Canine exocrine pancreatic insufficiency: A comprehensive review of pathophysiology, diagnosis, and modern management strategies

Abstract

Canine Exocrine Pancreatic Insufficiency (EPI) is a chronic gastrointestinal disorder caused by insufficient secretion of digestive enzymes from the exocrine pancreas, resulting in maldigestion, nutrient malabsorption, and ongoing weight loss. The most common underlying cause in dogs is pancreatic acinar atrophy (PAA), particularly in German Shepherds and related breeds, where autoimmune mechanisms are strongly implicated. This article reviews the etiology, pathogenesis, clinical signs, diagnostic methods, and treatment options for EPI in dogs. Common symptoms include frequent, bulky diarrhoea, increased appetite, weight loss, and poor coat condition. Diagnosis is most reliably confirmed through serum canine trypsin-like immunoreactivity (cTLI), regarded as the gold standard. Long-term management depends on pancreatic enzyme replacement therapy (PERT), dietary modifications, vitamin B12 (cobalamin) supplementation, and treatment of secondary small intestinal dysbiosis. Emerging strategies include enteric-coated enzyme preparations, probiotic use, and potential stem cell therapies. The review also stresses the importance of early detection in predisposed breeds, along with the role of genetic and immune research in understanding disease mechanisms. Future directions focus on non-invasive diagnostic tools, immunomodulatory approaches, and microbiota-centered interventions. While EPI is manageable, undiagnosed cases significantly impair quality of life, making timely recognition and integrated care essential for optimal outcomes.