Exocrine Pancreatic Insufficiency (Maldigestion)

It is a common belief that a hungry dog is a healthy dog. While things are not quite this simple, it is true that a decrease in appetite is an important symptom that should be taken seriously.

But what if your dog is TOO hungry?

A ravenous appetite, particularly when combined with weight loss, can be just as important to note. Medical causes of increased appetite in dogs range from internal parasites to diabetes to bowel diseases.

If your dog is unusually hungry and yet keeps losing weight, something is amiss.

Today we'll take a look at exocrine pancreatic insufficiency (EPI).

Exocrine pancreatic insufficiency (EPI) is the inability to properly digest and therefore absorb food due to a lack of digestive enzymes made by the pancreas.
(source: Wikipedia)

Meet the pancreas

The pancreas doesn’t get a lot of publicity. That is until it decides to stop running smoothly. Pancreatitis, diabetes … quite a trouble-maker.

Image Veterinary Partner

So what does the pancreas do when it works properly?

The pancreas is a glandular organ tucked in next to your dog's stomach and small intestine. It has two important functions endocrine (hormone-producing) and exocrine (enzyme producing).

Endocrine pancreatic cells secrete hormones that regulate blood sugar (e.g., insulin and glucagon). The exocrine pancreas produces digestive enzymes that are released into the small intestine.  Some of these enzymes are:
  • amylase (digestion of carbohydrates)
  • lipases (digestion of fats)
  • trypsin and proteases (digestion of proteins)

When the pancreas fails to supply these enzymes, your dog cannot properly digest the food he eats.

That's why this condition is often referred to as maldigestion.

When food is not digested properly, it cannot be absorbed by the intestinal tract. So, regardless of the amount of food ingested, your dog's body doesn't get the nutrition that he needs.

Untreated or misdiagnosed dogs with EPI may die a painful death either by starvation or organ failure.

The most common cause of EPI is pancreatic acinar atrophy, a fancy name for a shriveled up, dysfunctional pancreas. Genetics plays a role in some cases, particularly in the German Shepherd breed.

The most obvious symptoms of exocrine pancreatic insufficiency are:
  • weight loss in spite of voracious appetite
  • frequent soft, greasy, clay-colored stools
  • coprophagy  (eating of feces)
  • dry, flaky skin

Your vet will need to run blood and/or fecal tests to determine if EPI is causing your dog’s symptoms.

Fortunately, many dogs with EPI that are fed a highly digestible diet and supplements containing the missing enzymes do very well, but treatment does have to continue for the rest of their lives.

The most important point is to pay attention to your dog’s symptoms.

Related articles:
Weight Loss, Brittle Fur, Starving All The Time ... Beaner's Story (Part I)
Beaner Has Exocrine Pancreatic Insufficiency: Beaner's Story (Part II)


  1. I've never heard of this -- can cats get it too? Mine always seem ravenous, but they are a healthy weight so I presume their "I'm starving here!" is just a ploy to get more food or to get fed faster. :-)

  2. Hi Julia, this condition is most commonly found in dogs. If your cat has a healthy weight and showing no other symptoms this wouldn't be it :-) There are more reasons for ravenous appetite, including behavioral. Normally no one symptom comes by its lonesome. When ravenous appetite is a sign of illness, it might come with stool changes, drinking and urination changes, coat changes, stamina changes etc.

  3. Hi Jana, I saw the title of your post and just had to check it out. Both Georgia and Rufus have been having bad tums for a while. Not continuously but maybe once a week. Thats what comes from foraging at the park! Anyway, a round of meds for colitis later, they both seem much better.

    We've had a lot of experience with bad tums over the years and especially lately with rufus's pancreatitis. He does have a voracious appetite these days (which I thought might have something to do with my great cooking, but maybe not). But
    his weight is stable.

    The most interesting symptom in your list was the eating poop bit. I know quite a few dogs in the neighborhood that have a taste for it (fortunately not G and R!)

