Hyperbaric Oxygen Therapy shows potential with Irritable Bowel Disease
Irritable bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, has traditionally been managed with corticosteroids, anti-inflammatories, and immunomodulators. Regrettably, these treatment approaches often fall short in providing long-term symptom relief.
However, a recent study conducted by researchers has yielded promising results regarding the use of hyperbaric oxygen therapy (HBOT) in conjunction with steroids. The study found that this combined approach led to higher rates of response and remission among patients, while also reducing the likelihood of disease progression to more severe stages.
IBD gives rise to significant complications, characterized by symptoms such as abdominal pain, fever, weight loss, mucosal inflammation, and diarrhea. Unfortunately, many patients with IBD fail to respond adequately to conventional treatments. A study by Siegel in 2018 shed light on the severity of the condition, revealing that nearly 25% of patients experiencing a severe acute episode of ulcerative colitis require hospitalization. Of those hospitalized, 30% ultimately undergo surgery, and within this group, 25% encounter post-operative complications. Consequently, the need for alternative therapeutic approaches for IBD patients becomes evident.
In a multi-center study conducted in 2017 by Dulai et al., hospitalized patients with moderate to severe flare-ups of ulcerative colitis (UC) were enrolled in a double-blind randomized trial. The study involved a total of 18 patients, with 10 receiving HBOT in combination with steroids and 8 receiving a sham HBOT treatment alongside steroids. Following ten days of daily treatments, the HBOT group exhibited a response rate of 80% compared to 25% in the sham group. Moreover, remission was achieved by 50% of the HBOT group, whereas the sham group showed no remission. Notably, some patients in the HBOT group demonstrated a response as early as the third day of treatment.
Based on these findings, the researchers concluded that HBOT, in conjunction with steroids, leads to higher response and remission rates, while also reducing the need for colectomy surgeries (0% in the HBOT group compared to 38% in the sham group). Furthermore, HBOT was associated with a decreased likelihood of progressing to anti-TNF therapy in hospitalized patients experiencing moderate to severe UC flares. Given these outcomes, HBOT should unquestionably be considered as a viable option for patients with UC, particularly those requiring hospitalization.
Two recent literature reviews conducted by Rossignol in 2012 and Dulai et al. in 2014 aimed to assess the response rates of IBD patients to HBOT. In the Rossignol review, 19 studies were included, focusing on patients with Crohn's disease and ulcerative colitis who had not responded to standard medical treatments. The results indicated that 78% of Crohn's disease patients and 100% of ulcerative colitis patients showed improvement following HBOT.
In the Dulai et al. review, which included 17 studies, 88% of Crohn's disease patients exhibited a positive overall response to HBOT, with 43% achieving complete healing and 41% experiencing partial healing. Among ulcerative colitis patients, the overall response rate was 100%, with all 39 patients showing improvement.
Hyperbaric oxygen therapy presents a promising new treatment avenue as it effectively targets tissue hypoxia and inflammation, which are key factors in IBD. While the precise mechanisms underlying its benefits are not yet fully understood, HBOT operates on multiple levels, including the suppression of inflammatory gene expression, tissue and blood vessel regeneration, and antibacterial effects.
Chronic inflammatory bowel disease poses considerable challenges in terms of treatment, and the systematic reviews cited above demonstrate impressive responses to HBOT.