Skip to main content
Gut logoLink to Gut
. 1992 Jul;33(7):922–928. doi: 10.1136/gut.33.7.922

Treatment of ulcerative colitis with fish oil supplementation: a prospective 12 month randomised controlled trial.

A B Hawthorne 1, T K Daneshmend 1, C J Hawkey 1, A Belluzzi 1, S J Everitt 1, G K Holmes 1, C Malkinson 1, M Z Shaheen 1, J E Willars 1
PMCID: PMC1379405  PMID: 1353742

Abstract

The effect of fish oil on the course of ulcerative colitis was investigated in a randomised blinded controlled study. Eighty seven patients received supplements of 20 ml HiEPA fish oil as triglyceride (4.5 g of eicosapentaenoic acid) or olive oil placebo daily for one year. The oils were given in addition to standard drug therapy and trial entry was stratified for disease activity. Fish oil significantly increased the eicosapentaenoic acid content of rectal mucosa to 3.2% of total fatty acids at six months, compared with 0.63% for patients on olive oil. This was associated with increased synthesis of leukotriene B5, and 53% suppression of leukotriene B4 synthesis by ionophore--stimulated neutrophils. Leukotriene B4 suppression persisted for at least two months after treatment was stopped. Treatment with fish oil resulted in measurable, but only limited clinical benefit. For patients entering the trial in relapse (n = 53), there was a significant reduction in corticosteroid requirement after one and two months treatment. There was a trend towards achieving remission (off corticosteroids) faster in the patients on fish oil, although differences were not significant. For patients in remission at trial entry or during the trial (n = 69), there was no significant difference in the rate of relapse by log rank analysis. We conclude that fish oil supplementation produces a modest corticosteroid sparing effect in active disease, but there is no benefit in maintenance therapy.

