Therapeutic potential of fish oil in the treatment of ulcerative colitis

McCall, Therese; O’Leary, Donal Peter; Bloomfield, Jonathan; O’Moráin, Colm

doi:10.1111/j.1365-2036.1989.tb00232.x

Cited by 90 publications

(20 citation statements)

References 33 publications

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“…9 Orally administered n-3 is readily incorporated in IBD-affected bowel mucosa, 34,57 thereby reducing the level of arachidonic acid and increasing the level of LTB 5 , which induces a much weaker inflammatory response. 34,58 Fish oil also alters signaling pathways and has a direct effect on the expression of many genes.…”

Section: Discussionmentioning

confidence: 99%

Maintenance of remission in inflammatory bowel disease using omega-3 fatty acids (fish oil): A systematic review and meta-analyses

Turner

Shah

Steinhart

et al. 2011

Inflammatory Bowel Diseases

159

115

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The objective was to systematically review the efficacy and safety of n-3 (omega-3 fatty acids, fish oil) for maintaining remission in Crohn's disease (CD) and ulcerative colitis (UC). Electronic databases were searched systematically for randomized controlled trials of n-3 for maintenance of remission in inflammatory bowel disease (IBD). Studies of patients of any age group who were in remission at the time of recruitment and were followed for at least 6 months were included. The primary outcome was relapse rate at the end of the follow-up period. Nine studies were eligible for inclusion; six studies of CD (n = 1039) and three of UC (n = 138). There was a statistically significant benefit for n-3 in CD (relative risk [RR] 0.77; 95% confidence interval [CI] 0.61-0.98); however, the studies were heterogeneous (I(2) = 58%). The absolute risk reduction was -0.14 (95% CI: -0.25 to -0.02). Opinions may vary on whether this is a clinically significant effect. Two well-done studies with a larger sample size reported no benefit. A sensitivity analysis excluding a small pediatric study resulted in the pooled RR being no longer statistically significant. A funnel plot analysis suggested publication bias for the smaller studies. For UC, there was no difference in the relapse rate between the n-3 and control groups (RR 1.02; 95% CI: 0.51-2.03). The pooled analysis showed a higher rate of diarrhea (RR 1.36; 95% CI: 1.01-1.84) and symptoms of the upper gastrointestinal tract (RR 1.96; 95% CI: 1.37-2.80) in the n-3 treatment group. There are insufficient data to recommend the use of omega 3 fatty acids for maintenance of remission in CD and UC.

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Section: Discussionmentioning

confidence: 99%

Maintenance of remission in inflammatory bowel disease using omega-3 fatty acids (fish oil): A systematic review and meta-analyses

Turner

Shah

Steinhart

et al. 2011

Inflammatory Bowel Diseases

159

115

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“…Small open-label or pilot studies reported clinical benefit of fish oil supplementation in ulcerative colitis [83,87]. A number of randomised, placebo-controlled, double-blind studies of In the absence of misoprostol pretreatment, ileal fluid absorption was normal in the fish oil group but not in the other two groups; with misoprostol pretreatment, colonic fluid loss was reversed (to absorption) in the fish oil group but not in the other two groups and colonic injury was lower in the fish oil group than in the other two groups 76 Rat TNBS Safflower oil vs. perilla oil (rich in ALA)…”

Section: Trials Of N-3 Pufas In Inflammatory Bowel Diseasesmentioning

confidence: 98%

Polyunsaturated fatty acids, inflammatory processes and inflammatory bowel diseases

Calder

2008

Molecular Nutrition Food Res

402

311

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With regard to inflammatory processes, the main fatty acids of interest are the n-6 PUFA arachidonic acid (AA), which is the precursor of inflammatory eicosanoids like prostaglandin E(2) and leukotriene B(4), and the n-3 PUFAs eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). EPA and DHA are found in oily fish and fish oils. EPA and DHA inhibit AA metabolism to inflammatory eicosanoids. They also give rise to mediators that are less inflammatory than those produced from AA or that are anti-inflammatory. In addition to modifying the lipid mediator profile, n-3 PUFAs exert effects on other aspects of inflammation like leukocyte chemotaxis and inflammatory cytokine production. Some of these effects are likely due to changes in gene expression, as a result of altered transcription factor activity. Fish oil has been shown to decrease colonic damage and inflammation, weight loss and mortality in animal models of colitis. Fish oil supplementation in patients with inflammatory bowel diseases results in n-3 PUFA incorporation into gut mucosal tissue and modification of inflammatory mediator profiles. Clinical outcomes have been variably affected by fish oil, although some trials report improved gut histology, decreased disease activity, use of corticosteroids and relapse.

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“…Long-chain nҀ3 PUFAs are incorporated into gut mucosal tissue of patients with inflammatory bowel disease who supplement their diet with fish oil (132)(133)(134), and there are reports that this results in antiinflammatory effects, such as decreased LTB 4 production by neutrophils (134 -136) and colonic mucosa (136,137), decreased PGE 2 and thromboxane B 2 production by colonic mucosa (133), and decreased production of PGE 2 by blood mononuclear cells (138). Small open-label or pilot studies reported clinical benefit of fish oil supplementation in ulcerative colitis (135,139).…”

Section: Inflammatory Bowel Diseasesmentioning

confidence: 99%

n−3 Polyunsaturated fatty acids, inflammation, and inflammatory diseases

Calder

2006

The American Journal of Clinical Nutrition

2,123

1,476

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Inflammation is part of the normal host response to infection and injury. However, excessive or inappropriate inflammation contributes to a range of acute and chronic human diseases and is characterized by the production of inflammatory cytokines, arachidonic acid-derived eicosanoids (prostaglandins, thromboxanes, leukotrienes, and other oxidized derivatives), other inflammatory agents (eg, reactive oxygen species), and adhesion molecules. At sufficiently high intakes, long-chain nҀ3 polyunsaturated fatty acids (PUFAs), as found in oily fish and fish oils, decrease the production of inflammatory eicosanoids, cytokines, and reactive oxygen species and the expression of adhesion molecules. Long-chain nҀ3 PUFAs act both directly (eg, by replacing arachidonic acid as an eicosanoid substrate and inhibiting arachidonic acid metabolism) and indirectly (eg, by altering the expression of inflammatory genes through effects on transcription factor activation). Long-chain nҀ3 PUFAs also give rise to a family of antiinflammatory mediators termed resolvins. Thus, nҀ3 PUFAs are potentially potent antiinflammatory agents. As such, they may be of therapeutic use in a variety of acute and chronic inflammatory settings. Evidence of their clinical efficacy is reasonably strong in some settings (eg, in rheumatoid arthritis) but is weak in others (eg, in inflammatory bowel diseases and asthma). More, better designed, and larger trials are required to assess the therapeutic potential of long-chain nҀ3 PUFAs in inflammatory diseases. The precursor nҀ3 PUFA ␣-linolenic acid does not appear to exert antiinflammatory effects at achievable intakes.Am J Clin Nutr 2006;83(suppl):1505S-19S.

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Therapeutic potential of fish oil in the treatment of ulcerative colitis

Cited by 90 publications

References 33 publications

Maintenance of remission in inflammatory bowel disease using omega-3 fatty acids (fish oil): A systematic review and meta-analyses

Maintenance of remission in inflammatory bowel disease using omega-3 fatty acids (fish oil): A systematic review and meta-analyses

Polyunsaturated fatty acids, inflammatory processes and inflammatory bowel diseases

n−3 Polyunsaturated fatty acids, inflammation, and inflammatory diseases

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