Administration of omega-3 fatty acid supplements did not appear to improve the rate of relapse in patients with Crohn’s disease, according to a study released on April 9, 2008 in JAMA.

Crohn’s Disease is a gastrointestinal disorder which is indicated by chronic inflammation of the wall of the digestive tract, usually in the ileum or large intestines. The disease involves constant cycles of flare-ups and remission throughout the life of the patient, and without proper treatment, must be addressed surgically. It is considered an inflammatory bowel disease (IBD), similar to ulcerative colitis. Therapy to induce remission in Crohn’s disease is an unmet medical need, usually attempted with the use of certain immunosuppressive drugs, which are associated with infection and other risks. Many Crohn’s patients turn to alternative medications in the face of disappointing overall results.

Omega-3 fatty acids unsaturated fatty acids usually found in marine fish. They have anti-inflammatory properties, and have been used to treat some inflammatory disorders such as rheumatoid arthritis. Earlier studies have evalued omega-3 fatty acids for the maintenance of remission in Crohn’s disease, but have had inconsistent results.

To attempt to rectify this, Brian G. Feagan, M.D., of the Robarts Research Institute, University of Western Ontario, London, Ontario, and colleagues performed two large trials of high-dose omega-3 free fatty acids as therapy in Crohn’s patients who were in remission. The studies, called the Epanova Program in Crohn’s Study 1 and 2 [EPIC-1 and EPIC-2], were conducted between January 2003 and February 2007 at 98 different centers in Canada, Europe, Israel, and the United States. There were 363 and 375 patients involved respectively, all with Crohn’s disease which was in remission at the time. Patients were randomly assigned in approximately equal numbers to either a group administered four grams per day of omega-3 fatty acids or a placebo, to be taken for up to 58 weeks.

There was no significant difference found in the relapse rates between the two treatment groups in either of the trials. In EPIC-1, 54 patients treated with the fatty acids and 62 patients with placebo experienced a clinical relapse. The set of patients experiencing a relapse within 360 days in the omega-3 group was estimated to be 31.6%, compared with 35.7% in the placebo group. EPIC-2 had 84 patients who were treated with omega-3 fatty acids and 94 who took the placebo experienced relapse. The set of patients experiencing a relapse within 360 days in the omega-3 group was estimated to be 47.8%, in contrast with 48.8% in the placebo group.

Any serious adverse events were uncommon, and those that did occur were mostly related to Crohn’s disease itself.

The researchers believe that this conclusion is significant because it has serious implications on the self treatment of Crohn’s patients. “Our results are important because the use of alternative medicines in general, and omega-3 free fatty acid formulations in particular, is widespread among patients with inflammatory bowel disease. This may be due, in part, to dissemination of the positive results obtained in [a trial by Belluzzi et al]. Given the negative results observed in the EPIC trials and in [a trial by Lorenz-Meyer et al], we do not endorse this practice, since patients with Crohn disease who are at risk for relapse would be better served by taking medications of known efficacy,” they write.

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Sonoenteroclysis, a new sonographic method in evaluating and diagnosing small bowel disorders is an effective alternative to the usual method of barium enteroclysis, according to a recent study conducted by researchers at the Postgraduate Institute of Medical Education and Research in Chandigarh, India. Sonoenteroclysis is a new way of doing transabdominal ultrasound. Patients are given fluid through the nasojejunal tube in order to alleviate gas in the bowel.

“Various techniques available until now for evaluating the small bowel have been either inadequate or have various disadvantages and limitations,” said Birinder Nagi, MD, lead author of the study. “Radiologic evaluation of the small bowel is usually done by barium examination which cannot evaluate the bowel wall and surrounding structures. With CT enteroclysis, another method, mucosal details cannot be well seen. Both of these techniques are associated with increased exposure to radiation. PET-CT enteroclysis is a new promising technique, but also requires ionizing radiation. MR enteroclysis is not widely available and there is concern about patients vomiting in the gantry while they are undergoing the examination.

The study consisted of 50 patients with suspected small bowel disorder who underwent sonoenteroclysis followed by barium enteroclysis. The findings of the two were compared. The researchers noted small bowel thickness, luminal diameter, peristalsis and extra intestinal lesions. Of the 50 patients, 10 showed normal small bowel on both sonoenteroclysis and barium enteroclysis. The study also showed that 25 of the remaining 40 patients showed abnormality in the form of: strictures, dilated loops, thickened folds, mass lesions, etc. on both techniques as well. Additional findings on sonoenteroclysis were thickened bowel wall with loss of stratification, ascites, and lymphadenopathy. These were later diagnosed as cases of tuberculosis.

“The results of sonoenteroclysis were comparable to barium enteroclysis and also provided additional information regarding bowel wall and surrounding structures,” said Dr. Nagi. “This examination is simple, non-invasive, without radiation, cheap and can be used as an initial investigation in patients with suspected small bowel diseases,” he said.

The full results of this study will be presented on Thursday, April 17, 2008 during the American Roentgen Ray Society’s annual meeting in Washington, DC.

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Scientists have for the first time discovered that people with the same cancer susceptibility genes respond differently depending on their race. Their results are published in Nature Genetics* .

The team from the University of Edinburgh has shown that a genetic marker is associated with an increased the risk of colon cancer in Europeans, but not in the Japanese population. But this genetic variant was associated with a similar risk of rectal cancer in both populations.

While dietary differences are already well known to be important, this discovery shows for the first time that genetic factors might explain some of the differences in bowel cancer risk between populations**.

This is one in a series of Cancer Research UK funded studies searching for bowel cancer susceptibility genes. The international collaborative project has the long term aim to find a set of genetic markers that could be used to identify subgroups of the population with an increased risk of bowel cancer.

Lead author, Cancer Research UK’s Professor Malcolm Dunlop based at the Institute of Genetics and Molecular Medicine at the University of Edinburgh, said: “This is the first time that a race-specific effect has been found for a genetic marker. It’s an important step forward in our knowledge of the causes of bowel cancer, bringing us ever closer to a genetic test for those at high risk of the disease.

“It’s important to catch bowel cancer at an early stage when it’s more likely to be treated successfully.”

Prof Dunlop and his team looked at the complete genetic make up of over 33,000 people in seven different countries.

In a parallel study, also published today in Nature Genetics***, a team of researchers led by Professor Richard Houlston based at the Institute of Cancer Research and Professor Ian Tomlinson at Cancer Research UK’s London Research Institute , along with Professor Dunlop and Professor Campbell in Edinburgh, found two new gene variants that increase the risk of bowel cancer.

Cancer Research UK’s director of cancer information, Dr Lesley Walker, said: “Our understanding of the causes of bowel cancer is quickly increasing. We can now begin to explain the some of the difference in rates of the disease between populations through specific genes.

“This international collaboration has helped us appreciate the complexity of the genetics behind bowel cancer. This collaboration will continue to bring knowledge that will eventually allow us to test people with a family history of the disease, catching cancer earlier in those who are at the highest risk or preventing it all together.”

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