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Crohn's Disease Forum » Treatment » Hyperbaric oxygen therapy for Crohn's and IBD


 
04-24-2011, 09:20 PM   #1
MyButt
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Hyperbaric oxygen therapy for Crohn's and IBD

Has anyone here utilized hyperbaric oxygen therapy in the treatment of their Crohn's Disease or other forms of IBD? If so, how were your results, were you able to obtain remission?

I've heard of some pretty good results from people doing HBOT but I'd love all the insight I can get. Thank you
04-27-2011, 07:18 PM   #2
JJOM
 
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I too am looking for information on this.

I have made an inquiry with a local provider, and the cost was WAY more than I expected. This providers' equipment is like and inflatable raft with a couple of pumps (not the huge units found at some hospitals).

It would be helpful if anyone who has experience with Hyperbaric therapy could include information about the quality of their 'provider', the equipment used, cost for treatment and number of treatment utilized.

Thanks, JJOM
04-28-2011, 09:01 AM   #3
HBOTlady
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Hyperbaric Oxygen Therapy (HBOT) is an extremely effective treatment for Chrohn's, IBS and other inflammatory bowel diseases and conditions. I would not recommend going to a provider that uses inflatable chambers - only hospital grade, as inflatable chambers cannot acheive the treatment depth needed to treat Chrohn's and IBS. Also, make sure that the provider you chose has a physician as its medical director. Unfotunately, free standing hyperbaric centers are not well regulated. In hospital hyperbaric facilities will not treat Chron's or IBS as those conditions are still considered, "off-label". You will need a series of treatments, probably at least 10 on the low side, but the hyperbaric physician will determine that after hearing your medical history. HBOT is considered a medical treatment and requires a prescription. Good luck and I hope you can find a provider close to where you are!
04-28-2011, 09:11 PM   #4
HBOTlady
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To read the latest medical research going on Interntionally and in the States, go to the Research Page on HBTUSA's website to see the progress that has been made.
07-22-2011, 02:42 PM   #5
phillycrohns
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Hi everyone:

I have not posted for a long time. I wanted to reply to this post because I have completed 30 sessions of HBOT about 2 months ago. Here is the back story:

I was diagnosed with Crohns about 12 years ago, although my doctor tells me my disease is presenting as colitis--and so she calls my disease colitis. Doesn't matter, except to ensuring that meds reach the target area, as they are both IBD. Anyhow, I am a firm believer that there is something out there that can help me control my disease with minimumal risk and toxicity and I just have to find it/them. My personal belief is that immunosuppresants and biological agents (or whatever you want to call them) are dangerous in the long run. I am not knocking anyone who is taking them. I believe everyone should do whatever works for you. But me personally, they are my last resort.

I have tried many different treatments over the years from anti-oxidant therapy (intravenous alpha-lipoic acid) to MMS (Miracle Mineral Solution) to low-dose naltrexone (I am still taking this). Some did not work at all or made me worse, others worked temporarily, but then failed. Early this year, I was having a difficult time controlling my symptoms and inflammation (not that they were ever well-controlled anyway) and my doctor said Imuran was my next step. Well, I refused to take that step until I had exhausted all other possiblities, especially because I wanted to start a family within the next few years.

So, I come to HBOT. Initial clinical trials for Crohns/Colitis patients had produced some very positive results. I also noticed that HBOT is indicated (meaning approved and thus covered by insurance) for treatment of radiation-induced proctitis (I realize that the causes of radiation induced proctitis are very different from IBD-caused proctitis--which is a form of colitis--but ultimately a wound is a wound and HBOT is a wound-healer). If it will heal that form of procitis, why not the same condition (or similar) but caused by something else. SO I did a ton of research and decided this was my next treatment option. HBOTLady is correct, DO NOT BOTHER SPENDING YOUR MONEY ON INFLATABLE CHAMBERS. Hard-shell chambers are the real-deal and the only kind that you should use.

I began to call hospitals and treatment centers that had HBOT chambers to get information and pricing. Hospital run HBOT chambers are prohibitively expensive--they charge about $2,500 per session. You need a minimum of 30 sessions. My doctor, who ran the center where I received my treatment, stated that if you don't see results within 10 sessions, you likely should stop treatment and save your $ as it likely won't work for you.

So, I happened to find a HBOT center in a hospital that is not run by the hospital (and thus does not charge $2500 per session), but rather is run by an independent company. I felt good that this center was 1) in a hospital, 2) run by a physician, 3) had hard shell chambers (here is a picture of the EXACT chamber that I was in http://drcranton.com/hbo.htm - its a hard shell Seachrist model), 4) "dove" patients to a therapeutic level of 2x atmosphere minimum (don't quote me on this number, I don't have my notes in front of me, but based on the research I did it was considered the optimum therapeutic level for wound healing) at 100% pure oxygen, 5) followed safety procedures AT ALL TIMES such as patients can ONLY wear hospital gowns into the chamber with no jewelry, make-up, skin creams, nail polish, etc., 6) had staff there at all time monitoring patients. If you cannot find a HBOT center that offers all of these things, WALK AWAY and save your money and time!

