Pancreatic Enzyme Replacement in Dogs

Pancreatic enzyme replacement therapy is required in dogs when malfunction occurs in the pancreas resulting in a lack of enzymes being produced naturally. Enzymes produced in the pancreas are used to aid in the breakdown of food in the digestive system. If enzymes are deficient, your dog is unable to absorb nutrients, and food passes through the digestive system undigested. This condition is referred to as exocrine pancreatic insufficiency (EPI) and results in your dog becoming malnourished in spite of being given a sufficient diet. Your veterinarian can treat this condition with pancreatic enzyme replacement therapies which will allow your dog to adequately process food and absorb the nutrients they require.

Most dogs are treated on an outpatient basis with pancreatic enzyme replacement therapy and dietary supplements. If diabetes is also present, inpatient treatment with supportive care may be necessary until issues are resolved.

Digestive enzymes are usually provided with each meal. Enzyme supplements commonly come in powdered form and are derived from cow or pig pancreatic tissue. A dosage of 1 tsp/10kg of body weight is a typical dosage for initial treatment. The dosage can be adjusted as necessary based on results. Due to the expense, the amount will usually be reduced to find the lowest effective dosage for your dog. The process of finding the correct dosage can take some time, and continued monitoring of enzyme levels based on stool quality reported by the dog owner and examination and tests performed by your veterinarian will be required. Pancreatic enzymes are also available for dogs in tablets and capsule form, which are given 30 minutes before meals, but may not be absorbed as efficiently in dogs. Your veterinarian will work with you to achieve correct dosage and appropriate form of pancreatic enzyme replacement delivery. Fresh cow pancreas can also be used, finely chopped and administered to your dog. However, accurate dosing can be problematic. Usually one to three oz of fresh chopped pancreas replaces 1 tsp of powdered enzyme replacement. 

Incubation of powdered enzymes by adding them to moistened food and allowing them to sit for 30 to 60 minutes may increase absorption and prevent some side effects such as mouth sores. Evidence of this has not been established, however your veterinarian may recommend this procedure as part of administration of treatment. 

Pancreatic enzyme replacement in dogs is associated with good recovery of digestive functioning and good long-term prognosis. Although some anecdotal recovery of EPI has been reported, in the vast majority of cases enzyme replacement therapy will be required on a life long basis and food can not be given without enzymes or flare ups can occur.

The addition of antibiotic therapy, vitamin B12 injections, and specialized diet improves the effectiveness of enzyme replacement therapy and prognosis for EPI dogs. Cobalamin deficiency is associated with EPI and enzyme replacement treatment, and if it occurs will also require supplemental treatment.

Dogs on pancreatic enzyme replacement therapy can experience a normal life and normal life expectancy.

A small percentage of dogs do not respond to initial treatment due to the presence of other medical conditions such as cobalamin deficiency, diabetes, inflammatory bowel disease or other digestive illness. If progress does not occur these conditions will need to be identified and treated in conjunction with pancreatic enzyme replacement therapy in order for a good outcome to be achieved.

Pancreatic enzyme replacement therapy is required on a life long basis. 

Dogs with EPI may experience food aversions and allergies, this may disappear with enzyme replacement therapy. Your dog may experience side effects including, a strong body odor, bleeding gums and mouth sores. 

If Cobalamin deficiency occurs this will need to be treated by giving cobalamin subcutaneously on a regular basis.

You will need to monitor your dog's stool, especially while dosage is being determined, and report findings to your veterinarian to aide in achieving the correct dosage. You should also monitor your dog's weight gain and report any lack of progress to your veterinarian.

Your veterinarian may recommend a specialized diet and supplements to address side effects or recommend additional medical treatment for side effects.

The initial cost of tests and diagnosis of EPI can cost $150 to $300. The cost of pancreatic enzyme replacement therapy varies widely depending on the dosage required. For large dogs requiring significantly more enzyme replacement, costs are greater. A variety of enzyme therapy products are available, and the product that works best for your dog will need to be determined. Usually, a high dose is started and then lowered to achieve the most cost efficient and effective dosage for your dog. Enzyme replacement therapy can range from $500 to $3,000 or more per year. Cost saving can be achieved by using fresh pancreatic tissue although this is time-consuming and dosing can be complicated. Another strategy is to use generic brands or to join an EPI pet owners co-op that buys pancreatic enzyme supplements in bulk.

Pancreatic enzyme replacement therapy can be both financially costly and time-consuming for dog owners. Determining the appropriate form of enzyme replacement and joining a co-op can reduce the resources required for this treatment.

There is a small risk of disease being transmitted from the use of pancreatic tissue of other animals, however, this is minimal and the benefits of the treatment exceed risks substantially.

EPI dogs should be removed from breeding programs to prevent the spread of genetic factors contributing to dysfunction of the pancreas. Chronic pancreatitis should be addressed before disease becomes established and disrupts pancreatic enzyme production.