Probiotics in feline pancreatitis

RE: Probiotics in feline pancreatitis

Kate Richardson — Mon, 14 Nov 2016 21:03:46 GMT

Easy to give if they have EPI! They'd eat anything!

RE: Probiotics in feline pancreatitis

Luca Poddighe — Mon, 14 Nov 2016 18:39:23 GMT

I'll give it a go...

RE: Probiotics in feline pancreatitis

Martin Atkinson — Mon, 14 Nov 2016 18:08:38 GMT

[quote user="Luca Poddighe"]I found out that are extremely difficult to give to a cat since they are not palatable at all. At least this is my experience with them.[/quote]I have a cat on Lypex and it seems to take it alright and is effective - at least the owner hasn't been back with a relapse in several months when it used to be every couple of weeks.

RE: Probiotics in feline pancreatitis

Luca Poddighe — Mon, 14 Nov 2016 17:34:03 GMT

[quote user="Robin Grimmer"]What about pancreatitic enzyme supplementation? I work in one practice where they use this quite a lot in dogs with pancreatitis. The theory is I guess that it reduces the need for the pancreas itself to produce enzymes. But I don't know if there is any evidence or if this is widely used.[/quote]

I found out that are extremely difficult to give to a cat since they are not palatable at all. At least this is my experience with them.

RE: Probiotics in feline pancreatitis

Rob Davis — Fri, 11 Nov 2016 19:52:01 GMT

Many thanks for the above replies, particularly Andy for his detailed response. I will avoid using them for the moment.

RE: Probiotics in feline pancreatitis

Hannah Wynne Richards — Fri, 11 Nov 2016 18:05:23 GMT

A difficult one. Until more is known, then the safest option would be "Do no harm" so avoid giving

Wynne

RE: Probiotics in feline pancreatitis

Martin Atkinson — Fri, 11 Nov 2016 18:00:27 GMT

[quote user="Anthony Dennison"]Ed Hall does quite an effective bit when he does GI talks about probiotics to prove a point. He gets people to put their hands up if they use probiotics in diarrhoea cases. Then tells people to keep their hands up if they think it cured the diarrhoea. [/quote]I suspect that we don't give them for long enough. It can take weeks, even months, sometimes never, for gut flora and the villous processes to recover to normal after a serious GI insult. I recommend giving 3 weeks worth with a different source each week. The tincture of time could have worked wonders in that time. I reiterate: IMO if there is a benefit of probiotics in pancreatitis in cats it is more to do with managing the likely concurrent IBD than any effect directly on the pancreas.

RE: Probiotics in feline pancreatitis

Anthony Dennison — Fri, 11 Nov 2016 16:42:07 GMT

[quote user="Andrew Kent"]unlike in other GI diseases where we can say that they might not do anything but won't do any harm,[/quote]

Ed Hall does quite an effective bit when he does GI talks about probiotics to prove a point. He gets people to put their hands up if they use probiotics in diarrhoea cases. Then tells people to keep their hands up if they think it cured the diarrhoea.

A lot of hands go down after the second question.

RE: Probiotics in feline pancreatitis

Andrew Kent — Thu, 10 Nov 2016 17:40:48 GMT

[quote user="Sarah Keir"]My question is how does the pancreas know it is NOT needed? Pancreatic exocrine secretion is controlled by hormones released in stomach and small intestines in response to food. Is that response going to stopped by pancreatic enzymes already being there from being present in the food?[/quote]

No - I think the theory that giving enzymes triggers some kind of negative feedback response has largely fallen out of favour now. But, as Chris comments above the main reason that they might have a role is because exocrine function is probably reduced during inflammation as if this is significant it can compress the pancreatic ducts. So supplementing may aid digestion and therefore probably aid recovery etc. They are routinely used in people with pancreatitis for this reason.