Now, I went to the center M-F for 6 weeks (total of 30 sessions). Each "dive" (they call it a dive because the pressure is as if you are scuba diving) was 1 hour and 50 mins total. I cannot tell you the name of the center that I went to or how much I paid for treatment, as the doctor was giving me the lowest price he could charge and basically doing me a favor. I promised him that I would not give out this information. But if you call around, you will get a sense of what the costs are. And be aware that you will be paying out of pocket! This is treatment of IBD is not covered by insurance (at least none that I know of, but it never hurts to check). It is a lot of money and a huge time commitment. I traveled 1 hour to and from the center everyday, in addition to almost 2 hours in the chamber. But it was worth my time and money.

So the outcome: for the first time in years (and I really can't remember how long its been) I have been relatively symptom free to almost 3 mos straight. Let me also say, that prior to starting the HBOT treatment and during the entire treatment, I was following the Specific Carbohydrate Diet. Why? Because I wanted to give this treatment all the help I could give it. The SCD diet really does help my digestion, and I wanted to make sure the oxygen was given all the help I could give it in killing the bad critters and healing my wounds and balancing the microbes in my gut. Now that I am post treatment, I do not follow SCD strictly anymore. But I try to eat 2 out of 3 meals per day (if not severals days in a row) strictly following SCD and I don't want to take any chances and undo the good work that the HBOT has done. I have yet to have blood tests to confirm where my inflammation markers are. But I will say I have no bleeding and have well-formed stools and only go 1-2 x per day. My bowel movements are as close to normal as they can be. But I don't think I am necessarily 100% normal. I won't be convinced of that until I see how far this treatment will take me and how long this "feeling good" will last.

HBOT is a big financial investment. And I have no idea if it will work for everyone. That is the frustrating thing about undertaking treatments not covered by insurance, you have to be a guinea pig (often) and risk losing your money. But I don't regret my choice one bit.

I am still taking my Colitis meds. I don't want to get off of them just yet and rock the boat. Maybe someday.

The only downside to this treatment is if you have sensitive ears. And I do. The pressure caused my ear drums to be severely bruised and caused sinus problems. Midway through treatment, I had to have tubes put in my ears to help me regulate the pressure. But all of the other patients that were there (and I got to know many of them well as we saw eachother every day!) did not have the same ear problems that I did. And if anyone is wondering, I was the only IBD patient receiving treatment. All the other patients were wound patients and often has diabetes.

That is my story. I hope this helps you all. If you have any questions, just let me know. BTW, here is what the Mayo Clinic says about HBOT: "The increased oxygen dissolves in your blood during hyperbaric oxygen therapy, and circulates throughout your body. Oxygen-rich blood stimulates your body to release substances called growth factors and stem cells, which promote healing." God knows we all need some serious guy healing.

Chris
07-22-2011, 02:49 PM   #6
phillycrohns
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One thing I forget to mention. As I started HBOT treatment, I had just finished completely tapering off of prednisone to control a flare. So at the time I was relatively symptom-free. HOwever, given my past, I have always begun having symptoms again within 2 weeks of stopping prednisone. This time I did not, and I knew something was happening. GIven the fact that I am now 3mos symptom-free, I attribute this to the HBOT. I am telling you this because if you are in really bad shape, you may not be able to make it through even one treatment. Why? Because it takes an absolute minimum of 5 mins to take you down to pressure or bring you back up, and you are locked in the chamber for almost 2 hours, and there is pressure being put on your entire body including your intestines. I don't know if this treatment would be painful for someone in bad shape, or that you won't have to go to the bathroom at some point during the 2 hours you are in there due to the pressure. Something to think about....

Christine
07-23-2011, 10:36 AM   #7
stefan
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I've also had 40 sessions of HBOT back in 2004, entirely subsidised by the South Australian Government, but this was for a persistent and unresponsive infection that was unrelated to and prior to my IBD diagnosis.

Nobody I've spoken to here has been willing to make any claims about benefit or otherwise with HBOT treatment for IBD. They will say it definitely does help fight infection, specific cancers, or toxins such as venoms, plus a few other specific, and often very acute, conditions.

I do vaguely recall some conceptual discussions with my treating doctors about HBOT for IBD, and that while HBOT may help with healing, it can also be seen as an immune system booster, which may not be desirable for us. I'm not sure anybody here got to the stage of asking the HBOT team specifically whether HBOT was counterintuitive for people on immunosuppression, but being expensive and publicly subsidised, they tend not to take patients without good reason either.

I don't know how the protocol differs, but this hospitals' chamber seated 2-8 patients plus a specially trained nurse, all running for 2 hours 6 days a week. We were at 2 atmospheres of pressure, and breathing 100% oxygen through sealed but transparent hoods. At 2 atmospheres I would have expected the extra pressure put on the body was minimal, and is roughly equivalent to being 10m underwater. The large chambers I saw all had a toilet in the air lock, so it's accessible most of the time, just not necessarily quickly!

The chamber I was in is the white one that looks like a shipping container on the right at http://www.rah.sa.gov.au/hyperbaric/ you can also see the inside of it at http://www.rah.sa.gov.au/hyperbaric/patient_info.php.

I did just have a quick scan of pubmed for any journals relating to HBOT and Crohn's, and while there's definitely active research going on, it still doesn't look like there's any firm evidence it will help, while it does look promising at least for acute chronic perianal Crohn's.

I'm not sure I'd be investing thousands of dollars in to HBOT for IBD, but it's definitely worth considering, and hopefully there will be some more progress with research soon.
07-23-2011, 04:06 PM   #8
hopeful
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I had about 30 sessions. Definitvely helped with perianal fistula, and helped somewhat for the Crohn's inflammation but did not put ,e in remission or anywhere near it.

