Ae. Duggan et al., CLARIFICATION OF THE LINK BETWEEN POLYUNSATURATED FATTY-ACIDS AND HELICOBACTER-PYLORI-ASSOCIATED DUODENAL-ULCER DISEASE - A DIETARY INTERVENTION STUDY, British Journal of Nutrition, 78(4), 1997, pp. 515-522
Epidemiological evidence has suggested that the declining prevalence o
f duodenal ulcer disease may be attributable to rising consumption of
polyunsaturated fatty acids, a hypothesis supported by in vitro eviden
ce of toxicity of such substances to Helicobacter pylori. The objectiv
e of the present study was to establish whether this association is ca
usal. Forty patients with proven infection with H. pylori and endoscop
ic evidence of past or present duodenal ulcer disease were randomized
to receive either polyunsaturated fatty acids (PUFA group), in the for
m of capsules and margarine, or a placebo (control). Both groups recei
ved concurrent Hz antagonist therapy. Efficacy of therapy was determin
ed endoscopically by assessment of ulcer healing while H. pylori statu
s was determined by antral biopsy, urease (EC 3.5.1.5) culture and his
tological assessment of the severity of H. pylori infection. Antral le
vels of prostaglandin E-2 (PGE2) and leukotriene B-4 (LTB4) were quant
ified. Compliance was monitored. Before treatment, both groups were co
mparable for severity of H. pylori infection, smoking status and level
s of LTB4 and PGE(2). Despite a significant difference in consumption
of linoleic acid (19.9 (SE 1.6) g for PUFA group v. 6.7 (se 0.8) g for
controls (P < 0.01) and linolenic acid (2.6 (SE 0.2) g nu. 0.6 (SE 0.
03) g (P < 0.01) there was no significant change in either the severit
y of H. pylori infection or prostaglandin levels in either group at 6
weeks. Consumption of a considerable amount of PUFA does not inhibit t
he colonization of the stomach by H. pylori nor does this alter the in
flammatory changes characteristic of H. pylori gastritis. We conclude
that the association between duodenal ulceration and a low level of di
etary PUFA is likely to be spurious, probably reflecting the effect of
confounding factors such as affluence, social class or smoking.