Adjunctive Hyperbaric Oxygen Therapy in Refractory Crohn’s Disease: An Observational Study

Abstract

Background and Aims. Patients may experience complications of Crohn’s disease (CD) even when treated with optimal medical therapy strategies. Previous data have shown the efficacy of hyperbaric oxygen therapy (HBOT) in the management of complicated CD. However, there is no consensus regarding the optimal number of sessions or duration of treatment regimens. The aim of the present study was to investigate the efficacy of HBOT in CD patients who were refractory to conventional medical management. Methods. This study included patients who underwent HBOT for the treatment of the following complications: perianal fistulizing Crohn’s disease (pCD), enterocutaneous fistulas (ECF), or pyoderma gangrenosum (PG). Complete healing was defined as the closure of external orifice and the absence of active draining (in pCD), complete wound healing (in PG), and granulation or complete wound epithelialization with no enteric draining (in ECF). The persistence of draining and the absence of wound granulation were defined as incomplete healing. Results. Forty patients were included. The mean CD duration was 10.6 ± 5.8 years. pCD comprised most of the included patients (25/62.5%), followed by ECF ( n = 13 / 32.5 % ) and PG ( n = 6 / 15 % ). In two patients (5%), a combination of ECF and PG was diagnosed, and in one patient (2.5%), all three complications were observed. A total of 32 patients (82.5%) had complete healing. Patients with PG had the highest healing rates (100%), followed by those with ECF (84.6%) and pCD (80%). Conclusions. Adjunctive HBO was associated with significant healing rates for CD-associated complications such as pCD, ECF, and PG.

Role of hyperbaric oxygen therapy in patients with inflammatory bowel disease

“…The study included 20 patients 29]. Retrospective studies in patients with perianal fistulizing Crohn's disease, enterocutaneous fistulas, or pyoderma gangrenosum who underwent HBOT showed complete healing in 82.5% of patients with fistulas and 100% healing in patients with pyoderma gangrenosum [30]. In another study of 14 patients with refractory enterocutaneous fistulas, perineal disease, or pyoderma gangrenosum, 11 patients had improvement, healing, and local control of inflammation after HBOT sessions [31].…”

Efficacy and Safety of Hyperbaric Oxygen Therapy in Fistulizing Crohn’s Disease

“…These included 4 CRs, 11 CS, and 1 case-controlled trial with a total of 164 patients. 23,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] The majority of patients had underlying severe disease refractory to conventional therapy, including corticosteroids, antibiotics, immunomodulators (IMs), surgery, and/or biologic agents. Treatment outcomes were reported based on clinical judgment, magnetic resonance imaging (MRI), standardized questionnaires, and/or endoscopy.…”

“…Six studies were published in the prebiologic era (before 1998) 23,42,43,[46][47][48] and 10 studies were published in the prebiologic era. 41,44,45,[49][50][51][52][53][54][55] Subgroup analysis based on the timing of publication demonstrated that the pooled overall clinical response to HBOT was 86% (95% CI: 0.68-0.95, I 2 = 0) in the prebiologic era and 82% (95% CI: 0.74-0.87, I 2 = 0) in the biologic era (Fig. 4A).…”

“…Sensitivity analysis showed no difference in outcome when CRs or studies with patients with J-pouch were excluded. 44,[49][50][51][52][53][54] Iezzi et al 45 revealed an 80% overall clinical response rate after HBOT without distinguishing clinical remission and partial response. Piotrowicz and colleagues compared HBOT, IMs, and biologics in 3 patients with HBOT and IMs in 4 patients with fistulizing perineal CD.…”

A Review of Hyperbaric Oxygen Therapy for Inflammatory Bowel Disease

“…HBOT was identified as an adjunctive therapy for treating IBD, but not considered as the main treatment, as the results from various studies varied and bias was observed. In a study 48 focusing on the effect of HBOT on complicated Crohn’s disease (in the patients who were refractory to conventional treatment practices), it was identified that HBOT was effective on patients with various complications including perianal fistulizing Crohn’s disease (pCD) (80% healing rate), enterocutaneous fistulas (ECF) (84.6%), or pyoderma gangrenosum (PG) (100%). Similarly, HBOT was also identified to be an effective adjunctive approach for treating metastatic Crohn’s disease.…”