In England (where I started it), the multiple sclerosis patient groups 9a charity) all have them, and they charge 10 pounds a session (about $16).

In the USA there are many of them, but you can expect to pay about $75 and up a session.
04-17-2012, 03:43 PM   #9
raechel
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phillycrohns- How are you doing now? Do you still feel optimistic about HBOT for crohns?
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Diagnosed 2007, 1 resection in dec 2010 (12 inches of illeum and cecum), several abcesses.

Meds I've tried:Stelara, Pentasa, Entocort, Prednisone (over and over again) Remicade, Humira, Flagyl, 6MP, Imuran, Methotrexate.. I'm sure there's more I can't think of...
06-15-2012, 10:00 AM   #10
phillycrohns
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Hi Raechel:

My apologies for not responding sooner. I am actually not on the site very often. I consider myself in remission. I phrase it this way because I have not had a colonoscopy since my HBOT treatment to clinically prove that I am so. However, I have normal BM's and no bleeding or inflammation, none of the normal symptoms of colitis. It's been about a year since I finished my HBOT therapy.

I don't know if it was the HBOT that "healed" me or the combination of HBOT and the SCD diet that I was on while I was doing the therapy. I have also cut out most sugar from my diet (including fructose, i.e. fruit!) and try to eat a high fiber diet including legumes. So I don't expect that HBOT has "cured" me. Its just put me in a good state of health and it is up to me to keep me there by eating well and cutting out the stuff that is not good for the gut.

I wish I could give you and everyone else interested in HBOT a firm answer as far as whether or not it will work for you. I just don't know. Everyone's disease presents differently. Mine presented as proctitis. And maybe that is why HBOT worked for me. The further up the "gut" your disease is, perhaps that harder it is to treat. I just don't know. BUt I don't regret for on instance having tried it. I was willing to try and do anything in order to avoid Imuran and Remicade and these other strong drugs.

I hope this helps.

Chris
07-26-2013, 10:37 AM   #11
BoyMama2000
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Very interesting thread. We are considering this for my 15 year old son with an abscess resistant to treatment that has consisted of 4 surgeries, Entocort and pentasa/ antibiotics. When his Fecal Calprotectin goes up, his wound stops healing and gets worse. His disease is only in the ileum with no signs in rectum or sigmoid on recent scopes but a perianal abscess that won't fully heal. I hate to put him on a systemic immune suppressor since his disease is stable in his gut. I spoke with a doctor who runs a local children's hospital hyperbaric O2 clinic. He said he doubts it would be covered but will evaluate my son. He is first getting a 2nd opinion from an adult color-rectal surgeon who is highly recommended and the HBO2 doc knows well. He wants to know what he thinks first. I am glad to hear it has helped some with abscesses and fistulas. Recent MRI's show no fistula but there really could be one present.

Any thoughts from those of you who have done this for a 15 year old? School starts soon so imagine missing a lot will be an issue but hopefully we can work around that. The hospital is only 30 minutes away.

Thanks.
07-29-2013, 06:47 PM   #12
hopeful
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The data is good and the treatment is certainly safe, so what's there to lose? There are many "private" chambers in the US at wellness centers that would be much cheaper pers sessions than hospitals.
07-29-2013, 07:06 PM   #13
BoyMama2000
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Do you think they would work and be safe? The hospital one is approx. 800 per treatment and the local clinic one near our home is $175 per session. We are looking into both right now. The biggest issue with us is the time commitment with my son starting back to his sophomore year of high school in 3 weeks. I agree it is totally worth trying!
07-29-2013, 11:10 PM   #14
hopeful
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In England the Multiple Sclerosis day centers have them for 10 pounds a go - i.e. $15!!
07-30-2013, 12:03 AM   #15
BoyMama2000
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Maybe I can justify a trip for us! WOW!
07-30-2013, 02:04 AM   #16
rollinstone
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im very curious to know how this works with crohns?
08-02-2013, 06:02 PM   #17
BoyMama2000
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HBO2 is an "off label" use for Crohns. If you google hyperbaric oxygen and crohns or anti TNF, you will find a lot of studies and references. Basically, there is growing evidence that this works in inflammatory diseases and may work in a similar way to biologics. It has been used for years for assistance with wound healing (especially in diabetic population) and decompression sickness and the uses are now expanding.

We just visited with a hyperbaric medicine doctor this morning that is a part of a hospital in Denver. The most significant side effect is that it takes a lot of time. The treatment is about 2 hours and with driving it will be about a 3.5 hour commitment per day. It is often done for 20-40 days. We are waiting to see if it will be covered.

There are a few other potential side effects but all are reversible and to those of us used to making decisions for Crohn's meds, they seem like nothing.

The unit at this hospital is large and if approved, we will work with my son's school to make this work. He can bring a book and a pencil and paper in so he could do work in there. There are also smaller units that work as well.

For us, we started methotrexate and our doc would like to add remicade but we are hoping to see what methotrexate does and add HBO2. If it is not covered at this facility, there is a place near his high school that costs $175 per treatment that we may consider. If I had a girl, I may do remicade but the cancer risk is highest in boys and young men.

I will let you all know if it gets covered. Fingers crossed!
08-08-2013, 01:30 PM   #18
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Hi everybody!

