FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Volume 334:1557-1560 June 13, 1996 Number 24 Next

	Full Text PDF Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Patients with Crohn's disease may have periods of remission, interrupted by relapses. Because fish oil has antiinflammatory actions, it could reduce the frequency of relapses, but it is often poorly tolerated because of its unpleasant taste and gastrointestinal side effects.

Methods We performed a one-year, double-blind, placebo-controlled study to investigate the effects of a new fish-oil preparation in the maintenance of remission in 78 patients with Crohn's disease who had a high risk of relapse. The patients received either nine fish-oil capsules containing a total of 2.7 g of n-3 fatty acids or nine placebo capsules daily. A special coating protected the capsules against gastric acidity for at least 30 minutes.

Results Among the 39 patients in the fish-oil group, 11 (28 percent) had relapses, 4 dropped out because of diarrhea, and 1 withdrew for other reasons. In contrast, among the 39 patients in the placebo group, 27 (69 percent) had relapses, 1 dropped out because of diarrhea, and 1 withdrew for other reasons (difference in relapse rate, 41 percentage points; 95 percent confidence interval, 21 to 61; P<0.001). After one year, 23 patients (59 percent) in the fish-oil group remained in remission, as compared with 10 (26 percent) in the placebo group (P = 0.003). Logistic-regression analysis indicated that only fish oil and not sex, age, previous surgery, duration of disease, or smoking status affected the likelihood of relapse (odds ratio for the placebo group as compared with the fish-oil group, 4.2; 95 percent confidence interval, 1.6 to 10.7).

Conclusions In patients with Crohn's disease in remission, a novel enteric-coated fish-oil preparation is effective in reducing the rate of relapse.

Source Information

From the Institute of Clinical Medicine and Gastroenterology (A.B., C.B., M.C., M.M.) and the Department of Clinical Pharmacology (S.B.), University of Bologna, Bologna; and the Department of Gastroenterology, S. Giovanni Battista Hospital, Turin (A.P.) — both in Italy.

Address reprint requests to Dr. Belluzzi at via Vizzani, 36, 40138 Bologna, Italy.

Full Text of this Article

Related Letters:

Enteric-Coated Fish Oil in Crohn's Disease
Guthy E., Belluzzi A., Boschi S., Brignola C.
Extract | Full Text  
N Engl J Med 1996; 335:1397-1398, Oct 31, 1996. Correspondence

This article has been cited by other articles:

