be necessary.
Can all dog breeds develop EPI? Yes, in principle, any dog breed can develop EPI, but certain breeds are more susceptible. The German Shepherd and the Rough-haired Dachshund are particularly frequently affected. Genetic predispositionA predisposition is an innate inclination or susceptibility of an organism to certain diseases or conditions. In dogs and cats, there may be a genetic predisposition to certain conditions such as hip dysplasia or certain heart diseases. plays a role, and it is believed that certain hereditary factors may contribute to the development of the disease.
How does nutrition affect a dog with EPI? Nutrition is an essential component in the management of EPI. A special diet that is easily digestible and has a moderate fat content can help to alleviate the symptoms. High-quality proteins and easily digestible carbohydrates are often recommended. Frequent, smaller meals can also be beneficial to aid digestion.
How often should a dog with EPI be fed? Dogs with EPI often benefit from several small meals per day instead of one or two large meals. This helps to facilitate digestion and optimize enzyme activity. The exact feeding frequency should be adjusted in consultation with a veterinarian, based on the individual needs of the dog.
Do dogs with EPI need lifelong treatment? Yes, dogs with EPI usually require lifelong therapyTherapy refers to the treatment of diseases or disorders with the aim of alleviating symptoms, promoting healing, or improving quality of life. Therapies can be medicinal, surgical, or through other medical interventions. with enzyme supplements and an adapted diet. These measures are necessary to control the symptoms and ensure adequate nutrient absorptionAbsorption refers to the uptake of substances by living cells or tissues. In the context of veterinary medicine, it often refers to the absorption of nutrients, drugs, or toxins from the digestive tract into the bloodstream.. Regular veterinary check-ups are also important to monitor the dog’s health and adjust the therapyTherapy refers to the treatment of diseases or disorders with the aim of alleviating symptoms, promoting healing, or improving quality of life. Therapies can be medicinal, surgical, or through other medical interventions. if necessary.
Can probiotic supplements help with EPI? Probiotics can be helpful in some dogs with EPI because they can support the balance of the intestinalIntestinal refers to the intestine, the part of the digestive tract that extends from the stomach to the anus. Intestinal diseases affect the small and/or large intestine. flora. A healthy intestinalIntestinal refers to the intestine, the part of the digestive tract that extends from the stomach to the anus. Intestinal diseases affect the small and/or large intestine. flora can improve digestion and alleviate some of the symptoms of EPI. However, it is important to consult a veterinarian before using probiotics to ensure that they are suitable and do not have any negative interactions with other treatments.