Exocrine pancreatic insufficiency (EPI)
Almost all cats will suffer from diarrhoea at some point in their lives. In most cases this lasts no more than a few days and generally gets better without any treatment. However, in a few cases the diarrhoea is due to a more serious underlying cause and does not resolve. EPI, although uncommon in the cat, is a condition that can cause chronic diarrhoea by reducing the ability to digest food. This means that an affected pet will suffer from chronic diarrhoea and be significantly underweight. Cats with EPI have a good appetite but despite consuming lots of food they are literally starving. Your vet is best placed to advise you on any illness in your pet so if you are worried about your pet's health a visit to the vet's surgery for a check over is always warranted.
What is EPI?
The pancreas is a small organ located close to the stomach. It has an important role in the digestion of food and produces large volumes of digestive enzymes after each meal which are released into the gut to help digest food as it leaves the stomach. These enzymes are normally stored in specialised storage granules in the pancreas until they are needed. In EPI the pancreas is not able to produce sufficient quantities of these enzymes and so food is poorly digested. The undigested food cannot be absorbed into the body and passes through the gut resulting in the production of smelly greasy faeces. Despite consuming plenty of calories the affected cat is only able to use a small fraction of these and the rest pass out unused in the faeces.
The pancreas also has a second, and completely separate, function which is to produce the hormone insulin which helps to control levels of blood sugar. Cats with EPI may also develop diabetes due to insufficient production of insulin.
Why has my cat got EPI?
In a most affected cats EPI develops as a consequence of long term pancreas damage due to chronic inflammation (pancreatitis), or a tumour of the pancreas or the bowel.
How would I know if my cat had EPI?
The most obvious sign of EPI is weight loss over several months despite a normal or ravenous appetite. Some cats are so hungry they start to steal food. Faeces are bulky and they may be greasy or smelly and diarrhoea is common. In most cases affected cats appear to be well in themselves although the haircoat may be greasy and unkempt in appearance. In some animals there is a history of previous pancreatitis (abdominal pain, vomiting and diarrhoea).
How will my vet know that my cat has EPI?
Your vet may suspect that your cat has EPI from the clinical signs. However, there are lots of other diseases that cause weight loss and diarrhoea and a variety of investigations may be necessary. Diagnosis can be confirmed by blood tests.
What is the treatment for EPI?
Fortunately, the management of EPI is relatively straightforward (at least in theory). If the disease is the consequence of an insufficient production of digestive enzymes then the treatment should be to supplement these enzymes.
Dietary changes may be necessary to provide a good quality energy dense diet. Improvements in consistency of faeces should be seen within a few days of treatment although it may take several months for weight and appetite to return to normal.
Cats with EPI are unable to absorb the vitamin B12, therefore regular injections are needed once or twice a month, or alternatively tablets may be recommended.
In some cases short courses of antibiotics are also required to stabilise the bacterial population in the bowel which may flourish before the enzyme supplementation starts. Many cats with EPI may have other diseases at the same time such as small bowel disease, liver disease and even diabetes mellitus.
Will my cat get better?
In most cats it is possible to manage the signs of EPI to allow cats to maintain their body weight (and maybe even put on some weight), occasionally patients will not respond to therapy and your vet may need to perform investigations to ensure this is not as a consequence of concurrent disease. However, the underlying problem will never go away and if diagnosed your pet will require treatment for the rest of its life. It is important to consider the cost implications of this when embarking on treatment initially.
If you have any concerns about our cat contact your own vet for further advice.