Full text

PDF
922

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BARON J. H., CONNELL A. M., LENNARD-JONES J. E. VARIATION BETWEEN OBSERVERS IN DESCRIBING MUCOSAL APPEARANCES IN PROCTOCOLITIS. Br Med J. 1964 Jan 11;1(5375):89–92. doi: 10.1136/bmj.1.5375.89. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bittiner S. B., Tucker W. F., Cartwright I., Bleehen S. S. A double-blind, randomised, placebo-controlled trial of fish oil in psoriasis. Lancet. 1988 Feb 20;1(8582):378–380. doi: 10.1016/s0140-6736(88)91181-6. [DOI] [PubMed] [Google Scholar]
  3. Bjørneboe A., Søyland E., Bjørneboe G. E., Rajka G., Drevon C. A. Effect of dietary supplementation with eicosapentaenoic acid in the treatment of atopic dermatitis. Br J Dermatol. 1987 Oct;117(4):463–469. doi: 10.1111/j.1365-2133.1987.tb04926.x. [DOI] [PubMed] [Google Scholar]
  4. Broadhurst A. J., Wharf S. G., Stockley L. Fatty acid composition of selected foods consumed in a mixed diet study. Hum Nutr Appl Nutr. 1987 Apr;41(2):96–100. [PubMed] [Google Scholar]
  5. Budiarso I. T. Fish oil versus olive oil. Lancet. 1990 Nov 24;336(8726):1313–1314. doi: 10.1016/0140-6736(90)92993-r. [DOI] [PubMed] [Google Scholar]
  6. Endres S., Ghorbani R., Kelley V. E., Georgilis K., Lonnemann G., van der Meer J. W., Cannon J. G., Rogers T. S., Klempner M. S., Weber P. C. The effect of dietary supplementation with n-3 polyunsaturated fatty acids on the synthesis of interleukin-1 and tumor necrosis factor by mononuclear cells. N Engl J Med. 1989 Feb 2;320(5):265–271. doi: 10.1056/NEJM198902023200501. [DOI] [PubMed] [Google Scholar]
  7. Ford-Hutchinson A. W., Bray M. A., Doig M. V., Shipley M. E., Smith M. J. Leukotriene B, a potent chemokinetic and aggregating substance released from polymorphonuclear leukocytes. Nature. 1980 Jul 17;286(5770):264–265. doi: 10.1038/286264a0. [DOI] [PubMed] [Google Scholar]
  8. Goldman D. W., Pickett W. C., Goetzl E. J. Human neutrophil chemotactic and degranulating activities of leukotriene B5 (LTB5) derived from eicosapentaenoic acid. Biochem Biophys Res Commun. 1983 Nov 30;117(1):282–288. doi: 10.1016/0006-291x(83)91572-3. [DOI] [PubMed] [Google Scholar]
  9. Hawthorne A. B., Filipowicz B. L., Edwards T. J., Hawkey C. J. High dose eicosapentaenoic acid ethyl ester: effects on lipids and neutrophil leukotriene production in normal volunteers. Br J Clin Pharmacol. 1990 Aug;30(2):187–194. doi: 10.1111/j.1365-2125.1990.tb03764.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Kremer J. M., Jubiz W., Michalek A., Rynes R. I., Bartholomew L. E., Bigaouette J., Timchalk M., Beeler D., Lininger L. Fish-oil fatty acid supplementation in active rheumatoid arthritis. A double-blinded, controlled, crossover study. Ann Intern Med. 1987 Apr;106(4):497–503. doi: 10.7326/0003-4819-106-4-497. [DOI] [PubMed] [Google Scholar]
  11. Leaf A., Weber P. C. Cardiovascular effects of n-3 fatty acids. N Engl J Med. 1988 Mar 3;318(9):549–557. doi: 10.1056/NEJM198803033180905. [DOI] [PubMed] [Google Scholar]
  12. Lee T. H., Hoover R. L., Williams J. D., Sperling R. I., Ravalese J., 3rd, Spur B. W., Robinson D. R., Corey E. J., Lewis R. A., Austen K. F. Effect of dietary enrichment with eicosapentaenoic and docosahexaenoic acids on in vitro neutrophil and monocyte leukotriene generation and neutrophil function. N Engl J Med. 1985 May 9;312(19):1217–1224. doi: 10.1056/NEJM198505093121903. [DOI] [PubMed] [Google Scholar]
  13. Lee T. H., Menica-Huerta J. M., Shih C., Corey E. J., Lewis R. A., Austen K. F. Characterization and biologic properties of 5,12-dihydroxy derivatives of eicosapentaenoic acid, including leukotriene B5 and the double lipoxygenase product. J Biol Chem. 1984 Feb 25;259(4):2383–2389. [PubMed] [Google Scholar]
  14. Lobos E. A., Sharon P., Stenson W. F. Chemotactic activity in inflammatory bowel disease. Role of leukotriene B4. Dig Dis Sci. 1987 Dec;32(12):1380–1388. doi: 10.1007/BF01296664. [DOI] [PubMed] [Google Scholar]
  15. Magaro M., Altomonte L., Zoli A., Mirone L., De Sole P., Di Mario G., Lippa S., Oradei A. Influence of diet with different lipid composition on neutrophil chemiluminescence and disease activity in patients with rheumatoid arthritis. Ann Rheum Dis. 1988 Oct;47(10):793–796. doi: 10.1136/ard.47.10.793. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. McCall T. B., O'Leary D., Bloomfield J., O'Moráin C. A. Therapeutic potential of fish oil in the treatment of ulcerative colitis. Aliment Pharmacol Ther. 1989 Oct;3(5):415–424. doi: 10.1111/j.1365-2036.1989.tb00232.x. [DOI] [PubMed] [Google Scholar]
  17. Nishida T., Miwa H., Shigematsu A., Yamamoto M., Iida M., Fujishima M. Increased arachidonic acid composition of phospholipids in colonic mucosa from patients with active ulcerative colitis. Gut. 1987 Aug;28(8):1002–1007. doi: 10.1136/gut.28.8.1002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Pacheco S., Hillier K., Smith C. Increased arachidonic acid levels in phospholipids of human colonic mucosa in inflammatory bowel disease. Clin Sci (Lond) 1987 Oct;73(4):361–364. doi: 10.1042/cs0730361. [DOI] [PubMed] [Google Scholar]
  19. Prescott S. M., Zimmerman G. A., Morrison A. R. The effects of a diet rich in fish oil on human neutrophils: identification of leukotriene B5 as a metabolite. Prostaglandins. 1985 Aug;30(2):209–227. doi: 10.1016/0090-6980(85)90186-8. [DOI] [PubMed] [Google Scholar]
  20. Robinson D. R., Prickett J. D., Makoul G. T., Steinberg A. D., Colvin R. B. Dietary fish oil reduces progression of established renal disease in (NZB x NZW)F1 mice and delays renal disease in BXSB and MRL/1 strains. Arthritis Rheum. 1986 Apr;29(4):539–546. doi: 10.1002/art.1780290412. [DOI] [PubMed] [Google Scholar]
  21. Salomon P., Kornbluth A. A., Janowitz H. D. Treatment of ulcerative colitis with fish oil n--3-omega-fatty acid: an open trial. J Clin Gastroenterol. 1990 Apr;12(2):157–161. doi: 10.1097/00004836-199004000-00009. [DOI] [PubMed] [Google Scholar]
  22. Schwartz D., Lellouch J. Explanatory and pragmatic attitudes in therapeutical trials. J Chronic Dis. 1967 Aug;20(8):637–648. doi: 10.1016/0021-9681(67)90041-0. [DOI] [PubMed] [Google Scholar]
  23. Sharon P., Stenson W. F. Enhanced synthesis of leukotriene B4 by colonic mucosa in inflammatory bowel disease. Gastroenterology. 1984 Mar;86(3):453–460. [PubMed] [Google Scholar]
  24. Sperling R. I., Weinblatt M., Robin J. L., Ravalese J., 3rd, Hoover R. L., House F., Coblyn J. S., Fraser P. A., Spur B. W., Robinson D. R. Effects of dietary supplementation with marine fish oil on leukocyte lipid mediator generation and function in rheumatoid arthritis. Arthritis Rheum. 1987 Sep;30(9):988–997. doi: 10.1002/art.1780300905. [DOI] [PubMed] [Google Scholar]
  25. Terano T., Salmon J. A., Higgs G. A., Moncada S. Eicosapentaenoic acid as a modulator of inflammation. Effect on prostaglandin and leukotriene synthesis. Biochem Pharmacol. 1986 Mar 1;35(5):779–785. doi: 10.1016/0006-2952(86)90246-7. [DOI] [PubMed] [Google Scholar]
  26. Vilaseca J., Salas A., Guarner F., Rodríguez R., Martínez M., Malagelada J. R. Dietary fish oil reduces progression of chronic inflammatory lesions in a rat model of granulomatous colitis. Gut. 1990 May;31(5):539–544. doi: 10.1136/gut.31.5.539. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Wiles S. J., Nettleton P. A., Black A. E., Paul A. A. The nutrient composition of some cooked dishes eaten in Britain: a supplementary food composition table. J Hum Nutr. 1980 Jun;34(3):189–223. doi: 10.3109/09637488009143440. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES