Feline EPI; are we missing these cases?


Exocrine pancreatic insufficiency (EPI) is a well-recognised syndrome in dogs, with clearly defined breed predispositions (including German Shepherds, Cavalier King Charles Spaniels, Rough Collies, Chows) and clinical signs (diarrhoea in 95%, poor body condition in 87%, polyphagia in 52%,). EPI should often spring to mind when the patient has diarrhoea, poor body condition +/- accompanying polyphagia.
Until recently, relatively little has been known about feline EPI; but we are now in a much more informed position. The TLI test shows excellent sensitivity and specificity for EPI….. but are we testing the right cats?
In light of recent literature, we need to be aware that cats with EPI can present very differently to their canine counterparts.

 Auger et al, 2021 N= 22 totalXenoulis et al, 2016 N= 150 totalSteiner and Williams, 2000 N= 20
Weight loss68%91%95%
Poor appetite56%45%“present in some”
Vomiting36%19%“present in some”
Weight loss as the only clinical sign9%5%—————–

Points of note:
• Only around 50% of cats with EPI have diarrhoea.
• Polyphagia is seen in the minority of feline EPI cases, in fact poor appetite is more common in these cases
• Weight loss can be the only clinical signs in some feline EPI cases (19% in Thompson et al, 2019)
EPI should be on your radar for non-specific feline weight loss. Neither polyphagia nor diarrhoea are enormously consistent findings in feline EPI.
Hypocobalaminaemia is common in dogs with EPI (82% in Batchelor et al, 2007). It was historically considered that cats with EPI should all show hypocobalaminaemia, as in the cat only the pancreas produces the intrinsic factor (IF) needed to absorb vitamin B12 enterally, whereas in the dog both pancreas and stomach produce IF. The literature however shows that hypocobalaminaemia in cats with EPI is far from universal (59-77%).

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