Pancreatitis
A good site to go to for an “overall” view about Pancreatitis is The Whole Dog Journal:
Canine Pancreatitis – Whole Dog Journal (whole-dog-journal.com)
To read about Chronic Pancreatitis segueing into EPI … please go to Pancreatitis to EPI page
To understand about testing for Pancreatitis, please go to the TAMU Gastrointestinal Laboratory website: http://vetmed.tamu.edu/gilab/research/pancreatitis-information
Posted March 4, 2025: Taken from Veterinary News, written by Andrew Linklater, DVM, DACVECC
What’s New in Pancreatitis: TREATMENT
https://www.veterinarypracticenews.com/new-in-pancreatitis/?en_click=1&utm_campaign=2025-03-04&utm_medium=email&utm_source=newsletter&utm_content=news&oly_enc_id=3025F5696690F2X
Treatment
Treating pancreatitis mainly includes fluid therapy to correct hypovolemia and dehydration, analgesia, antiemetics, and early enteral nutrition;2 prokinetics and gastric acid reducers are often complementary.
Managing critically ill patients has demonstrated overhydration should be avoided, so judicious use of crystalloids is recommended.11 Nutritional management for critically ill patients is essential, and enteral nutrition is generally preferred. It has been demonstrated to be well-tolerated by patients with pancreatitis, with few complications. Nutrition supplementation may be attempted with appetite stimulants, such as capromorelin or mirtazapine. However, short- or long-term feeding tubes, such as nasogastric/nasoesophageal or esophagostomy tubes, are often chosen due to their ease of placement and use, and minimal cost. Parenteral nutrition is generally avoided unless enteral options are non-viable.11
Surgical treatment of pancreatitis is rarely indicated. However, a recent study examined long-term outcomes in dogs with pancreatitis and biliary obstruction and noted an improved survival rate in dogs treated with surgery.12 Therefore, surgical intervention may benefit some patients with progressive biliary obstruction which is not improving with medical management.
Three treatment options remain controversial for patients with pancreatitis: plasma, antibiotics, and steroids. Historically, plasma was recommended for supplementation of alpha-macroglobulin, a protease inhibitor. However, a retrospective study demonstrated no benefit to fresh frozen plasma administration and was negatively associated with outcome.13
Plasma may still provide some benefit in select patients with significant complications of pancreatitis, including hypoproteinemia (and need
for colloid support) or coagulopathies, which can develop as a consequence of systemic inflammation. The cost of plasma may also play into the decision if it should be used or not.
Antibiotics have commonly been recommended, with the argument of limiting bacterial translocation. However, multiple prospective, randomized human trials have not demonstrated a benefit, so they only considered it in select patients,2 such as those that are immunosuppressed (e.g. neutropenic [<2000/ul], perioperative antibiotics if surgery is performed or when a focal infection is identified); adhering to antibiotic stewardship guidelines is recommended.
Glucocorticoids have generally been avoided as historical evidence potentially presented a correlation between their use and the development of pancreatitis. However, a recent literature review examined a wide range of causes of experimental and naturally occurring pancreatitis and concluded steroids may have a benefit on outcomes.14 Large, evidence-based trials have yet to be conducted. Although many clinicians consider anti-inflammatory doses of steroids, particularly in cats, evidence is currently lacking to support this decision. Critically ill patients, which are hospitalized for several days, may also develop critical-illness related corticosteroid insufficiency (CIRCI) and may also benefit from the use of steroids. Still, the diagnosis of CIRCI in veterinary patients has not been standardized.
A new leukocyte function-associated antigen-1 (LFA-1) activation inhibitor has recently been available in the market for the treatment of acute pancreatitis in dogs, fuzapladib sodium. The company manufacturing it claims in a pilot field study that patients with acute pancreatitis had improved clinical scores.15 In an experimental study in mice, it did not improve postoperative ileus but did decrease the number of macrophages. Much more is yet to be determined about this new medication, and cost remains a significant factor.16
Conclusion
In conclusion, pancreatitis is a common disease diagnosed in dogs and cats. Diagnosis is often based on symptoms, physical exam findings, laboratory tests (including a PLI) and abdominal imaging, such as ultrasound. Standard treatment includes a combination of supportive care, including anti-emetics, analgesics, fluids and nutrition; some patients may develop severe complications, and surgery is rarely indicated unless abscessation or refractory biliary obstruction are present. A novel neutrophil inhibitor may be of use, but more information is needed. The use of scoring systems, steroids, antibiotics and plasma remain controversial with little evidence to support their use.
Posted November 2022: FDA Conditionally Approves First Drug to Manage Acute Onset of Pancreatitis in Dogs
Today, the U.S. Food and Drug Administration conditionally approved Panoquell-CA1 (fuzapladib sodium for injection) for the management of clinical signs associated with acute onset of pancreatitis in dogs. Panoquell-CA1 is an injectable drug intended for use while the dog is hospitalized for treatment of the disease.
