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Exocrine pancreatic insufficiency in cats
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A D V A NC E S
Exocrine pancreatic insufficiency in cats Background Exocrine pancreatic insufficiency (EPI) is characterized by inadequate production of pancreatic enzymes from pancreatic acinar cells and has been previously considered rare in the cat. The related literature consists mainly of case reports of confirmed or suspected EPI cases in cats, with only 10 reports published between 1975 and 2009. In addition, there have been only two small case series of EPI in cats that have been reported in the English peer-reviewed literature. Since the introduction and validation of the fTLI test, EPI in cats has been diagnosed more frequently. However, many cases may still remain undiagnosed. This suggestion is not surprising if one takes into consideration the fact that the clinical presentation, clinicopathologic findings, treatment options, and response to treatment of cats with EPI have not been well described.
A D V A NC E S
Objectives
Inclusions
To describe the signalment, clinical signs, clinicopathologic abnormalities, concurrent diseases, and response to treatment in cats with EPI.
Three figures, 3 tables, 25 references.
Procedure These authors performed a retrospective case series. The diagnostic criterion for EPI was a serum fTLI concentration ≤8 μg/L, which is the currently recommended cutoff value for the diagnosis of EPI in cats. A random subset of submitting veterinarians were contacted by phone and asked to participate in this study by filling out a standardized questionnaire for each affected cat. Questions included age at diagnosis, breed, sex and neuter status, body weight and body condition score, medical history, clinical signs, concurrent medical problems, and treatment (including type of pancreatic enzyme replacement, dietary modifications, and adjunctive treatment). For each cat, the response to treatment was subjectively graded by the submitting veterinarian as good, partial, or poor.
Results Questionnaires were sent to 261 veterinarians, and 150 (57%) were returned with data suitable for statistical analysis. The median age of the cats with EPI was 7.7 years. The median body condition score was 3 of 9. Ninety-two of 119 cats had hypocobalaminemia, and 56 of 119 cats had increased and 6 of 119 cats had decreased serum folate concentrations. Clinical signs included weight loss, unformed feces, poor hair coat, anorexia, increased appetite, lethargy, watery diarrhea, and vomiting. Eighty-seven cats (58%) had concurrent diseases. Treatment response was reported to be good in 60%, partial in 27%, and poor in 13% of 121 cats. Trypsin-like immunoreactivity <4 μg/L was associated with a positive response to treatment. Also, cobalamin supplementation improved the response to treatment.
Author Conclusions Exocrine pancreatic insufficiency in cats often has a different clinical presentation than in dogs. The age range for EPI in cats is wide, and many cats can be ≤5 years of age. Most cats respond well to appropriate treatment for EPI, and cobalamin supplementation appears to be necessary for a good response.
Editor Annotation Exocrine pancreatic insufficiency is not commonly diagnosed in feline patients, and there are limited reports evaluating the typical clinical presentation of afflicted animals. These authors performed a retrospective study assessing patients that tested positive for EPI as indicated by a diminished serum fTLI concentration. Sixty percent of patients treated with supplemental enzymes reported good results (near complete or complete resolution of clinical signs). It is suggested that concurrent treatment with cobalamin may enhance treatment response (even if not measurably decreased). Antibiotics were used in approximately 50% of the cases, but their use was not found to affect the outcome. The results of this survey indicate that evaluation of fTLI is warranted in feline patients presenting with unexplained weight loss and poorly formed feces. The etiology of reduced exocrine pancreatic function was not evaluated by this study. Age is not a limiting factor, and not all cats demonstrated diarrhea or a ravenous appetite (JR and MM) Xenoulis PG, Zoran DL, Fosgate GT, et al. Feline exocrine pancreatic insufficiency: A retrospective study of 150 cases. JAVIM;30:1790-1797.
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A D V A NC E S
Exocrine pancreatic insufficiency in cats Background Exocrine pancreatic insufficiency (EPI) is characterized by inadequate production of pancreatic enzymes from pancreatic acinar cells and has been previously considered rare in the cat. The related literature consists mainly of case reports of confirmed or suspected EPI cases in cats, with only 10 reports published between 1975 and 2009. In addition, there have been only two small case series of EPI in cats that have been reported in the English peer-reviewed literature. Since the introduction and validation of the fTLI test, EPI in cats has been diagnosed more frequently. However, many cases may still remain undiagnosed. This suggestion is not surprising if one takes into consideration the fact that the clinical presentation, clinicopathologic findings, treatment options, and response to treatment of cats with EPI have not been well described.
A D V A NC E S
Objectives
Inclusions
To describe the signalment, clinical signs, clinicopathologic abnormalities, concurrent diseases, and response to treatment in cats with EPI.
Three figures, 3 tables, 25 references.
Procedure These authors performed a retrospective case series. The diagnostic criterion for EPI was a serum fTLI concentration ≤8 μg/L, which is the currently recommended cutoff value for the diagnosis of EPI in cats. A random subset of submitting veterinarians were contacted by phone and asked to participate in this study by filling out a standardized questionnaire for each affected cat. Questions included age at diagnosis, breed, sex and neuter status, body weight and body condition score, medical history, clinical signs, concurrent medical problems, and treatment (including type of pancreatic enzyme replacement, dietary modifications, and adjunctive treatment). For each cat, the response to treatment was subjectively graded by the submitting veterinarian as good, partial, or poor.
Results Questionnaires were sent to 261 veterinarians, and 150 (57%) were returned with data suitable for statistical analysis. The median age of the cats with EPI was 7.7 years. The median body condition score was 3 of 9. Ninety-two of 119 cats had hypocobalaminemia, and 56 of 119 cats had increased and 6 of 119 cats had decreased serum folate concentrations. Clinical signs included weight loss, unformed feces, poor hair coat, anorexia, increased appetite, lethargy, watery diarrhea, and vomiting. Eighty-seven cats (58%) had concurrent diseases. Treatment response was reported to be good in 60%, partial in 27%, and poor in 13% of 121 cats. Trypsin-like immunoreactivity <4 μg/L was associated with a positive response to treatment. Also, cobalamin supplementation improved the response to treatment.
Author Conclusions Exocrine pancreatic insufficiency in cats often has a different clinical presentation than in dogs. The age range for EPI in cats is wide, and many cats can be ≤5 years of age. Most cats respond well to appropriate treatment for EPI, and cobalamin supplementation appears to be necessary for a good response.
Editor Annotation Exocrine pancreatic insufficiency is not commonly diagnosed in feline patients, and there are limited reports evaluating the typical clinical presentation of afflicted animals. These authors performed a retrospective study assessing patients that tested positive for EPI as indicated by a diminished serum fTLI concentration. Sixty percent of patients treated with supplemental enzymes reported good results (near complete or complete resolution of clinical signs). It is suggested that concurrent treatment with cobalamin may enhance treatment response (even if not measurably decreased). Antibiotics were used in approximately 50% of the cases, but their use was not found to affect the outcome. The results of this survey indicate that evaluation of fTLI is warranted in feline patients presenting with unexplained weight loss and poorly formed feces. The etiology of reduced exocrine pancreatic function was not evaluated by this study. Age is not a limiting factor, and not all cats demonstrated diarrhea or a ravenous appetite (JR and MM) Xenoulis PG, Zoran DL, Fosgate GT, et al. Feline exocrine pancreatic insufficiency: A retrospective study of 150 cases. JAVIM;30:1790-1797.
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