Omega-3 Fatty Acids in the Maintenance of Ulcerative Colitis

Abstract

Immunomodulation of the gut associated lyn-phoid tissue is a key issue in the clinical manage-ment of inflammatory bowel disease (IBD). Often toxic drugs are used to obtain clinical remission, sometimes in already immunocompromized patients. The presence of important co-morbidity might also heavily affect the clinical strategy. Poly-unsaturated fatty acids (PUFAs) might represent a valid therapeutical option in IBD patients and further controlled clinical studies are warranted. Case report This report presents the management of a 38-year-old Caucasian woman with ulcerative colitis who had extra-intestinal manifestations (polyarthritis) and mitral valve prolapse, and whose treatment included essential fatty acids. In 1998, at the age of 27, she presented to the emergency department with 10 days of bloody diarrhoea and lower abdominal cramping pain. She described up to 15 bowel motions daily with urgency, and approximately 3 kg weight loss. She denied emesis or a family history for IBD and/or colorectal cancer. She was a smoker with no history of medical illness or surgery, and denied recent antibiotic or non-steroidal anti-inflammatory drug use. She had no known sick contacts or exposure to at-risk foods. However, she had experienced increased emotional stress over the past several weeks. She was clinically dehydrated. Laboratory inves-tigations and inflammatory markers were remark-able only for a moderately low haemoglobin (100 g/L), a low blood ferritin (7 ng/mL) and a high cholesterol (245 mg/dL). The patient was admitted to the hospital for presumed infectious enterocolitis to start intrave-nous hydration and symptomatic treatment. Stool microbiology was negative for pathogens, but faecal leukocytes were present. After 48 hours with minimal response to therapy, she underwent flexible sigmoidoscopy and biopsies, which showed friable and erythematous mucosa in a diffuse circumferential distribution from the anal verge to the splenic flexure. There were no pseu-domembranes. Histological evaluation revealed acute inflammation without architectural distor-tion consistent with either acute infectious colitis or new inflammatory bowel disease favouring ulcerative colitis. The patient's symptoms substantially resolved over the next 3 –4 days, and she was discharged with a course of antibiotics. However, a few days after discharge, she returned with recurrent bloody diarrhoea and abdominal pain. Aworking diagnosis of ulcerative colitis was made and she was started on mesala-zine 2.4 g daily with oral prednisone 40 mg daily. After three days of this treatment, stool frequency had decreased to twice a day, with rare blood-tinged stools. The abdominal cramping had improved, but still occurred episodically with some tenesmus. Steroid side-effects included depressed mood and insomnia, which resolved as the dose was tapered. Due to persistent rectal urgency, an ileocolono-scopy was performed after six weeks; this showed mild erythema and granularity from the rectum to the sigmoid colon and in the ascending colon. The transverse colonic mucosa and terminal ileum were grossly normal. However, biopsies