Feline EPI is a rare but important cause of chronic, voluminous diarrhea accompanied by weight loss in cats. The cornerstone
of EPI management is pancreatic enzyme replacement. Powdered pancreatic enzyme extract (Pancrezyme—Virbac) should be mixed
with food before feeding at a dose of 1/4 to 3/4 tsp per meal. Alternatively, chopped cow or pig pancreas can be added to
the food at a dose of 1 to 3 oz per meal. Fresh pancreas is inexpensive and can be obtained at slaughterhouse facilities and
occasionally at local grocery stores by special order. It can be frozen for up to three months while maintaining enzyme activity.
Any cat with EPI should also receive parenteral cobalamin supplementation (Table 4).
Prebiotics are nondigestible ingredients that promote specific changes in GI microflora, which are presumed to confer various
health benefits on the host.25 Many prebiotics are moderately fermentable fibers such as beet pulp, psyllium, or soy and appear to favor beneficial colonic
bacteria. Psyllium fiber supplements (Vetasyl—Virbac) are often used for their laxative properties but may also help improve
fecal consistency in cats with chronic large bowel diarrhea. The recommended dose is 1 tsp mixed with food once or twice daily.
Patients receiving psyllium should have access to water at all times to prevent fecal impaction and intestinal obstruction.
Canned pumpkin is an alternative fiber source for cats and can be useful in managing patients with colitis.
Fructooligosaccharides (FOS) are long chains of fructose molecules and are found in many different plants. FOS selectively
feed Bifidobacterium species, Lactobacillus acidophilus, and other lactobacilli species. Supplementation with FOS is thought to favor the growth of beneficial bacteria and improve
intestinal health and function.26 To date, no studies have been performed in cats with chronic diarrhea that demonstrate positive response to treatment.
Probiotics are live microorganisms administered in amounts that confer health benefits on the host. They are reported to play
a role in improving immune response, replenishing normal GI microflora, and hastening the resolution of diarrhea. They must
be viable and metabolically active with the GI tract of the host to be beneficial. Because probiotics are nutritional supplements,
they are not regulated by the FDA, and manufacturers are not required to show efficacy or viability of product contents.
When commercial probiotics were evaluated, the contents of many products did not match the organisms listed on the package.27 Only recommend products from reputable companies with labels describing the strain and number of live organisms present.
Many veterinary probiotics are available, each with various species and strains of bacteria, and an individual patient may
show a positive response to one formulation but not another. However, little independent data support the use of probiotic
products in cats with clinical disease, and probiotics should not be used in place of standard therapeutics in cats with infectious