The Dreaded Chronic Pancreatitis – Dogster

Does your dog vomit occasionally for no apparent reason? Unexpectedly refuse her favorite food? Experience bouts of gas, diarrhea or painful tummy after eating? If so, it could be due to an often-overlooked diagnosis: chronic pancreatitis.

Most dog lovers have heard of pancreatitis. The typical tale involves a doggo that is overfed a rich meal of “people foods,” tears into the trash after a celebratory meal or somehow eats too much fatty food. The resulting torrent of vomiting, diarrhea (often bloody) and intense abdominal pain is indelibly disturbing. If you’ve ever witnessed a dog in the throes of acute pancreatitis, you won’t forget it. Acute pancreatitis is so traumatizing for both dog and dog parent that any sudden, severe case of vomiting and diarrhea is considered “pancreatitis” until proven otherwise.

We’re just beginning to recognize that a more subtle, chronic form of pancreatitis exists in dogs, just like humans, and may be more common than we know. What is chronic pancreatitis? What causes it? And, can we treat or prevent it?

Let’s Start with the Pancreas

The pancreas is a slender, pink organ attached near the bottom of the stomach and beginning of the small intestine. This location is crucial to its primary function: secreting enzymes that help digest foods, also known as its “exocrine function.” Its “endocrine function” is responsible for regulating blood glucose by producing insulin and glucagon and other essential hormones.

The digestive enzymes are responsible for pancreatitis. Pancreatitis occurs when these enzymes begin digesting the pancreas, just as they break down fats, carbs and proteins. The classic case of acute pancreatitis follows a high-fat meal that triggers a spike in pancreatic enzyme secretion, resulting in damage to the pancreas and liver. These enzymes spill over throughout the pancreas, backwash into the pancreatic duct, or erode the stomach and intestinal walls, dissolving sensitive tissues.

Who Gets It

Miniature Schnauzers are predisposed to pancreatitis because of their genetically associated altered fat metabolism (hyperlipidemia), causing the pancreas to secrete excessive fat digestive enzymes leading to injury. Other causes of pancreatitis include obesity and altered fat metabolism, pancreatic trauma or tumors and certain drugs including antibiotics containing sulfa, chemotherapy and potassium bromide. Diabetes, hypothyroidism and hypercalcemia are also documented causes of canine pancreatitis. Genetic research in the United Kingdom is evaluating if certain lines of English Cocker Spaniels may have an inherited form of autoimmune chronic pancreatitis.

What It Looks Like

Dogs with chronic pancreatitis most commonly have mild, intermittent symptoms, making diagnosis challenging. Anorexia or inexplicable food refusal, mild bouts of colitis and diarrhea, occasional vomiting, increased borborygmi (“tummy gurgles”) and abdominal discomfort, especially following a meal, may be the only signs for months to years. In other words, most dogs display some clinical signs of chronic pancreatitis sometimes. How can you find out?

Most dogs aren’t diagnosed until a mild chronic case becomes seriously severe and acute. Others find out after they’ve developed diabetes mellitus or exocrine pancreatic insufficiency (EPI). In both instances, these final episodes are the result of a long, subclinical progression that has caused significant pancreatic damage.

Tell your veterinarian if your dog has suffered these symptoms in the past, because they may be at greater risk for developing diabetes, EPI or both. If I diagnose a middle-aged to older dog with EPI or a healthy-weight dog with diabetes, I search for chronic pancreatitis as the culprit. I’ve also stumbled into a diagnosis after switching a patient to a therapeutic low-fat diet and the owner reports the dog is more playful, less picky and more energetic. The bottom line: Don’t ignore these persistent, vague cycles of upset stomach and pain. Trust your gut on this one.

The classical case of acute pancreatitis follows a high-fat meal that triggers a spike in pancreatic enzyme secretion, resulting in damage to the pancreas and liver.

The Challenge of Diagnosis

Unfortunately, there is not a specific test for chronic pancreatitis. Diagnosis is usually made on a combination of symptoms, pancreatic lab tests (notably SPEC cPL or specific canine pancreatic lipase), liver enzymes, blood fats and abdominal ultrasound. Definitive diagnosis is based on pancreatic biopsy, although it is rarely performed in dogs.

Because chronic pancreatitis is a diagnosis of exclusion, made by ruling out everything else, it can be a frustrating journey. More vets are realizing chronic pancreatitis is a real issue in many dogs and are diagnosing it earlier. The therapeutic objective is to prevent further harm to the pancreas, preserving function and avoiding debilitating diseases such as diabetes and EPI.

The 7 Symptoms of Chronic Pancreatitis

Unlike acute (sudden) pancreatitis, dogs with chronic pancreatitis show symptoms for months to years. Watch for these symptoms happening continuously over time:

1. Anorexia
2. Inexplicable food refusal
3. Mild bouts of colitis (inflammation of large intestine or colon that results in loose stools or diarrhea containing mucus or fresh blood)
4. Mild bouts of diarrhea (watery or soft stools)
5. Occasional vomiting
6. Increased tummy gurgles (borborygmi)
7. Abdominal discomfort or pain after a meal

Low-Fat Feeding is the Key

In cases that progress to acute pancreatitis, the veterinarian needs to be aggressive with treatment to reduce pancreatic tissue destruction and future complications. Treating chronic pancreatitis typically involves discovering a low- to ultra-lowfat diet the dog can tolerate.

Look for a diet containing less than 7% fat on a dry matter basis. For example, if a canned food lists crude fat as 4% on the label, the actual fat is about 16% on a dry matter basis, much too high (76% moisture, 24% dry matter, 4/24 = 16%). For dry kibble claiming 14% crude fat, that also equals about 16% true fat (10% moisture, 90% dry matter, 14/90 — 15.6%). Examples of low- to ultra-low-fat dog foods include Royal Canin Gastrointestinal Low Fat, Hill’s Prescription Diet i/d low fat and Purina Pro Plan Veterinary Diets EN Gastroenteric Low Fat Canine Formula — available in a wet or dry formulas through your veterinarian.

(Tip from the editor: After our dog Justice, who had chronic pancreatitis, came home from a week in the hospital, he was reluctant to eat. The veterinary technician told us to make small patties out of Royal Canin Gastrointestinal Low Fat wet food the hospital had given us and bake them in the oven for a few minutes, so they are a little crisp on the outside. I tried it, and he ate it!)

Dogs suffering from chronic pancreatitis also need to be fed low-fat and low-calorie treats. I’ve seen too many dogs spiral into acute pancreatitis after a well-intentioned friend, dog sitter or family member “showed them a little too much love.”

Baby carrots, sliced cucumbers and zucchini and other crunchy veggies are my favorite goodies for my chronic pancreatitis patients. In addition, excess weight increases a dog’s risk, so keeping your dog lean and healthy is always great preventive medicine.

Chronic pancreatitis is serious in dogs and probably more common than previously thought. No dog should endure a lifetime of tummy torment. The earlier you can help, the better your dog’s chances for a long, healthy, pain-free life.

Low-Fat Products: Hill’s Prescription Diet i/d low fat, Purina Pro Plan Veterinary Diets EN Gastroenteric Low Fat Canine Formula, Royal Canin Gastrointestinal Low Fat.

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