Exocrine pancreatic insufficiency in cats: More common than veterinarians think

Exocrine pancreatic insufficiency in cats: More common than veterinarians think

A recent survey defines and demystifies the clinical signs of this disease in cats.
Mar 01, 2013

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Chronic weight loss and diarrhea can be frustrating conditions to resolve in cats. There are many differential diagnoses to consider, but new research suggests that one we should more closely examine is exocrine pancreatic insufficiency (EPI).

The diagnosis of EPI has become more common since the assay for feline trypsin-like immunoreactivity (fTLI) became available. The test is considered diagnostic for EPI if a concentration of < 8 µg/L is found. Previously, making the diagnosis was more complicated and based on clinical signs and several fecal digestion assays.

Previous research

Researchers have published little information on EPI in cats—some individual case reports and three case series that reviewed 41 cases.1-3 The case series showed that weight loss was the most common clinical sign of EPI in cats. Diarrhea was common but not present in all cats and often not like the typical feces noted in dogs (voluminous and malodorous with signs of steatorrhea). Polyphagia was uncommon. Patients ranged in age from 3 months to 16 years, with most being middle-aged.

Although the cases in the series are interesting, they provide information on a small number of patients. Consider that in 2010, veterinarians submitted 775 samples to the Gastrointestinal Laboratory at Texas A&M University with fTLI concentrations consistent with a diagnosis of feline EPI.4

Survey sheds new light

At the 2011 ACVIM Forum in New Orleans, researchers from the GI Laboratory and Department of Clinical Sciences at Texas A&M presented an abstract outlining the results of a new EPI survey.5 The team searched its database over a 15-month period for cats with a TLI concentration below 8 µg/L. Questionnaires were sent to the veterinarians who submitted the samples, and 150 surveys were returned.

Many breeds were affected by EPI, although the study could not definitively show that there is no clear breed predilection. The affected cats' mean age was 8.1 years ± 4; 41 percent were females and 59 percent were males. Body condition was poor with a median of 3/9. Of the cats with EPI that had their cobalamin concentrations measured, 77 percent were deficient, and many had undetectable concentrations. In affected cats in which the folate concentration was tested, 47 percent showed an increase.

The most common clinical sign in this study was weight loss, which was seen in 91 percent of the cats. The amount of weight loss varied widely from 40 g (1.4 oz) to 6.82 kg (15 lb) with a median of 1.4 kg (3 lb). Loose stools were seen in only 62 percent of affected cats. Other clinical signs included poor haircoat (50 percent), anorexia (45 percent), increased appetite (42 percent), depression (40 percent), watery diarrhea (28 percent) and vomiting (19 percent). Concurrent diseases were also commonly reported (58 percent). The most common ones were inflammatory bowel disease (IBD, 21 percent), diabetes (14 percent), pancreatitis (11 percent) and hepatic lipidosis (6 percent).

Of the cats affected with EPI, 68 percent were treated with pancreatic enzyme supplementation. Doctors saw a good response in 66 percent of treated cats, a partial response in 24 percent and a poor response in 10 percent.