I will start this therapy in a couple of weeks in Spain, I will update how it works on me... positively I hope. I am on perianal and a bowel flare for almost 9 months now, although the bowel flare is almost asymptomatic. The really bad thing is the perianal flare because I already had surgery 4 times for fistulaes, with 5 setons implanted, and still I am on antibiotics with intense pain and with a rebel perianal abscess.


In the hospital they've told me that I will breath oxygen at 100% in a 2atm environment and that in their experience of 30 years of therapy they've treated 3 patients with Crohn (2 perianal) with great improvements of their quality of life.

We will see. My Crohn in fact is a bit complex, started 15 years ago and had a really bad evolution. All possible medical treatments failed on me: prednisone, azatioprine, infliximab, humira, metotextrate and tacrolimus. I have been operated two times for resection and 4 times for perianal fistula.

I really wish this finally works on me... anyway I will keep you updated!
08-08-2013, 05:59 PM   #19
rollinstone
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I hope it works for you too, bless you!
08-08-2013, 06:09 PM   #20
BoyMama2000
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I also hope this is your answer and am very eager to hear how it goes!!! Best of luck to you. I hope and pray this is the first step to finally fixing this!

Thanks in advance for sharing your journey with us!
08-31-2013, 07:04 AM   #21
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Hi!

This week I finally started with the therapy. Fom Monday to Friday I had 4 sessions (had to be 5 but in one I had to exit the chamber because I had problems stabilizing pressure of my ears).

It's still too early to say anything about what the results are, but what I can say is that I left the antibiotics a week ago and at least I'm feeling as if I were still taking them. Hope this is a good signal.

Cheers!
08-31-2013, 10:46 AM   #22
BoyMama2000
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We can both give updates here together. My son starts next Tuesday. Any tips on working with the ear pressure? I think no antibiotics and no worsening is very likely a good sign!
09-24-2013, 03:49 PM   #23
BoyMama2000
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Hi Everyone,

My son is completing his 18th HBO2 treatment and the doctors will be discharging him at 20 treatments. We had up to 30 approved. His wound is healing really well as is the fistulotomy region next to the wound. The skin is filled in and the outer layer of skin is almost covering the wound. This Friday will be 4 weeks since his surgery. It will be great to have him be back at school full time but it has been worth the time and effort to get to HBO2.

We will be getting his fecal calprotectin measure later this week and see if there was any effect there. After 8 visits, we had one done for other reasons and it had gone up slightly but we also changed some meds. I am hoping and praying that his perianal disease will remain silent and that his ileal disease gets under control with his new meds.

It has been an 8 month haul with 5 surgeries, a ton of missed school and a lot of stress. I am hopeful he can lead a normal life for a little while. Fingers and toes are crossed.
10-03-2013, 09:59 PM   #24
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Hello I'm new to this thread. We are going to try this treatment. My daughter already had one treatment on Monday. It's a 3 hour drive each way and $200 plus dollars. We are trying to not have to have surgery on her ileum. The Wellness center we went to said to try HBOT therapy, reflexology, and frequency specific microcurrent therapy. We just started LDN. Is it important to do HBOT several times a week. I didn't ask, as these treatments are all new to me. any thoughts if once a week would work.
10-03-2013, 11:01 PM   #25
BoyMama2000
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HBO2 therapy is given 5-7 times a week to work. All of the research done relative to Crohn's disease has been done at 2.5 atmospheric pressure with 100% O2 for 1.5 hours which actually takes 2 hours to accomplish. If you don't mind me asking, what are your daughter's symptoms? It will be important to document them and look for improvement. If you are paying out of pocket, you will want to see changes for the better after 10 sessions. My son had his sessions 5 x week for 4 weeks. Does your daughter have perianal disease? This is where HBO2 seems most effective but there is research to show improvement with disease further up as well. My son's Crohns is in the terminal ileum but he did get a perianal abscess and fistula. The surgeons did not see signs of inflammation in his sigmoid and rectum on sigmoidoscopy and multiple surgeries.

Please, please, please let us know how she does!
10-05-2013, 12:24 PM   #26
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Hello BoyMama2000. I'm glad to hear this is working for your son. I'm gonna rant for just one moment. Why aren't more people, especially doctors, bringing this up as a potential treatment. Instead they just push medicines that have caused cancer in pediatric crohn's patients. sheesh! My daughter is 15, and I'm so glad I took her to the Wellness Institute and found this group at the same time. Because I'm sure I would have fallen over at the doctor's office if they told my how long, and how much HBOT will cost. We are doing some blood work, stool samples, and food allergy testing, when the results come in, I imagine that's when they will give us the plan of attack. currently we are most concerned about healing her ileum, this is where the inflammation is, and her GI said if we can't get it healed they will do a resection. She was in the hospital for a week in July. She was dx's 5 years ago, she did have a fistula, and took 1 treatment of Remicade. Then we researched this med, and freaked out. But for whatever reason, it put her in remission for 4 ish years, no meds, until now. So while in the hosp this year, I'm pretty sure the docs thought we were nuts, they argued for Humira because of the perianal disease, according to her MRI she has no fistulas, or fissures, but she does have a skin tag that bleeds occasionally, I argued against it, but gave in, because they are the experts. She started Humira, was release from the hosp, and within a week and a half she got worse, not better, as far as having belly problems, and now we can feel the ileum when you touch her stomach. So we luckily had a second opinion at Cedars-Sinai, they put her on prednisone, and 2 antibiotics, and if the inflammation got better to start Humira. So the Humira is sitting in our fridge, and I started researching. We are trying marijuana extracts, but can't tell a difference. I heard of LDN, and that's how I got to the Wellness center. I suppose I will call around to see if there is a HBOT place closer to home, compare prices and what not. It's such a roller coaster ride, hope, then set backs, but today I have hope again. So thanks to all who are on here. OH an any links to the research where it shows the atmospheric pressure and time, would be appreciated.
10-05-2013, 09:54 PM   #27
BoyMama2000
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Here are some references and one article: It is a bit jumbled but I didn't save the links, I just have a lot of research in PDF. Google and you will find a lot of stuff especially with regards to perianal Crohn's disease!