• Fetterman, J. W. Jr., Zdanowicz, M. M. (2009). Therapeutic potential of n-3 polyunsaturated fatty acids in disease. Am J Health Syst Pharm 66: 1169-1179 [Abstract] [Full Text]  
• Mizota, T., Fujita-Kambara, C., Matsuya, N., Hamasaki, S., Fukudome, T., Goto, H., Nakane, S., Kondo, T., Matsuo, H. (2009). Effect of Dietary Fatty Acid Composition on Th1/Th2 Polarization in Lymphocytes. JPEN J Parenter Enteral Nutr 33: 390-396 [Abstract] [Full Text]  
• Marion-Letellier, R, Dechelotte, P, Iacucci, M, Ghosh, S (2009). Dietary modulation of peroxisome proliferator-activated receptor gamma. Gut 58: 586-593 [Abstract] [Full Text]  
• Mane, J., Pedrosa, E., Loren, V., Ojanguren, I., Fluvia, L., Cabre, E., Rogler, G., Gassull, M. A. (2009). Partial Replacement of Dietary (n-6) Fatty Acids with Medium-Chain Triglycerides Decreases the Incidence of Spontaneous Colitis in Interleukin-10-Deficient Mice. J. Nutr. 139: 603-610 [Abstract] [Full Text]  
• Ulitsky, A. (2009). Comment On: Omega-3 Free Fatty Acids for the Maintenance of Remission in Crohn Disease: The EPIC Randomized Controlled Trials. Nutr Clin Pract 24: 102-103 [Abstract] [Full Text]  
• Yashodhara, B M, Umakanth, S, Pappachan, J M, Bhat, S K, Kamath, R, Choo, B H (2009). Omega-3 fatty acids: a comprehensive review of their role in health and disease. Postgrad. Med. J. 85: 84-90 [Abstract] [Full Text]  
• Musiek, E. S., Brooks, J. D., Joo, M., Brunoldi, E., Porta, A., Zanoni, G., Vidari, G., Blackwell, T. S., Montine, T. J., Milne, G. L., McLaughlin, B., Morrow, J. D. (2008). Electrophilic Cyclopentenone Neuroprostanes Are Anti-inflammatory Mediators Formed from the Peroxidation of the {omega}-3 Polyunsaturated Fatty Acid Docosahexaenoic Acid. J. Biol. Chem. 283: 19927-19935 [Abstract] [Full Text]  
• Issa, M., Binion, D. G. (2008). Bowel Rest and Nutrition Therapy in the Management of Active Crohn's Disease. Nutr Clin Pract 23: 299-308 [Abstract] [Full Text]  
• Wiese, D. M., Rivera, R., Seidner, D. L. (2008). Is There a Role for Bowel Rest in Nutrition Management of Crohn's Disease?. Nutr Clin Pract 23: 309-317 [Abstract] [Full Text]  
• Johnson, E. J, Chung, H.-Y., Caldarella, S. M, Snodderly, D M. (2008). The influence of supplemental lutein and docosahexaenoic acid on serum, lipoproteins, and macular pigmentation. Am. J. Clin. Nutr. 87: 1521-1529 [Abstract] [Full Text]  
• Feagan, B. G., Sandborn, W. J., Mittmann, U., Bar-Meir, S., D'Haens, G., Bradette, M., Cohen, A., Dallaire, C., Ponich, T. P., McDonald, J. W. D., Hebuterne, X., Pare, P., Klvana, P., Niv, Y., Ardizzone, S., Alexeeva, O., Rostom, A., Kiudelis, G., Spleiss, J., Gilgen, D., Vandervoort, M. K., Wong, C. J., Zou, G. Y., Donner, A., Rutgeerts, P. (2008). Omega-3 Free Fatty Acids for the Maintenance of Remission in Crohn Disease: The EPIC Randomized Controlled Trials. JAMA 299: 1690-1697 [Abstract] [Full Text]  
• Clarke, J. O., Mullin, G. E. (2008). A Review of Complementary and Alternative Approaches to Immunomodulation. Nutr Clin Pract 23: 49-62 [Abstract] [Full Text]  
• Plat, J., Jellema, A., Ramakers, J., Mensink, R. P. (2007). Weight Loss, but Not Fish Oil Consumption, Improves Fasting and Postprandial Serum Lipids, Markers of Endothelial Function, and Inflammatory Signatures in Moderately Obese Men. J. Nutr. 137: 2635-2640 [Abstract] [Full Text]  
• Nowak, J., Weylandt, K. H., Habbel, P., Wang, J., Dignass, A., Glickman, J. N., Kang, J. X. (2007). Colitis-associated colon tumorigenesis is suppressed in transgenic mice rich in endogenous n-3 fatty acids. Carcinogenesis 28: 1991-1995 [Abstract] [Full Text]  
