Subclinical exocrine pancreatic insufficiency in dogs.
OBJECTIVE
To study progression of autoimmune-mediated atrophic lymphocytic pancreatitis from the subclinical to the clinical phase (exocrine pancreatic insufficiency [EPI]) and determine whether progression of the disease could be halted by treatment with immunosuppressive drugs.


METHODS
Randomized controlled trial.


METHODS
20 dogs with subclinical EPI.


METHODS
Diagnosis of subclinical EPI was determined on the basis of repeatedly low serum trypsin like-immunoreactivity (TLI) in dogs with no signs of EPI. Laparotomy was performed on 12 dogs with partial acinar atrophy and atrophic lymphocytic pancreatitis. A treatment group (7 dogs) received an immunosuppressive drug (azathioprine) for 9 to 18 months, and a nontreatment group (13) received no medication.


RESULTS
During the subclinical phase, serum TLI was repeatedly low (< 5.0 microg/L). Although a few dogs had nonspecific gastrointestinal tract signs, they did not need diet supplementation with enzymes. While receiving immunosuppressive medication, treated dogs had no clinical signs of EPI, but within 2 to 6 months after treatment was stopped, 2 dogs had signs of EPI, and diet supplementation with enzymes was started. Five of the 13 untreated dogs needed diet supplementation with enzymes within 6 to 46 months. During follow-up of 1 to 6 years, 3 of the 7 treated dogs and 8 of the 13 untreated dogs did not need continuous diet supplementation with enzymes.


CONCLUSIONS
Progression of atrophic lymphocytic pancreatitis varied widely. The subclinical phase may last for years and sometimes for life. The value of early treatment with an immunosuppressive drug was questionable and, because of the slow natural progression of the disease, cannot be recommended.
Wiberg
Maria E
ME
Department of Clinical Veterinary Sciences, Faculty of Veterinary Medicine, University of Helsinki, Finland.
Westermarck
Elias
E
D000818:Animals; D001379:Azathioprine / Q000627:therapeutic use; D019587:Dietary Supplements; D018450:Disease Progression; D004283:Dog Diseases / Q000178:diet therapy / Q000188:drug therapy* / Q000517:prevention & control; D004285:Dogs; D057487:Enzyme Therapy; D004798:Enzymes / Q000008:administration & dosage; D010188:Exocrine Pancreatic Insufficiency / Q000178:diet therapy / Q000188:drug therapy / Q000517:prevention & control / Q000662:veterinary*; D005260:Female; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D010179:Pancreas / Q000201:enzymology; D010195:Pancreatitis / Q000150:complications / Q000662:veterinary; D014357:Trypsin / Q000097:blood
D004798:Enzymes; D007166:Immunosuppressive Agents; D014357:Trypsin; D001379:Azathioprine