Hyperbaric Oxygen for Ulcerative Colitis: Evidence Update

Sometimes a good small study is enough to merit serious attention, help prove a concept, and inspire others to expand the investigation.

The last and only time we reported on hyperbaric oxygen therapy (HBOT) for inflammatory bowel disease (IBD), the subject was a 2012 systematic review of the medical literature. IBD, or chronic inflammation of the digestive tract, includes Crohn's disease and ulcerative colitis. The author selected just 19 human studies for his analysis but showed promise for future research. Dozens of papers have been published since, and it's a pretty mixed bag.

Now comes an interesting little study on HBOT for ulcerative colitis. Including only 18 patients, but quite well designed, the randomized, double-blind, sham-controlled trial was conducted by gastroenterologists at Dartmouth, the Mayo Clinic, University of Pittsburgh, and University of California San Diego. They presented their findings at the 12th Congress of the European Crohn's and Colitis Organisation (ECCO) in February.

Follow this link to the Study Abstract. Then read this helpful Summary and Perspective, which closes with a caveat:

This trial had a very small sample size, and while it produced a suggestive signal of efficacy, more research is clearly needed to determine the optimal dose, how often the therapy should be administered, and how quickly it works. Hyperbaric oxygen therapy is also very expensive, so if it does work, it has to work well to be worth the high cost. 

Hear, hear. Still, clinicians who have have been following the research on hyperbaric oxygen in IBD may find this work newly encouraging. Its careful design, authorship by leading physicians at major academic centers, and presentation at a leading medical conference set it apart from the growing medical literature on this topic.

People living with these chronic diseases should understand these results mark the very first stages of human clinical trials. We will be waiting and watching for more evidence and trends in clinical practice in the months and years ahead. As we see more activity we may add inflammatory bowel disease, including Crohn's and ulcerative colitis, to our directory of diseases and conditions treated with hyperbaric oxygen therapy.

We think it is vitally important that patients and referring physicians get information about the state of clinical evidence, for both approved and off-label conditions, so they can jointly make the best healthcare decisions. Learn more about our Editorial Policy for selecting the information we publish on HyperbaricLink.

Hyperbaric Oxygen for Inflammatory Bowel Disease (IBD): Systematic Review of the Medical Literature

We are loath to recommend the work of such a controversial figure as Dr Daniel Rossignol. But his new systematic review and analysis of the medical literature on hyperbaric oxygen therapy (HBOT) for inflammatory bowel disease is very helpful indeed.

Inflammatory bowel disease (IBD), the chronic inflammation of all or part of the digestive tract, includes Crohn's disease and ulcerative colitis. Rossignol's review includes both human and animal models, touches on some of the physiologic mechanisms that may (or may not) be involved, and finds the published clinical evidence for HBOT stronger for Crohn's than for ulcerative colitis:

In the studies of Crohn's disease, 78% of treated patients had an improvement with HBOT at a pressure ranging from 2.0 to 2.8 ATA. In the studies of ulcerative colitis, all treated patients showed improvements with a pressure delivered at 2.0 ATA. These studies suggest that a higher pressure may be needed to achieve these improvements. However, because none of these studies utilized a lower pressure of HBOT, it is not known if a lower pressure or oxygen level would be beneficial in IBD. However, some investigators have reported improvements in GI function in some children with autism using HBOT at 1.3 to 1.5 ATA [117,118]. Furthermore, previous studies have reported improvements in certain neurological conditions using hyperbaric treatment at lower pressures and/or oxygen levels [119-122]. Additional studies using HBOT at varying oxygen concentrations and atmospheric pressures would be helpful in determining optimal treatment protocols.

This self-serving argument and the mild HBOT studies cited, 117-122, including Rossignol's own widely discredited autism study, significantly weaken an otherwise fine review of the medical literature on this important topic.

[Image: findingDulcinea]