Intest Res.  2022 Apr;20(2):231-239. 10.5217/ir.2021.00056.

Efficacy and tolerability of hyperbaric oxygen therapy in small bowel stricturing Crohn’s disease: a pilot study

• Kante B
• Sahu P
• Kedia S
• Vuyyuru SK
• Soni K
• Singhal M
• Sharma R
• Makharia G
• Ahuja V

• KMID: 2529569
• DOI: http://doi.org/10.5217/ir.2021.00056

Abstract

Background/Aims
Existing therapeutic options for complicated Crohn’s disease (CD) like biologics and surgery are limited by inadequate long-term efficacy, cost, and adverse effects. Tissue hypoxia is important in CD pathogenesis and may be ameliorated with hyperbaric oxygen therapy (HBOT). We assessed the efficacy and tolerability of HBOT in small bowel stricturing CD.
Methods
This pilot study included patients of small bowel stricturing CD (from April 2019 to January 2020) who underwent HBOT. These patients were refractory to conventional medical treatment or had multiple strictures not amenable to resection. Each session of HBOT was given for 60 minutes with a pressure of 1.5–2.5 atm. Clinical, biochemical responses and Short Inflammatory Bowel Disease (SIBD) questionnaire were evaluated at 2 and 6 months, and radiological response was evaluated at 6 months.
Results
Fourteen patients (mean age, 42.9±15.7 years; male, 50%) were subjected to 168 HBOT sessions. Thirteen patients (92.7%) had strictures and 1 patient had enterocutaneous fistula in addition. Median number of HBOT sessions was 11 (range, 3–20) which were administered over a median of 4 weeks. Most patients tolerated it well except 1 who had hemotympanum. At 2 and 6 months of follow-up, 64.2% of patients had a clinical response, 50% and 64.2% of patients had clinical remission respectively. Steroid-free clinical remission was seen in 8 (57%) of patients with radiological improvement in 50%. There was a significant improvement in SIBD scores at 2-month follow-up (59.4 vs. 44.5, P=0.03).
Conclusions
HBOT can be a safe and effective therapeutic option in patients with stricturing small bowel CD refractory to conventional medical treatment.

Keyword

Crohn disease; Stricturing disease; Hyperbaric oxygen therapy

Figure

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  Fig. 1. Consort chart. CD, Crohn’s disease; HBOT, hyperbaric oxygen therapy.

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  Fig. 2. Magnetic resonance enterography images. (A) T1 weighted contrast image of a patient showing ileal stricture with proximal dilatation and marked enhancement (pre-HBOT) calculated MEGS score 7. (B) T1 weighted contrast image of a patient showing ileal stricture with proximal dilatation and reduced enhancement (post 6 months of HBOT) compared to (A) calculated MEGS score 5. HBOT, hyperbaric oxygen therapy; MEGS, magnetic resonance enterography global score.

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