    Have a great day :)

  4. Hi Georgia. There can be a whole lot of reasons for upset tummy. Fending for themselves could certainly cause GI upset :-)

    Sometimes dogs with pancreatitis also eat anything they can lay their mouths on (see Bridget's story http://dawgbusiness.blogspot.com/2010/08/house-is-on-fire-bridgets-pancreatitis.html)

    There also can be a number of reasons for increased appetite (yummy cooking could be one of them :-) ) It the weight is stable and the poops are good (at least for most part) I'd think it is not this.

    I wrote on this condition because one of my friend's dogs has is and I'll be publishing their story soon.

    Poop eating can have bunch of different reasons as well, though it is believed that nutrient or enzyme deficiency can be one of them.

    I would very much like if you shared your pancreatitis story on my blog.

  5. lucky i checked back! :)

    i would love to share the story. actually, it's already in my blog, in a series of sickies posts. the blog helped keep me sane during that time, just being able to document the many ailments rufus had. they weren't "technical" posts though, if you know what i mean.

    i'm very bad at remembering names of medications and illnesses [i should be better seeing as how i did pathology,anatomy and physiology courses as part of an integrated bodies study. and did very well in them too, as i remember!]

    anyway, maybe you'd like to check the posts out if you have time. let me know. no problems at all! your site is a marvellous fount of useful information!

  6. Very lucky you checked back, at least for me and my readers :-)

    I am not looking for technical, (though the names of medications and diagnostic tests used would be good), I'm looking for symptoms, how you noticed, what you did, would you do anything differently ... for people who's dog might be having undiagnosed pancreatitis to know when to suspect it and what to do.

    For example Bridget's pancreatitis went undiagnosed for a long time, in spite of frequent visits to emergency vet.

    Would you mind pointing me to the particular posts, since you don't have search on your blog?

  7. lucky i checked back AGAIN!

    the posts are labelled under "sickies". if you scroll all the way down to "find, girl, find" you'll see the label cloud. sorry to make it so hard for you. i would give you the links but there are quite a few of them. they're really more a diary of events than anything diagnostic [cool word].

  8. oh dear, i've had a quick look at the posts. there are too many of them. THE OLDER ONES are probably what you want. [the newer ones seem to be more about georgia's bad tum!] and rufus's update is sometimes only a section of the posts, under the heading How is Rufus B Thumper.

    too complicated and time-consuming for you to look through everything.

    if i get some time, maybe tomorrow or SOON, i will do a quick cut and copy and email you instead. how about that?

  9. Thank you for checking back :-) I'll see if I can make my way through those posts. But if you consolidated it for me, that'd be the most awesomest ;-)

  10. just sent you an email - the one i found on your profile :)

  11. Maldigestion should not be confused with indigestion. The latter is also known as dyspepsia and covers a range of gastrointestinal symptoms that are known as indigestion or stomach upset.

  12. I have a dog, a deutsch drahthaar, 1 year and 3 months old that has had digestive problems his whole life. he would always be hungry but his stool was terrible and he would eat anything he could get ahold of, and I was feeding him way more then recommended. To make a long story short. I tried oatmeal and blands diet. I switched his food to grain free..still no fix. I got him tested for EPI, the vet and I both were sure the results would come back positive...But, they came back in the normal range (high range tho) like 34 out of a 36 range or something in that nature. I felt hopeless untill a cattle vet that stoped by our farm talked to me about the dog and said he would order a small bottle of PancrePlus, which is the enzyme used to treat EPI. Although the test results were normal, this enzyme has caused my dogs stool to become normal and he has gained weight. He has more energy and is definetly happier then before. For anyone out there that gets their dog tested and it reports back normal, try a enzyme anyway ( there are a few diff brands out there, all pricey). It never hurts to buy a 4oz bottle and try.

  13. Hi, thank you for sharing the story! Yes the beauty of the enzyme supplementation is that it is quite benign. So it's one of the things that doesn't hurt to run a therapeutic trial and see what happens. Test results are often open to interpretation, happens with thyroid testing as well.


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