• Sun, Y.-P., Oh, S. F., Uddin, J., Yang, R., Gotlinger, K., Campbell, E., Colgan, S. P., Petasis, N. A., Serhan, C. N. (2007). Resolvin D1 and Its Aspirin-triggered 17R Epimer: STEREOCHEMICAL ASSIGNMENTS, ANTI-INFLAMMATORY PROPERTIES, AND ENZYMATIC INACTIVATION. J. Biol. Chem. 282: 9323-9334 [Abstract] [Full Text]  
• Petursdottir, D. H., Hardardottir, I. (2007). Dietary Fish Oil Increases the Number of Splenic Macrophages Secreting TNF-{alpha} and IL-10 But Decreases the Secretion of These Cytokines by Splenic T Cells from Mice. J. Nutr. 137: 665-670 [Abstract] [Full Text]  
• Shaikh, S. R., Edidin, M. (2006). Polyunsaturated fatty acids, membrane organization, T cells, and antigen presentation. Am. J. Clin. Nutr. 84: 1277-1289 [Abstract] [Full Text]  
• Lee, S., Gura, K. M., Kim, S., Arsenault, D. A., Bistrian, B. R., Puder, M. (2006). Current Clinical Applications of {Omega}-6 and {Omega}-3 Fatty Acids. Nutr Clin Pract 21: 323-341 [Abstract] [Full Text]  
• Hudert, C. A., Weylandt, K. H., Lu, Y., Wang, J., Hong, S., Dignass, A., Serhan, C. N., Kang, J. X. (2006). Transgenic mice rich in endogenous omega-3 fatty acids are protected from colitis. Proc. Natl. Acad. Sci. USA 103: 11276-11281 [Abstract] [Full Text]  
• Calder, P. C (2006). n-3 Polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am. J. Clin. Nutr. 83: S1505-1519S [Abstract] [Full Text]  
• Friedman, A., Moe, S. (2006). Review of the Effects of Omega-3 Supplementation in Dialysis Patients. CJASN 1: 182-192 [Abstract] [Full Text]  
• Travis, S P L, Stange, E F, Lemann, M, Oresland, T, Chowers, Y, Forbes, A, D'Haens, G, Kitis, G, Cortot, A, Prantera, C, Marteau, P, Colombel, J-F, Gionchetti, P, Bouhnik, Y, Tiret, E, Kroesen, J, Starlinger, M, Mortensen, N J, for the European Crohn's and Colitis Organisation, (2006). European evidence based consensus on the diagnosis and management of Crohn's disease: current management. Gut 55: i16-i35 [Abstract] [Full Text]  
• Caprilli, R, Gassull, M A, Escher, J C, Moser, G, Munkholm, P, Forbes, A, Hommes, D W, Lochs, H, Angelucci, E, Cocco, A, Vucelic, B, Hildebrand, H, Kolacek, S, Riis, L, Lukas, M, de Franchis, R, Hamilton, M, Jantschek, G, Michetti, P, O'Morain, C, Anwar, M M, Freitas, J L, Mouzas, I A, Baert, F, Mitchell, R, Hawkey, C J, for the European Crohn's and Colitis Organisation, (2006). European evidence based consensus on the diagnosis and management of Crohn's disease: special situations. Gut 55: i36-i58 [Abstract] [Full Text]  
• MacLean, C. H, Mojica, W. A, Newberry, S. J, Pencharz, J., Garland, R. H., Tu, W., Hilton, L. G, Gralnek, I. M, Rhodes, S., Khanna, P., Morton, S. C (2005). Systematic review of the effects of n-3 fatty acids in inflammatory bowel disease. Am. J. Clin. Nutr. 82: 611-619 [Abstract] [Full Text]  
• Li, Q., Wang, M., Tan, L., Wang, C., Ma, J., Li, N., Li, Y., Xu, G., Li, J. (2005). Docosahexaenoic acid changes lipid composition and interleukin-2 receptor signaling in membrane rafts. J. Lipid Res. 46: 1904-1913 [Abstract] [Full Text]  
• Gassull, M. A., Mane, J., Pedrosa, E., Cabre, E. (2005). Macronutrients and Bioactive Molecules: Is There a Specific Role in the Management of Inflammatory Bowel Disease?. JPEN J Parenter Enteral Nutr 29: S179-S183 [Abstract] [Full Text]  
• Arita, M., Yoshida, M., Hong, S., Tjonahen, E., Glickman, J. N., Petasis, N. A., Blumberg, R. S., Serhan, C. N. (2005). Resolvin E1, an endogenous lipid mediator derived from omega-3 eicosapentaenoic acid, protects against 2,4,6-trinitrobenzene sulfonic acid-induced colitis. Proc. Natl. Acad. Sci. USA 102: 7671-7676 [Abstract] [Full Text]  
• Oh, R. (2005). Practical Applications of Fish Oil ({Omega}-3 Fatty Acids) in Primary Care. J Am Board Fam Med 18: 28-36 [Abstract] [Full Text]  
• Fan, Y.-Y., Ly, L. H., Barhoumi, R., McMurray, D. N., Chapkin, R. S. (2004). Dietary Docosahexaenoic Acid Suppresses T Cell Protein Kinase C{theta} Lipid Raft Recruitment and IL-2 Production. J. Immunol. 173: 6151-6160 [Abstract] [Full Text]  