Hyperbaric Oxygen for Perianal Crohn’s Disease
J Clin Gastroenterol 1994;19(3): 202-5
A. Lavy, M.D., G. Weisz, M.D., Y. Adir, M.D., Y. Rarnon, M.D.,
Y. Melamed, M.D., and S. Eidelman, M.D.
Perianal involvement in Crohn's disease is common (<= 50%), distressing, and frequently refractory to treatment. Clinical
features include painful induration and stenosis, discharging fistulas, and fissures. The pathogenesis of these lesions is
unclear, but local ischemia and secondary anaerobic infection may play a role. Following three sporadic reports of
successful treatment with hyperbaric oxygen (HBO), we undertook a trial of this method in 10 patients with refractory
perianal disease. These patients' perianal Crohn's disease had not responded to treatment that included local medications,
salicylates, corticosteroids, metronidazole, or 6-mercap-topurine were treated. Treatment was administered in a hyperbaric
chamber at a pressure of 2.5 atm absolute. Each session lasted 90 min, and each course consisted of 20 daily sessions.
Complete healing occurred in 5 patients after one to two courses. In an additional 2, after three courses, 1 patient improved
but did not heal, and 2 did not improve. No adverse effects were noted by any of the 10 patients. Follow-up of 18 months
did not reveal any recurrence. These preliminary results confirm that HBO therapy is a safe and efficient therapeutic option
for perianal Crohn's disease.
Key Words: Crohn's disease-Perianal involvement-Hyperbaric oxygen therapy.
Received October 5, 1993. Sent for revision December 13, 1993. Accepted April 30, 1994. From the
Department of Gastroenterology, Rambam Medical Center, and Israeli Naval Hyperbaric Institute, Haifa, Israel.
Address correspondence and reprint requests to Dr. A. Lavy at Department of Gastroenterology, Rambam
Medical Center, and Israeli Naval Hyperbaric Institute, Haifa, Israel.
Crohn's disease involves the perianal region in <= 50% of patients (1) and causes painful induration, abscesses, fistulas
with discharge, and fissures, which are extremely distressing to the patient and refractory to treatment (2,3). The reason for
these lesions is poorly understood (4,5). Their indolent nature is compatible with ischemia and secondary bacterial invasion
as possible pathogenetic factors. Wakefield et al. (5) conducted morphological studies that demonstrated occlusive fibrinoid
lesions of the arteries supplying areas of the intestine affected by Crohn's disease. Hypoxia can compromise wound healing
(6), whereas improved tissue oxygenation can restore a favorable cellular milieu in which the wound healing process and
host antibacterial mechanisms, particularly against anaerobes, are enhanced (6,7).
Following sporadic case reports of the successful integration of hyperbaric oxygen (HBO) treatment in patients with fistulas
due to Crohn's disease (8-10), we undertook a trial of this therapy in 10 consecutive patients, some of whom had not
responded to prolonged conventional therapy with salicylates, corticosteroids, metronidazole, and 6-mercaptopurine. Our
results are reported here.
METHODS
Ten patients with Crohn's disease involving the perianal region were treated with HBO. Perianal disease was selected as the
only obvious parameter to follow objectively. In most of the patients, activity of the disease, as demonstrated by the Harvey
Bradshaw activity index (11), was relatively low grade except for the perianal disease (Table 1).
Inclusion Criteria
The treatment was offered to all patients with perianal Crohn's disease who were willing to undergo the 90-mm daily
sessions in the hyperbaric chamber. Each had a complete physical examination and routine blood tests, as well as chest xray
and ear, nose, and throat (ENT) examination before therapy. The nature and severity of the perianal disease were
documented before and after each course of therapy.
HBO was administered in a multiplace hyperbaric chamber constructed by Drager, Germany. A course of 20 daily
treatments (6 times weekly) was given (100% oxygen for 90 mm at a pressure of 2.5 atm absolute). The patients were
reexamined at the end of the treatment period. A further treatment of 20 sessions was administered if complete resolution
had not occurred. The patients were reexamined, and a decision was made regarding a third course.
TABLE 1. Patients with Crohn's disease treated with hyperbaric oxygen
No Age,
Sex
Crohn’s
index
before/after
therapy
Duration of
disease(duration
of perianal
disease)
G.I.
involvement
Perianal
involvement
Concomitant
medication
20
treatment
assessment
40 treatment
assessment
60 treatment
assessment
1 58, F 154/148 3 yr
(2 yr)
Colon Fistual on
buttock,
Perianal
infiltration
Sulfasalazine Complete
healing
2 30, M 83/92 4 yr
(6 mo)
Terminal
ileum
Rectum
Perianal
infiltration
Mesalazine Complete
healing
3 36, F 268/245 14 yr
(8 yr)
Colon 2 perianal
fistulas to
skin, 1 to
vagina
Severe anal
narrowing
and
infiltration
(digital
examination
impossible)
Sulfasalazine Closure of
2 fistulas
Improved
anal
diameter
Improved
inflammation,
less
narrowing,
resolution of
abdominal
pain and
bloating
Further
improvement
Resolution of
stenosis
4 51, F 154/138 24 yr
(6 mo)
Colon Perianal
fistula and
infiltration
Mesalazine Closure of
fistula
infiltration
remains
Complete
healing
5 34, F 150/150 14 yr
(4 mo)
Colon Perianal
fistula and
infiltration
Sulfasalazine Closure of
fistula
infiltration
remains
Complete
healing
6 30, M 308/312 13 yr
(12 yr)
Diffuse
small and
large bowel
Severe
disease with
a fistula and
8 cm
circular
infiltration
Mesalazine Improved
fistula
Infiltration
reduced
3 cm
infiltration,
new fistula
7 59, M 92/90 40 yr
(10 yr)
Diffuse
small and
large bowel
Perianal
fistula
Prednisone
