CROHN'S DISEASE, IRRITABLE BOWEL SYNDROME, ULCERATIVE COLITIS
Hyperbaric oxygen therapy for pyoderma gangrenosum associated with ulcerative colitis.
Intest Res 2018 Jan 18;16(1):155-157. Epub 2018 Jan 18.
Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
Pyoderma gangrenosum (PG), an ulcerating skin condition, is rare in patients with ulcerative colitis (UC). We report a case of successful treatment of PG in a patient with UC using hyperbaric oxygen therapy (HBOT). The patient had UC that was in remission following treatment with mesalazine and azathioprine therapy. After visiting an orthopedic clinic, the patient opted for treatment with antibiotics and daily dressing of the ulcerative skin lesions, while azathioprine was discontinued. However, the lesions did not improve. Two months later, the patient visited a dermatologist who diagnosed the lesions as PG, and he was admitted to our unit. Surgical debridement and HBOT were performed by a plastic surgeon in the emergency department. After 3 months of HBOT and topical treatment, the patient's PG completely resolved. His UC was still in remission with mesalazine alone. HBOT may be an effective and safe alternative treatment for PG associated with UC, particularly in patients in whom anti-tumor necrosis factor agents are unnecessary.
Med Gas Res. 2012 Mar 15;2(1):6. doi: 10.1186/2045-9912-2-6.
Hyperbaric oxygen treatment for inflammatory bowel disease: a systematic review and analysis
1Rossignol Medical Center, 3800 West Eau Gallie Blvd,, Melbourne, FL 32934, USA. email@example.com.
Traditionally, hyperbaric oxygen treatment (HBOT) has been used to treat a limited repertoire of disease, including decompression sickness and healing of problem wounds. However, some investigators have used HBOT to treat inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis.
Comprehensive searches were conducted in 8 scientific databases through 2011 to identify publications using HBOT in IBD. Human studies and animal models were collated separately.
Thirteen studies of HBOT in Crohn's disease and 6 studies in ulcerative colitis were identified. In all studies, participants had severe disease refractory to standard medical treatments, including corticosteroids, immunomodulators and anti-inflammatory medications.
In patients with Crohn's disease, 31/40 (78%) had clinical improvements with HBOT, while all 39 patients with ulcerative colitis improved.
One study in Crohn's disease reported a significant decrease in proinflammatory cytokines (IL-1, IL-6 and TNF-alpha) and one study in ulcerative colitis reported a decrease in IL-6 with HBOT. Adverse events were minimal.
Twelve publications reported using HBOT in animal models of experimentally-induced IBD, including several studies reporting decreased markers of inflammation or immune dysregulation, including TNF-alpha (3 studies), IL-1beta (2 studies), neopterin (1 study) and myeloperoxidase activity (5 studies). HBOT also decreased oxidative stress markers including malondialdehyde (3 studies) and plasma carbonyl content (2 studies), except for one study that reported increased plasma carbonyl content.
Several studies reported HBOT lowered nitric oxide (3 studies) and nitric oxide synthase (3 studies) and one study reported a decrease in prostaglandin E2 levels. Four animal studies reported decreased edema or colonic tissue weight with HBOT, and 8 studies reported microscopic improvements on histopathological examination. Although most publications reported improvements with HBOT, some studies suffered from limitations, including possible publication and referral biases, the lack of a control group, the retrospective nature and a small number of participants.
HBOT lowered markers of inflammation and oxidative stress and ameliorated IBD in both human and animal studies. Most treated patients were refractory to standard medical treatments. Additional studies are warranted to investigate the effects of HBOT on biomarkers of oxidative stress and inflammation as well as clinical outcomes in individuals with IBD.
Aliment Pharmacol Ther. 2014 Jun;39(11):1266-75. doi: 10.1111/apt.12753. Epub 2014 Apr 16.
Systematic review: The safety and efficacy of hyperbaric oxygen therapy for inflammatory bowel disease
1Inflammatory Bowel Disease Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Center for Hyperbaric Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Hyperbaric oxygen therapy (HBOT) provides 100% oxygen under pressure, which increases tissue oxygen levels, relieves hypoxia and alters inflammatory pathways. Although there is experience using HBOT in Crohn's disease and ulcerative colitis, the safety and overall efficacy of HBOT in inflammatory bowel disease (IBD) is unknown.
To quantify the safety and efficacy of HBOT for Crohn's disease (CD) and ulcerative colitis (UC). The rate of adverse events with HBOT for IBD was compared to the expected rate of adverse events with HBOT.
MEDLINE, EMBASE, Cochrane Collaboration and Web of Knowledge were systematically searched using the PRISMA standards for systematic reviews. Seventeen studies involving 613 patients (286 CD, 327 UC) were included.
The overall response rate was 86% (85% CD, 88% UC). The overall response rate for perineal CD was 88% (18/40 complete healing, 17/40 partial healing). Of the 40 UC patients with endoscopic follow-up reported, the overall response rate to HBOT was 100%. During the 8924 treatments, there were a total of nine adverse events, six of which were serious. The rate of adverse events with HBOT in IBD is lower than that seen when utilising HBOT for other indications (P < 0.01). The risk of bias across studies was high.
Hyperbaric oxygen therapy is a relatively safe and potentially efficacious treatment option for IBD patients. To understand the true benefit of HBOT in IBD, well-controlled, blinded, randomised trials are needed for both Crohn's disease and ulcerative colitis.
Scand J Gastroenterol. 2013 Sep;48(9):1033-40. doi: 10.3109/00365521.2013.819443. Epub 2013 Jul 23.
Hyperbaric oxygen therapy does not improve the effects of standardized treatment in a severe attack of ulcerative colitis: a prospective randomized study
1Department of Internal Medicine and Geriatrics, Sahlgrenska University Hospital/Östra Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
BACKGROUND AND AIMS:
Complementary therapy options are needed in the treatment of active ulcerative colitis (UC). Hyperbaric oxygen therapy (HBOT) has been shown to have positive effects in experimental models of colitis and perianal Crohn's disease.
In the present prospective randomized open-label study, HBOT in addition to conventional medical treatment was compared with conventional treatment alone. The primary objective in this study was improved clinical outcome evaluated by Mayo score, laboratory tests and fecal weight. The secondary objectives were improvement in health-related quality of life, avoidance of colectomy and evaluation of HBOT safety.
The authors found no statistically significant differences between the treatment groups in any of the assessed variables.
The study results do not support the use of HBOT as a treatment option in a severe attack of UC.
Dis Colon Rectum. 2006 May;49(5):682-4.
Granulocyte-macrophage colony-stimulating factor for perianal hidradenitis suppurativa: report of a case.
Perianal hidradenitis suppurativa is a chronic inflammatory disease associated with significantly high morbidity, which severely affects the quality of life of those patients suffering from it. We describe a 46-year-old patient with extensive, severe gluteal and perianal PHS of 28 years duration. Repeated wide excisions, fistulotomies, treatments with hyperbaric oxygen, and finally a diverting colostomy were unsuccessful. A new form of treatment with repeated perilesional injections of granulocyte-macrophage colony-stimulating factor, in conjunction with surgical procedures, was performed with excellent results.