Hyperbaric Oxygen Therapy in Chronic Inflammatory Conditions of the Pouch

Background: Pouchitis can be a chronic complication of ileal pouch-anal anastomosis. We aimed to determine the efficacy and safety of hyperbaric oxygen therapy (HBOT) for chronic antibiotic-refractory pouchitis (CARP) and other inflammatory conditions of the pouch. Methods: This was a retrospective case series of adults with inflammatory bowel disease (IBD) who underwent ileal pouch-anal anastomosis and then developed CARP and received HBOT between January 2015 and October 2019. A modified Pouchitis Disease Activity Index (mPDAI) score was used to quantify subjective symptoms (0-6) and endoscopic findings (0-6) before and after HBOT. Results: A total of 46 patients were included, with 23 (50.0%) being males with a mean age of 43.6 12.9 years. The median number of HBOT sessions was 30 (range 10-60). There was a significant reduction in the mean mPDAI symptom subscore from 3.19 to 1.91 after HBOT (P < 0.05). The pre- and post-HBOT mean mPDAI endoscopy subscores for the afferent limb were 2.31 +/- 1.84 and 0.85 +/- 1.28 (P = 0.006); for the pouch body, 2.34 +/- 1.37 and 1.29 +/- 1.38 (P < 0.001); and for the cuff, 1.93 +/- 1.11 and 0.63 +/- 1.12 (P < 0.001), respectively. Transient side effects included ear barotrauma in 5 patients (10.9%) and hyperbaric myopic vision changes in 5 patients (10.9%). Conclusions: Despite minor adverse events, HBOT was well tolerated in patients with CARP and significantly improved symptoms and endoscopic parameters.

Automated summary

The study demonstrates that hyperbaric oxygen therapy is effective and safe for chronic antibiotic-refractory pouchitis and other inflammatory conditions of the pouch. It significantly improves symptoms and endoscopic parameters in patients, despite minor adverse events.