Sulfasalazine
Imodium
Complete
healing
8 64, M 62/66 11 yr
(1 yr)
Large bowel 2 fistulas
and
infiltration
Sulfasalazine Closure of
fistulas
less
infiltration
Complete
healing
9 40, M 374/360 12 yr
(8 yr)
Small bowel 20 cm
infiltration,
6 fistulas, 1
fistula to
groin
Mesalazine Closure of
3 fistulas
and 1 to
groin
No further
improvement
No further
improvement
10 34, M 34/34 18 mo
(same)
No intestinal
involvement
8 fistulas,
severe
infiltration
None Closure of
4 fistulas
Improved
inflammation
Healing
*Cases 4 and 10 are discussed in greater detail under "Representative Cases" subsection of "Results." See ref. 11.
Cost
The estimated cost of treatment is $100 per hour. This was covered in full by the patients' medical insurance.
RESULTS
The results are summarized in Table 1. Improvement occurred in 8 of 10 patients. In 3 patients, complete healing of
perianal lesions occurred after a single course; in 2, after two courses. In 3 patients, three courses were required. Two
patients did not improve. None of the patients reported side effects.
REPRESENTATIVE CASES
Case 4
A 51-year-old woman developed perianal disease after a 24-year history of Crohn's colitis with an active fistula and
circumferential perianal infiltration. She had been treated with Mesalazine only.
The fistula closed after 20 treatments, but there was residual scarring and inflammation. She was given a further 20
treatment sessions, with complete resolution of the perianal disease that has been maintained for 18 months of follow up on
maintenance mesalazine only.
Case 10
A 34-year-old man developed severe perianal disease without any bowel involvement. Examination revealed severe
inflammatory induration and 8 fistulas. Treatment for 1 year with salicylates, steroids, and metronidazole was ineffective.
After one course of HBO treatment, 4 fistulas closed, and after two additional courses his disease healed.
DISCUSSION
HBO, the inhalation of 100% oxygen at a pressure >1 atm (12), is now an established mode of therapy for a variety of
medical conditions (12-14). These conditions include chronic wounds in diabetes and the complications of trauma and
radionecrosis (15), including radiation damage to the gastrointestinal tract (16). The therapeutic effect of HBO is due to the
physiological effect of hyperoxia. Although the inhalation of high concentrations of oxygen has a limited impact on total
hemoglobin oxygen content, it produces an increase in the amount of dissolved oxygen in the plasma that is directly
proportional to the rise in the ambient pressure. When 100% oxygen is breathed at an absolute pressure of 3 atm, the
plasma oxygen content increases from 0.32 to 6.8 vol% (17). This considerable increase in the amount of oxygen that can
be delivered and made available to the tissues under conditions of high pressure is probably of great importance in cases
where improved tissue oxygenation is required. Hypoxia can appear in normally perfused tissue that is the site of an
inflammatory reaction. HBO at an absolute pressure of 2 atm has been shown to improve tissue oxygenation in this
situation (18).
The perianal lesion of Crohn's disease is in many ways a "chronic non healing wound" because of its indolent nature, its
refractoriness to treatment, and the possible role of local ischemia in its pathogenesis (2,3,5). The chronic non healing
wound is an established indication for HBO therapy (12-14). The best results have been reported for diabetic wounds, in
which microangiopathy, ischemia, and hypoxia are important pathophysiological factors. When a high partial pressure of
oxygen is breathed, there is correction of the surrounding hypoxia at sites supported by diseased vessels. The intermittent
correction of wound hypoxia by HBO therapy elevates oxygen tensions in ischemic or infected wound tissue (19).
Enhanced tissue oxygenation has a vasoconstrictive effect believed to reduce tissue edema (20) and restore fibroblast
proliferation, collagen synthesis (21), and capillary angiogenesis (22). Thus, oxygen may be the wound's most essential
nutrient (14).
Because of its location, the perianal lesion may be prone to bacterial contamination. Oxygen also has an antimicrobial
effect, particularly on anaerobes (7). It plays a crucial role in the cellular response to infection. Neutrophils require
molecular oxygen as a substrate for microbial killing by phagocytes, a process that depends on the formation of free
radicals. The oxidative burst observed in neutrophils after the phagocytosis of bacteria involves a 10- to 15-fold increase in
oxygen consumption (23,24). This oxidative antimicrobial system virtually ceases to function under conditions of hypoxia.
A tissue P02 >= 30 mm Hg is considered necessary for normal oxidative function (25). Partial pressure of oxygen in
diseased or injured tissue is often < 30 mm Hg (19). Improved oxygenation leads to restoration of white blood cell function
and renewal of adequate antimicrobial action.
HBO is administered in a hyperbaric chamber in which 100% oxygen is breathed at pressures greater than atmospheric. The
multiplace chamber used in this study is compressed with air, and oxygen is delivered to patients at the ambient pressure
via a mask. In such a chamber, <= 20 patients may be treated simultaneously and are always accompanied by a trained
attendant during treatment. Instrumentation and all the requirements for critical care support are on hand inside the
chamber.
Our present series confirms the encouraging results reported in previous isolated case reports. In all our patients with mild
or moderate disease and in some with severe disease, healing was complete after a single course of hyperbaric treatment