In terms of probiotics - this is a whole world of unknowns at the moment so there isn't really an answer. As Jenny says everybody has been a bit scared by the human studies suggesting that probiotics worsen the outcome with acute pancreatitis but as there is a big difference between the pathogenesis of pancreatitis in people (alcohol) and our patients we don't know if the same would be true.

In general terms the use of probiotics in cats and dogs needs a lot more work and there are many issues with it - not least because many commercial probiotic preparations don't actually contain what it says on the label (some even contain pathogenic bacteria) and we don't really know what bacteria we should be using because everybody tells us something different!

If we really want to exert some kind of pressure on our microbiota then its possible other methods (like faecal matter transplantation) might be more successful as they may be more likely to drive us back towards a 'normal' (whatever normal microbiota should be).

So to give my approach to the original question - I don't routinely use probiotics in feline pancreatitis and, unlike in other GI diseases where we can say that they might not do anything but won't do any harm, I'm not sure we can say that with confidence in the setting of this disease.

But watch this space!

Andy

RE: Probiotics in feline pancreatitis

Sarah Keir — Thu, 10 Nov 2016 16:43:37 GMT

My question is how does the pancreas know it is NOT needed? Pancreatic exocrine secretion is controlled by hormones released in stomach and small intestines in response to food. Is that response going to stopped by pancreatic enzymes already being there from being present in the food?

RE: Probiotics in feline pancreatitis

ChrisBVSc — Thu, 10 Nov 2016 12:20:44 GMT

[quote user="Robin Grimmer"]

What about pancreatitic enzyme supplementation? I work in one practice where they use this quite a lot in dogs with pancreatitis. The theory is I guess that it reduces the need for the pancreas itself to produce enzymes. But I don't know if there is any evidence or if this is widely used.

[/quote]

Isn't the theory behind this that chronic pancreatitis may in turn result in a degree of EPI simply due to ongoing damage to the pancreas & therefore loss of exocrine function? Rather than just giving the pancreas a rest? (happy to be corrected if I'm wrong!)

RE: Probiotics in feline pancreatitis

Martin Atkinson — Wed, 09 Nov 2016 22:37:45 GMT

I have a cat with recurrent pancreatitis and cystocholic disease which has done much better since going onto Lypex. Whether this is because it also has some degree of EPI or it 'gives the pancreas a rest' is contentious but it's repeat visits have become less frequent.

RE: Probiotics in feline pancreatitis

Rob Loxley — Wed, 09 Nov 2016 19:50:16 GMT

[quote user="Robin Grimmer"]What about pancreatitic enzyme supplementation? I work in one practice where they use this quite a lot in dogs with pancreatitis.[/quote]

My feelings are that often it's harder to diagnose EPI in animals with pancreatitis since one pushes TLI up and the other down, leaving a normal final result harder to interpret so maybe we are missing some EPI cases. And some dogs where having said all that we're pretty sure don't have EPI, just pancreatitis, do seem to improve on supplementation

RE: Probiotics in feline pancreatitis

Robin Grimmer — Wed, 09 Nov 2016 19:15:39 GMT

RE: Probiotics in feline pancreatitis

Martin Atkinson — Wed, 09 Nov 2016 18:57:02 GMT

My take on this is that as pancreatitis is often associated with IBD in the triaditis syndrome then probiotics may have some benefit if not directly on the pancreas but keeping the gut healthy so there is less inflammatory feedback.

RE: Probiotics in feline pancreatitis

Jenny Harris — Wed, 09 Nov 2016 17:23:06 GMT

Actually wasn't that recent 2008, in the lancet - probiotic prophylaxis in predicted severe acute pancreatitis: a randomised double blind placebo controlled trial

RE: Probiotics in feline pancreatitis

Jenny Harris — Wed, 09 Nov 2016 17:19:47 GMT

I don't know about any research relating to this in cats maybe someone else will? However a recent large human clinical trial looking at using probiotics for acute pancreatitis found that more than twice as many in the treatment group died. In particular 9 patients suffered bowel ischaemia. they don't know why, but concluded that it was a potentially harmful intervention in this group of patients....