• Trebble, T. M, Arden, N. K, Wootton, S. A, Calder, P. C, Mullee, M. A, Fine, D. R, Stroud, M. A (2004). Fish oil and antioxidants alter the composition and function of circulating mononuclear cells in Crohn disease. Am. J. Clin. Nutr. 80: 1137-1144 [Abstract] [Full Text]  
• Mishra, A., Chaudhary, A., Sethi, S. (2004). Oxidized Omega-3 Fatty Acids Inhibit NF-{kappa}B Activation Via a PPAR{alpha}-Dependent Pathway. Arterioscler. Thromb. Vasc. Bio. 24: 1621-1627 [Abstract] [Full Text]  
• Jho, D. H., Cole, S. M., Lee, E. M., Espat, N. J. (2004). Role of Omega-3 Fatty Acid Supplementation in Inflammation and Malignancy. Integr Cancer Ther 3: 98-111 [Abstract]  
• Nayar, M, Rhodes, J M (2004). Management of inflammatory bowel disease. Postgrad. Med. J. 80: 206-213 [Abstract] [Full Text]  
• Fan, Y.-Y., McMurray, D. N., Ly, L. H., Chapkin, R. S. (2003). Dietary (n-3) Polyunsaturated Fatty Acids Remodel Mouse T-Cell Lipid Rafts. J. Nutr. 133: 1913-1920 [Abstract] [Full Text]  
• Irons, R., Anderson, M. J., Zhang, M., Fritsche, K. L. (2003). Dietary Fish Oil Impairs Primary Host Resistance Against Listeria monocytogenes More than the Immunological Memory Response. J. Nutr. 133: 1163-1169 [Abstract] [Full Text]  
• Koeffler, H. P. (2003). Peroxisome Proliferator-activated Receptor {gamma} and Cancers. Clin. Cancer Res. 9: 1-9 [Abstract] [Full Text]  
• Simopoulos, A. P. (2002). Omega-3 Fatty Acids in Inflammation and Autoimmune Diseases. J. Am. Coll. Nutr. 21: 495-505 [Abstract] [Full Text]  
• Diaz, O., Berquand, A., Dubois, M., Di Agostino, S., Sette, C., Bourgoin, S., Lagarde, M., Nemoz, G., Prigent, A.-F. (2002). The Mechanism of Docosahexaenoic Acid-induced Phospholipase D Activation in Human Lymphocytes Involves Exclusion of the Enzyme from Lipid Rafts. J. Biol. Chem. 277: 39368-39378 [Abstract] [Full Text]  
• Podolsky, D. K. (2002). Inflammatory Bowel Disease. NEJM 347: 417-429 [Full Text]  
• Zeyda, M., Staffler, G., Horejsi, V., Waldhausl, W., Stulnig, T. M. (2002). LAT Displacement from Lipid Rafts as a Molecular Mechanism for the Inhibition of T Cell Signaling by Polyunsaturated Fatty Acids. J. Biol. Chem. 277: 28418-28423 [Abstract] [Full Text]  
• Grimble, R. F, Howell, W M., O'Reilly, G., Turner, S. J, Markovic, O., Hirrell, S., East, J M., Calder, P. C (2002). The ability of fish oil to suppress tumor necrosis factor {alpha} production by peripheral blood mononuclear cells in healthy men is associated with polymorphisms in genes that influence tumor necrosis factor {alpha} production. Am. J. Clin. Nutr. 76: 454-459 [Abstract] [Full Text]  
• Sethi, S., Ziouzenkova, O., Ni, H., Wagner, D. D., Plutzky, J., Mayadas, T. N. (2002). Oxidized omega-3 fatty acids in fish oil inhibit leukocyte-endothelial interactions through activation of PPARalpha. Blood 100: 1340-1346 [Abstract] [Full Text]  
• Terada, S., Takizawa, M., Yamamoto, S., Ezaki, O., Itakura, H., Akagawa, K. S. (2002). Eicosapentaenoic acid inhibits CSF-induced human monocyte survival and maturation into macrophage through the stimulation of H2O2 production. J. Leukoc. Biol. 71: 981-986 [Abstract] [Full Text]  
• Nieto, N., Torres, M. I., Rios, A., Gil, A. (2002). Dietary Polyunsaturated Fatty Acids Improve Histological and Biochemical Alterations in Rats with Experimental Ulcerative Colitis. J. Nutr. 132: 11-19 [Abstract] [Full Text]  
• Leiper, K, Woolner, J, Mullan, M M C, Parker, T, van der Vliet, M, Fear, S, Rhodes, J M, Hunter, J O (2001). A randomised controlled trial of high versus low long chain triglyceride whole protein feed in active Crohn's disease. Gut 49: 790-794 [Abstract] [Full Text]  