and has been maintained for <= 18 months following treatment. In some of the severe cases, there was also remarkable
improvement although several courses were required. Because systemic activity of Crohn's disease was relatively low grade
in all patients reported here, possible effects of HBO on other manifestations of Crohn's disease could not be estimated
from this study (see activity indexes, Table 1).
HBO is a safe form of therapy (26-28). No side effects were noted in this group of patients. Therefore, it should be
considered in patients suffering from perianal Crohn's disease who have failed to respond to conventional therapy.
Definitive proof of the efficacy of this mode of therapy requires a well controlled double blind study that we think is well
worth doing.
REFERENCES
1. Cohen Z, MeLeod RS. Perianal Crohn's disease. Gastroenterol Clin North Am 1987;16:175-89.
1. Bernstein LH, Frank MS, Brandt U, Boley SI. Healing of perineal Crohn's disease with metronidazole. Gastroenrerology 1980;79:357-65.
2. Brandt U, Bernstein LH, Boley SI, Frank MS. Metronidazole therapy for perineal Crohn's disease: a follow-up study. Gastroenrerology
1982;83:383-7.
3. Gorbach SL. Intestinal microflora in inflammatory bowel disease-implications for etiology. In: Kiraner lB, Shorter RG, eda. Inflammatory bowel
disease. New York: Lea & Febiger,1988:51-64.
4. Wakefield AJ, Sawycrr AM, Dhillon Ap, et at. Pathogenesis of Crohn's disease: multifocal gastrointestinal infarction. Lancet 1989;2:1057-62.
5. Davis IC, Hunt TK, eds. Problem wounds: the role of oxygen. New York: Elsevier, 1988.
6. Mader IT. Phagocytic killing and hyperbaric oxygen: antibacterial mechanisms. HBO Rev 1981;2:37-49.
7. Grim PS, Gottlieb U, Boodie A, Batson E. Hyperbaric oxygen therapy. JAMA 1990;263:2216-20.
8. Brady CE, Cooley BI, Davis IC. Healing of severe perineal and cutaneous Crohn's disease with hyperbaric oxygen. Gastroenterology 1989;97:756-
60.
9. Nelson Lw Jr, Bright DL, Villar LF. Closure of refractory perineal Crohn's lesion. Integration of hyperbaric oxygen into case management. Dig Dis
Sci 1990;35:1561-5.
10. Best WR, Becktcl JM, Singleton JW, Kern F. Development of a Crohn's disease activity index. Gastroenterology 1976;70:439-44.
11. 12.Mader JT, ed. hyperbaric oxygen therapy: a committee report. UHMS Publication Number 30 CR(HBO), 1989. Bethesda. Maryland:
Undersea and Hyperbaric Medical Society.
12. Kindwall E. Hyperbaric oxygen. BMJ 1993;307:515-16.
13. Grim PS, Gottlieb LI, Boddie A. Batson E. Hyperbaric oxygen therapy. JAMA 1990;263:2216-20.
14. Nakada T, Kubota Y, Sasagawa 1, Ct al. Therapeutic experience of hyperbaric oxygenation in radiation colitis. Dis Colon Rectum 1993;36:962-5.
15. Charneau I, Bonacour 6, Person B, Burtin P, Ronceray I, Boyer I. Severe hemorrhagic radiation proctitis advancing to gradual cessation with
hyperbaric oxygen. Dig Dis Sci 1991;36:371-5.
16. Bassett BE, Bennett PB. Introduction to the physical and physiological bases of hyperbaric therapy. In: Davis IC, Hunt TK. eds. Hyperbaric
Oxygen therapy. Bethesda, Maryland: Undersea Medical Society, 1977:11-24.
17. Carnochan FMT, Abbot NC, Beck IS, Ct al. Can hyperbaric oxygen correct hypoxia induced by inflammationreliminary findings. In: Schmutz 1,
Bakker DI, eds. Proceedings of the joint meeting: Second Swiss symposium on hyperbaric medicine and second European conference on
hyperbaric medicine. Basel: Foundation for Hyperbaric Medicine. 1990:47-54.
18. Shcffield P1. Tissue oxygen measurements. In: Davis IC. Hunt TK, eds. Problem wounds the role of oxygen. New York: : Elsevier, 1988:17-51.
19. Nylander G, Lewis D, Nordstrom H, Larsson I. Reduction of postischemic edema with hyperbaric oxygen. Plast Reconstr Surg 1985;76:596-601.
20. 21. Hunt TK, Pai MP. The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. Surg Gynecol Obstet
1972;135:561-7
21. 22. Knighton DR, Silver IA, Hunt TK. Regulation of wound- healing angiogenesis effect of oxygen gradients and inspired oxygen
concentration. Surgery 1981;90:262-70.
22. 23. Badwey JA, Karnovsky ML. Active oxygen species and the functions of phagocytic leukocytes. Annu Rev Diochem 1980;49:695-726.
23. Forman HJ, Thomas MJ. Oxidant production and bactericidal activity of phagocytes. Annu Rev Phvsiol 1986;48: 669-80.
24. 25. Hohn DC, MacKay RD, Halliday B, Hunt TK. The effect of O2 tension on the microbicidal function of leukocytes in wounds and in
vitro. Surg Forum 1976;27:18-20.
25. Shupak A, Greenberg E, Hardoff R, Gordon C, Melamed Y, Meyer WS. Hyperbaric oxygenation for necrotizing otitis media. Arch Otolaryngol
1989;115:1470-5.
26. Gozal D, Ziser A, Shupak A, Melamed Y. Accidental carbon monoxide poisoning. Clin Pediatr 1985;24:132-5.
27. Melamed Y, Bursztein S. Hyperbaric medieme. In: Reis ND, Dolev E, eds. Manual of disaster medicine. New York: Springer-Verlag, 1989:148-
50.
HBO2 Research
1. Noyer CM, Brandt LJ. Hyperbaric oxygen therapy for perineal Crohn's disease. Am J Gastroenterol. 1999;94:318-321.
2. Brady CED, Cooley BJ, Davis JC. Healing of severe perineal and cutaneous Crohn's disease with hyperbaric oxygen. Gastroenterology. 1989;97:756-760.
3. Brady CED. Hyperbaric oxygen and perineal Crohn's disease: a follow-up [letter]. Gastroenterology. 1993;105:1264.
4. Nelson EW Jr, Bright DE, Villar LF. Closure of refractory perineal Crohn's lesion: integration of hyperbaric oxygen into case management. Dig Dis Sci. 1990;35:1561-1565.
5. Lavy A, Weisz G, Adir Y, Ramon Y, Melamed Y, Eidelman S. Hyperbaric oxygen for perianal Crohn's disease. J Clin Gastroenterol. 1994;19:202-205.
6. Colombel JF, Mathieu D, Bouault JM, et al. Hyperbaric oxygenation in severe perineal Crohn's disease. Dis Colon Rectum. 1995;38:609-614.
10-09-2013, 01:24 PM   #28
Robs a
 
