Inflammatory bowel disease, the main types comprising Crohn’s disease and ulcerative colitis, is a debilitating chronic illness that affects millions of people worldwide. Though there are various therapies available for its treatment, many patients still struggle to control their symptoms and achieve remission. Recently, hyperbaric oxygen therapy (HBOT) has gained increasing interest as a treatment option for inflammatory bowel disease due to its potential, safety and efficacy.
Existing therapeutic options for complicated inflammatory bowel diseases like biologics and surgery are limited by inadequate long-term efficacy, cost, and adverse effects. Therefore, intensive research into coadjuvant treatment approaches has been required, leading to the emergence of hyperbaric oxygen therapy as a promising option. Preliminary high-quality evidence suggests that HBOT is safe and associated with substantial rates of clinical remission for multiple Inflammatory bowel disease phenotypes McCurdy et al.,2022
The exact cause of IBD is unknown. But, hypoxia is a known contributor to inflammation in inflammatory bowel diseases (IBD), and in recent years, a growing interest has emerged in pharmacologically targeting hypoxia response pathways to treat IBD. Hyperbaric oxygen therapy is a highly effective and proven method for increasing tissue oxygenation. During a hyperbaric oxygen therapy session, the patient inhales pure oxygen in a pressurized chamber, which allows for more oxygen to dissolve into their plasma.
Additionally, research indicates that HBOT has the ability to decrease inflammation, enhance tissue oxygenation and functionality, stimulate colonic stem cells for the purpose of fostering recovery from intestinal ulcers, mitigate infections and abscesses, as well as diminish the necessity for surgical intervention for some patients Bekheit et al., 2016
HBOT is found to be a safe and effective therapeutic option in patients with stricturing small bowel Crohn’s disease refractory to conventional medical treatment Kante et al., 2022. Moreover, case studies have provided evidence that hyperbaric oxygen therapy could be a promising option for treating stubborn cases of ulcerative colitis, as exemplified in this specific review Vazharov, 2017.
Additionally, there have been extensive and well-documented reports on the beneficial impacts of hyperbaric oxygen therapy in relation to treating perianal fistulas among patients with Crohn’s disease. A trial including 20 patients with therapy‐refractory perianal fistulas in Crohn’s disease that were treated with 40 sessions of hyperbaric oxygen therapy, has shown a significant improvement in clinical, radiologic, biochemical and patient‐reported outcomes, and the results maintained at 1-year follow-up Lansdorp, 2022. Nonetheless, previous limited research by the same author indicates that Hyperbaric oxygen therapy when used as a monotherapy was not found to be efficacious in addressing rectovaginal fistulas Lansdorp, 2021.
Regarding hospitalized patients, a study conducted by Dulai et al., revealed that hyperbaric oxygen therapy can enhance the efficacy of intravenous steroids in hospitalized ulcerative colitis patients experiencing acute flares. This treatment has been shown to result in low rates of re-hospitalization and colectomy within three months, indicating its positive impact on patient outcomes. An optimal clinical response to hyperbaric oxygen is typically achieved after a five-day course of treatment.
Finally, a recent meta-analysis conducted by McCurdy et al. in 2022 analyzed 19 studies involving a total of 809 patients, including three randomized controlled trials and sixteen case series. The results indicated significant rates of clinical remission in different types of inflammatory bowel diseases. The clinical remission rates for various inflammatory bowel diseases were reported as follows: 87% for ulcerative colitis, 88% for Crohn’s disease affecting the intestine lining, 60% for perianal Crohn’s disease, 31% for pouch disorders, 92 % for pyoderma gangrenosum, and finally 65 % for perianal sinus/metastatic Crohn’s Disease. Although twelve studies assessed treatment safety with hyperbaric oxygen therapy, findings showed that only minor adverse effects occurred in about 15% of patients. The studies’ quality was inadequate in most cases due to the lack of comparative groups, insufficient information on concurrent interventions and/or absence of quantifiable outcomes.
From a practical standpoint, the frequency and duration of hyperbaric oxygen therapy sessions necessary to achieve the therapeutic benefits may vary depending on factors such as a patient’s medical history, disease severity, and individual response to treatment. However, achieving effective outcomes from HBOT typically demands a regimen of 30 to 40 consecutive sessions.
In summary, hyperbaric oxygen therapy shows potential as a safe and effective option for treating individuals with inflammatory bowel disease in conjunction with conventional therapies like medication or surgery. Further research is needed to fully understand HBOT’s mechanisms of action in IBD and to optimize treatment protocols for the best possible outcomes.