Hyperbaric Oxygen Therapy shows potential with Irritable Bowel Disease

Irritable bowel disease (IBD), including Crohn’s disease and ulcerative colitis, are traditionally treated with corticosteroids, anti-inflammatories and immunomodulators. Unfortunately, these treatments seldom eliminate symptoms long-term.

In a multi-center, 2017 study by Dulai et al., patients who were hospitalized for moderate to severe flareups of UC were placed in a double blind randomized study. There were a total of 18 patients treated, (10 HBOT, 8 sham treatments), in several medical centers including UC San Diego, Mayo Clinic, Dartmouth Hitchcock Medical Center and the University of Pittsburgh Medical Center. The patients were treated either with steroids and HBOT or steroids and a sham HBOT treatment. After 10 days of daily treatments, the HBOT group had a response of 80% vs. 25% for the sham group, and remission of 50% for the HBOT group vs. 0% for the sham group. Response to HBOT was seen in some patients as early as the third day of treatment.

The researchers concluded that HBOT, along with steroids, resulted in higher rates of response and remission as well as a reduction in rates of colectomy surgeries (0% HBOT vs. 38% sham). It also resulted in reduced rates of progression on to anti-TNF therapy for hospitalized patients with moderate to severe flares. For patients with UC, and especially those who have been hospitalized, HBOT should clearly be considered.

There have been two recent literature reviews in the last decade, one by Rossignol in 2012 and one by Dulai et al. in 2014 to quantify the rate of response of IBD patients to treatment with hyperbaric oxygen therapy (HBOT).

In the Rossignol review published in 2012,^[1]This is the content of my tooltip! he identified 19 studies to include in his review, out of 466 publications identified:

In 13 studies on the use of HBOT on Crohn’s disease,

• 31/40 patients, or 78%, showed improvement.

In 6 studies on the use of HBOT on ulcerative colitis,

• 39/39 patients, or 100%, showed improvement.

In all of these studies, patients had severe (IBD) that was not responsive to standard medical treatment.

Dulai et al. ^[2] conducted a review in 2014 that identified 17 studies to use in their analysis and outcomes:

Out of 42 patients with Crohn’s disease in these studies:

• 18/40, or 43%, were completely healed, with perineal and/or fistulising Crohn’s
• 17/40, or 41%, showed partial healing,
• 5/40 were unresponsive
• 2/40 did not finish treatment
• 88% showed a positive overall response

Out of 42 patients with ulcerative colitis in these studies:

• 39/39 patients improved, which was a 100% overall response rate!

Hyperbaric oxygen therapy offers a promising new treatment option since it targets both tissue hypoxia and inflammation. Many of the mechanisms underlying the improvement are not really known partially because HBOT works on many levels including suppressing inflammatory gene expression, rebuilding microscopic blood vessels and tissues as well as antibacterial mechanisms.

Chronic inflammatory bowel disease is often difficult to treat and the two systematic reviews cited show impressive responses.

HBOT is a relatively safe treatment. Of course, we need more studies to understand the true benefits of HBOT. But given the severity of IBD and its impact on the patient’s work and family life, HBOT should be seriously considered as an adjunctive treatment for IBD.