Join Date: Oct 2012
Location: Cape Town, South Africa

My Support Groups:
Have only recently become aware of Hyperbaric Oxygen Therapy as a treatment option for Crohn's. Am so eager to find a viable alternative to the meds my 15 year old son is on. He is on Revellex infusions which have been brought closer to6 week intervals and am not sure how well this is working since he does not feel great, poor energy and is having so many allergy issues. Had his tonsils taken out on Monday because they were so large and infected, this only became an issue once he started the Revellex. Impossible to find a professional medical person who can advise on Hyperbaric Oxygent Therapy so very grateful to have found this thread.
10-27-2013, 09:58 AM   #29
Altair
 
Altair's Avatar
 
Join Date: Aug 2013
Hi everybody,

I am really happy for you BoyMama2000, it is great it worked as heavens!

Last week I ended a 40 sessions row of Hyperbaric Oxygen: 100% oxygen at 2atm. My feelings are positive, and in my case (unresolved perianal Crohn flare with fistulas and abscesses) it definetely worked. However, it does not put you any forward from the point surgery is required… as unfortunately is my case

Still, for two months my quality of life improved a lot and I could work in the afternoons-evenings which was an unthinkable option when I begun the treatment. It easened my pain and limited it to 5-6 hours after going to the toilette. Furthermore, with Hyperbaric Oxygen I reached a much better state than with Flagyl since my stomach/intestines felt stronger limitting my depositions to one per day.

For now onwards my surgeon told me that he would try a fistuloctomy in some fistulas even though there is Crohn's activity. He told me that after the surgery we will try another row of Hyperbaric Oxygen sessions to ease the cicatrization which is what everyone fears with patients like me, with an active Crohn's disease. At the same time I will restart Infliximab and see if it is enough that way.

I am feeling a bit part of an experiment, but it is ok to me for the other possible option is an ileostomy with little chance of reconnection. I'll will see…

I'll keep you updated!! I
07-24-2014, 07:46 AM   #30
Raynedark
 
Join Date: May 2012
Location: Vermont
Hey there any one who's still watching this thread. I'm being considered for hyperbaric treatment for a fistula that just won't heal and I was wondering how other folks are doing a few years down the line? Did the treatment work for you? Did the fistula return at all? What kind of questions should I ask my doctor?

Thanks!
__________________
Meds:50mg 6-MP; 500mg Cipro; 300mg Remicade every 8 weeks.

Surgeries: 10/11 Abscess drained, 1/12 EUA, 4/12 Seton placed, 07/14 Seton placed, 06/16 Seton placed and old ones replaced.

Shiny side up friends !
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