The potential of hyperbaric oxygen therapy in patients with inflammatory bowel disease: Do we have the evidence?

Abstract:

The evolution of therapeutic targets in inflammatory bowel diseases (IBD) includes alleviation of symptoms, achievement of sustained clinical remission, mucosal healing, prevention of cumulative bowel damage and complications, minimizing the need for hospitalization and surgery. The therapeutic approach is usually combined because different formulations of the one drug are not sufficient to control the inflammation, and the approach is also sequential, taking into account the fact that the same drug is not effective in all patients and in all phenotypes and stages of the biological course of the disease. The paradigm of intestinal inflammation in Crohn's disease (CD) and ulcerative colitis (UC) is characterized with chronic hypoxia of the intestinal mucosa. Study of murine models of experimental colitis showed the pronounced hypoxia in mucosal intestinal tissue and clinical studies documented the increased expression of HIF-1α i HIF-2α in intestinal mucosa of patients with Crohn's disease and ulcerative colitis, as well. It has also been shown that hyperbaric oxygenation therapy (HBOT) has anti-inflammatory effect, increases the fraction of oxygen dissolved in plasma, stimulates angiogenesis in early phase of tissue damage, increases the proliferation and differentiation of intestinal stem cells, stimulates the collagen synthesis and epithelialization and elicits the antimicrobial response, as well. The majority of published papers speak in favor of beneficial effect of HBOT in inflammatory bowel diseases, including perianal fistula sin Crohn’s disease. In the mentioned studies HBOT was applied in combination with standard pharmacotherapy, representing the complementary method that would enhance and foster the anti-inflammatory effect of standard therapy for intestinal inflammation. The results of expected and planned control trials should bring more evidence, whether the use of HBOT in treating the patients with IBD is scientifically justified. However, it is important to emphasize the fact that the results of published studies and clinical practice and experience speak in favor of HBOT use in patients with IBD. 

Key words:
intestinal inflammation; tissue hypoxia; inflammatory bowel diseases; therapy; hyperbaric oxygenation; hyperbaric chambers