Hyperbaric oxygen treatment for inflammatory bowel disease: a systematic review and analysis

: The objective of the present study was to quantify the national pediatric inpatient inflammatory bowel disease (IBD) burden in terms of the number of IBD-related hospitalizations, the number of days spent in the hospital, and hospitalization costs. : Hospitalizations for children and adolescents 20 years and younger with a primary diagnosis of either Crohn disease (CD) or ulcerative colitis (UC) were selected from the 2006 Kids' Inpatient Database (KID). Length of the hospital stay in days (LOS) and charges for the hospitalization were found directly in the Kids' Inpatient Database, and cost was calculated using the hospital's cost-to-charge ratio. Predictor variables included patient characteristics, such as age and severity of illness, and hospital characteristics. Ordinary-least-squares regressions were developed and estimated to explain hospitalization costs. : In 2006, there were 10,777 IBD-related hospitalizations. The total and mean costs for CD were $66.3 million and $10,176 (95% confidence interval [CI] $9647-$10,705), and for UC were $48.6 million and $11,836 (95% CI $10,760-$12,912). For CD, 0- to 5-year-old patients had the highest mean LOS (8.10, 95% CI 5.53-10.67, days) and mean cost ($13,894, 95% CI $9053-$18,735), whereas, for UC, 11- to 15-year-old patients had the highest mean LOS (7.49, 95% CI 6.88-8.10, 95% CI 5.53-10.67, days) and mean cost ($13,407, 95% CI $11,704-$15,110). : For a pediatric disease with a rather low prevalence rate, the estimated annual inpatient pediatric burden of IBD is a sizeable $152.4 million (2010 US$) and 64,985 days spent in the hospital. As medications and outpatient treatments improve for the treatment of IBD, there is an opportunity for significant reduction in inpatient burden.

Background Inflammatory bowel disease (IBD) is a chronic, debilitating disease with suboptimal success rates after conventional treatments. A potential new, additional approach is hyperbaric oxygen therapy (HBOT). We aimed to evaluate the efficacy and safety of HBOT in patients with IBD. Methods A systematic review of the published literature regarding HBOT as treatment for IBD was conducted according to the PRISMA guidelines. MEDLINE, Web of Science, EMBASE and the Cochrane Library were systematically searched. Search terms included ‘Hyperbaric Oxygenation’, ‘Inflammatory Bowel Diseases’, ‘Crohn’ and ‘Colitis’. All human studies with ≥5 patients and animal studies evaluating HBOT for IBD were included. Primary outcome was clinical response rate to HBOT. Secondary outcomes were radiological and endoscopic response rate, laboratory findings, adverse events and quality of life (QoL). Results The literature search resulted in 948 publications of which 26 were included (Figure 1); 11 human studies (778 patients) and 15 animal studies (554-558 animals). Seventeen were randomised controlled trials, 8 prospective cohort studies and 1 was a retrospective cohort study. The overall clinical response rate after 5-86 HBOT sessions was 82.1% (88.1% for ulcerative colitis and 78.7% for Crohn’s disease (CD)). Perineal CD was described in 56 patients, with a clinical response rate of 75%. The endoscopic response rate ranged from 50-100% in 4 studies and the radiological response in 1 study was 100%. Only one study described quality of life (QoL) and showed no significant differences in QoL between the HBOT and control group. Adverse events were described in 6 studies and occurred in 9 out of 75 patients (0.12%). Animal studies reported less weight loss after HBOT and a significantly decreased Disease Activity Index compared to controls. Furthermore, histopathological features and laboratory values including inflammatory markers (such as TNF-α and IL-1) and oxidative stress markers (such as myeloperoxidase and malondialdehyde) improved after HBOT. Conclusion HBOT is a promising IBD treatment with high clinical-, radiological- and endoscopic response rates and few adverse events. Animal studies support these findings. The challenge now is to identify the appropriate amount of HBOT sessions and timing in the IBD treatment process and to identify which IBD patients can benefit most from HBOT.

Manipulation of the Microbiota for Treatment of IBS and IBD—Challenges and Controversies

Inflammatory Bowel Disease Clinical

P-049: Reproducibility of serologic antibody activity at diagnosis and after treatment in pediatric ulcerative colitis and Crohn’s disease

Beyond Gene Discovery in Inflammatory Bowel Disease: The Emerging Role of Epigenetics

Hypoxia is a known contributor to inflammation in inflammatory bowel diseases (IBD), and a growing interest has emerged in pharmacologically targeting hypoxia response pathways to treat IBD. The most basic form of treatment for hypoxia is delivering higher amounts of oxygen to the intestinal mucosa. In this review, we summarize the evidence in support of hyperbaric oxygen therapy (HBOT), a mechanism to deliver high amounts of oxygen to tissue, for treating IBD. Two phase 2 clinical trials in hospitalized ulcerative colitis patients suffering from moderate-to-severe flares have demonstrated that HBOT improves responsiveness to steroids and avoidance of rescue medical and surgical therapy. Outpatient cohort studies in perianal fistulizing Crohn's disease and fistulizing complications of the pouch have demonstrated improved healing, particularly for complex fistulae. Several systematic reviews have now been completed, and HBOT has been observed to be well tolerated with low rates of adverse events. HBOT may be considered as an adjunctive treatment for hospitalized ulcerative colitis flares and Crohn's disease-related fistulae. Higher quality trials are needed to confirm efficacy.

Appropriateness of immunosuppressive drugs in inflammatory bowel diseases assessed by RAND method: Italian Group for IBD (IG-IBD) position statement

Positive Role of CCAAT/Enhancer-Binding Protein Homologous Protein, a Transcription Factor Involved in the Endoplasmic Reticulum Stress Response in the Development of Colitis

Covering the Cover

The Commensal Microbiota and Enteropathogens in the Pathogenesis of Inflammatory Bowel Diseases

Rac1 Takes Center Stage in Pancreatic Cancer and Ulcerative Colitis: Quantity Matters

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

Recurrent pericarditis due to mesalamine hypersensitivity: a pediatric case report and review of the literature.

Diagnosis and Management of Primary Sclerosing Cholangitis