Pancreatitis is a painful inflammatory disease of the pancreas that can be life-threatening and generally requires that dogs be hospitalized for treatment. In most cases, it occurs spontaneously. Common factors that increase the chance of developing pancreatitis include when dogs eat something outside of their normal diet (particularly fatty foods), treatment with certain medications, and diseases like diabetes mellitus. It is more common in certain breeds of dogs and in some dogs may become a recurring or chronic condition.
“This is the first drug to address a serious and life-threatening disease that previously could only be managed through supportive care, such as intravenous fluids, pain medication, anti-emetics, and dietary rest,” said Steven M. Solomon, D.V.M., M.P.H., director of the FDA’s Center for Veterinary Medicine. “The conditional approval pathway allows medications like Panoquell-CA1 to reach the marketplace more quickly, and in this case gives dogs suffering from acute onset of pancreatitis earlier access to a drug to manage this disease.”
Conditional approval also means that, when used according to the label, the drug is safe and has a reasonable expectation of effectiveness. Veterinarian access to critical animal drugs provides more options for treating animals with uncommon conditions, serious or life-threatening diseases, or diseases without existing or adequate therapies. The initial conditional approval is valid for one year with the potential for four annual renewals. During this time, the animal drug sponsor must demonstrate active progress toward proving substantial evidence of effectiveness for full approval. If the sponsor does not meet the requirements for substantial evidence of effectiveness at the conclusion of five years, the product can no longer be marketed.
Fuzapladib sodium, the active ingredient in Panoquell, has been approved since 2018 in Japan to improve clinical signs in the acute phase of pancreatitis in dogs, but not in the United States until today. The FDA reviewed data associated with fuzapladib’s use in Japan as part of its assessment of the application for conditional approval.
Veterinarians should advise owners about the possible side effects, which include loss of appetite, digestive tract disorders, respiratory tract disorders, liver disease and jaundice, before using the drug. The FDA encourages dog owners to work with their veterinarian to report any adverse events or side effects potentially related to the use of any drug, including Panoquell-CA1.
The FDA granted conditional approval of Panoquell-CA1 to Ishihara Sangyo Kaisha Ltd.
Posted November 2020: An EXCELLENT “ACVN / American College of Veterinary Nutrition Peer Reviewed 2016 read on how to manage Pancreatitis. Thank you Jill for bringing this to our attention!:
CONTROVERSIES IN
THE NUTRITIONAL MANAGEMENT OF PANCREATITIS
- Various recommendations in treating ACUTE PANCREATITIS in dogs
- Recommendations in treating CHRONIC PANCREATITIS in dogs and cats – gives actual food and composition recommendations… VERY USEFUL INFO!
Some additional tidbits that you might want to look into / consider if your dog is struggling with Pancreatitis:
- Low-protein diets have also been shown to predispose dogs to pancreatitis, especially when combined with high fat intake. Some prescription diets may be a concern, such as those prescribed to dissolve struvite bladder stones; to prevent calcium oxalate, urate, or cystine stones; and to treat kidney disease; especially for breeds prone to pancreatitis.
- Several medications have been associated with pancreatitis, most recently the combination of potassium bromide and phenobarbital used to control epilepsy. This combination has a much higher risk of causing pancreatitis than phenobarbital alone (no studies have been done on the use of potassium bromide by itself).
- Many other medications have been linked to pancreatitis, though the relationship is not always clear. These include certain antibiotics (sulfa drugs, tetracycline, metronidazole, nitrofurantoin); chemotherapy agents (azathioprine, L-asparaginase, vinca alkaloids); diuretics (thiazides, furosemide); other antiepileptic drugs (valproic acid, carbamazepine); hormones (estrogen); long-acting antacids (cimetidine, ranitidine); Tylenol (acetaminophen); and aspirin (salicylates).
- Corticosteroids, such as prednisone, are especially controversial: while veterinarians have long considered them to be the most common drug to cause pancreatitis, recent human studies have discounted this link. Based on anecdotal evidence, however, some believe the association does exist in dogs.
2024
Sponsored by Ceva Animal Health, LLC
Assessment & Treatment of
Acute Canine Pancreatitis
by: Lisa Singer, VMD, DACVIM
Excellent article on how to assess Acute Canine Pancreatitis ..please feel free to contact Dr. Singer for this article.. Unfortunately we do not have permission to post here.
December 2018 – Veterinary Practice News
Acute Pancreatitis & a new Pancreatitis Drug
being tested in Japan…..
This is a good and recent article on treating Acute Pancreatitis…. and i specifically cut and pasted the article so as not to lose track of information included of a possible new drug being tested in Japan for Pancreatitis treatment.