Ann Intern Med. 1992 Apr 15;116(8):609-14.  

 Dietary supplementation with fish oil in ulcerative colitis.

Stenson WF, Cort D, Rodgers J, Burakoff R, DeSchryver-Kecskemeti K, Gramlich TL,

Beeken W.

Jewish Hospital of St. Louis, Missouri 63110.

OBJECTIVE: To determine the efficacy of fish oil supplementation in patients

with active ulcerative colitis. DESIGN: Multicenter, randomized, double-blind,

placebo-controlled, crossover trail with 4-month treatment periods (fish oil and

placebo) separated by a 1-month washout. SETTING: Four gastroenterology

divisions. PATIENTS: Twenty-four patients with active ulcerative colitis entered

the study. Five dropped out, and one was noncompliant. Eighteen patients

completed the study. All patients had active disease as manifested by diarrhea

and rectal inflammation. INTERVENTIONS: Treatment with prednisone and

sulfasalazine was continued. Fish oil supplementation consisted of 18 capsules daily

 ( total eicosapentaenoic acid, 3.24 g; and total docosahexaenoic acid, 2.16 g ).

Placebo supplementation consisted of 18 identical capsules containing 

isocaloric amounts of vegetable oil. MEASUREMENTS: Patients

were evaluated at study entry and after each diet period. Evaluations included a

review of symptoms, flexible sigmoidoscopy, rectal biopsy, and rectal dialysis

to measure prostaglandin E2 and leukotriene B4 levels. RESULTS: Fish oil

supplementation resulted in a significant decrease in rectal dialysate levels of

leukotriene B4 from 71.0 to 27.7 pg/mL (average change, -43.3 pg/mL; 95% CI, -83

to -3.6). Significant improvements were seen in acute histology index (average

change, -8.5 units from a baseline of 10.5 units; CI, -12.9 to -4.2) and total

histology index (average change, -8.5 units from a baseline of 14.80; CI, -13.2

to -3.8) as well as significant weight gain (average weight gain, 1.74 kg, CI,

0.94 to 2.54). No significant changes occurred in any variable during the

placebo period. Seven patients received concurrent treatment with prednisone.

During the fish oil supplementation period, the mean prednisone dose decreased

from 12.9 mg/d to 6.1 mg/d and rose from 10.4 mg/d to 12.9 mg/d during the

placebo diet period (P greater than 0.20). CONCLUSIONS: Four months of diet

supplementation with fish oil in patients with inflammatory bowel disease

resulted in reductions in rectal dialysate leukotriene B4 levels, improvements

in histologic findings, and weight gain.