• McCowen, K. C, Ling, P. R., Bistrian, B. R (2000). Arachidonic acid concentrations in patients with Crohn disease. Am. J. Clin. Nutr. 71: 1008-1008 [Full Text]  
• Levy, E., Rizwan, Y., Thibault, L., Lepage, G., Brunet, S., Bouthillier, L., Seidman, E. (2000). Altered lipid profile, lipoprotein composition, and oxidant and antioxidant status in pediatric Crohn disease. Am. J. Clin. Nutr. 71: 807-815 [Abstract] [Full Text]  
• Webb, Y., Hermida-Matsumoto, L., Resh, M. D. (2000). Inhibition of Protein Palmitoylation, Raft Localization, and T Cell Signaling by 2-Bromopalmitate and Polyunsaturated Fatty Acids. J. Biol. Chem. 275: 261-270 [Abstract] [Full Text]  
• Eritsland, J. (2000). Safety considerations of polyunsaturated fatty acids. Am. J. Clin. Nutr. 71: 197S-201S [Abstract] [Full Text]  
• Belluzzi, A., Boschi, S., Brignola, C., Munarini, A., Cariani, G., Miglio, F. (2000). Polyunsaturated fatty acids and inflammatory bowel disease1. Am. J. Clin. Nutr. 71: 339S-342S [Abstract] [Full Text]  
• Rampton, D. S (1999). Regular review: Management of Crohn's disease. BMJ 319: 1480-1485 [Full Text]  
• Simopoulos, A. P (1999). Essential fatty acids in health and chronic disease. Am. J. Clin. Nutr. 70: 560S-569 [Abstract] [Full Text]  
• Byleveld, P. M., Pang, G. T., Clancy, R. L., Roberts, D. C. K. (1999). Fish Oil Feeding Delays Influenza Virus Clearance and Impairs Production of Interferon-{gamma} and Virus-Specific Immunoglobulin A in the Lungs of Mice. J. Nutr. 129: 328-335 [Abstract] [Full Text]  
• Stulnig, T. M., Berger, M., Sigmund, T., Raederstorff, D., Stockinger, H., Waldhausl, W. (1998). Polyunsaturated Fatty Acids Inhibit T Cell Signal Transduction by Modification of Detergent-insoluble Membrane Domains. JCB 143: 637-644 [Abstract] [Full Text]  
• Jabbar, M. A., Zuhri-Yafi, M. I., Larrea, J. (1998). Insulin Therapy for a Non-Diabetic Patient with Severe Hypertriglyceridemia. J. Am. Coll. Nutr. 17: 458-461 [Abstract] [Full Text]  
• Boullata, J. I. (1998). Parenteral Nutrition: Adjunctive or Primary Role in Gastrointestinal Therapeutics?. Nutr Clin Pract 13: 57-58  
• Fajas, L., Auboeuf, D., Raspe, E., Schoonjans, K., Lefebvre, A.-M., Saladin, R., Najib, J., Laville, M., Fruchart, J.-C., Deeb, S., Vidal-Puig, A., Flier, J., Briggs, M. R., Staels, B., Vidal, H., Auwerx, J. (1997). The Organization, Promoter Analysis, and Expression of the Human PPARgamma Gene. J. Biol. Chem. 272: 18779-18789 [Abstract] [Full Text]  
• Oliveira, F. L.C., Rumsey, S. C., Schlotzer, E., Hansen, I., Carpentier, Y. A., Deckelbaum, R. J. (1997). Triglyceride Hydrolysis of Soy Oil vs Fish Oil Emulsions. JPEN J Parenter Enteral Nutr 21: 224-229 [Abstract]  
• Klein, S., Kinney, J., Jeejeebhoy, K., Alpers, D., Hellerstein, M., Murray, M., Twomey, P. (1997). Nutrition Support in Clinical Practice: Review of Published Data and Recommendations for Future Research Directions: Summary of a Conference Sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. JPEN J Parenter Enteral Nutr 21: 133-156 [Abstract]  
• Guthy, E., Belluzzi, A., Boschi, S., Brignola, C. (1996). Enteric-Coated Fish Oil in Crohn's Disease. NEJM 335: 1397-1398 [Full Text]  
• (1996). Increasing fish oil intake - any net benefits?. DTB 34: 60-62 [Abstract] [Full Text]  
• (1996). FISH OIL PREVENTS RELAPSE IN CROHN'S DISEASE. JWatch General 1996: 6-6 [Full Text]  
• Hodgson, H. J. (1996). Keeping Crohn's Disease Quiet. NEJM 334: 1599-1600 [Full Text]  
• Stulnig, T. M., Huber, J., Leitinger, N., Imre, E.-M., Angelisova, P., Nowotny, P., Waldhausl, W. (2001). Polyunsaturated Eicosapentaenoic Acid Displaces Proteins from Membrane Rafts by Altering Raft Lipid Composition. J. Biol. Chem. 276: 37335-37340 [Abstract] [Full Text]