Systematic review: the safety and efficacy of hyperbaric oxygen therapy for inflammatory bowel disease

BackgroundHyperbaric oxygen therapy (HBOT) provides 100% oxygen under pressure,which increases tissue oxygen levels, relieves hypoxia and alters inflamma tory pathways. Although there is experience using HBOT in Crohn’s dis ease and ulcerative colitis, the safety and overall efficacy of HBOT ininflammatory bowel disease (IBD) is unknown.AimTo quantify the safety and efficacy of HBOT for Crohn’s disease (CD) andulcerative colitis (UC). The rate of adverse events with HBOT for IBD wascompared to the expected rate of adverse events with HBOT.MethodsMEDLINE, EMBASE, Cochrane Collaboration and Web of Knowledge weresystematically searched using the PRISMA standards for systematic reviews.Seventeen studies involving 613 patients (286 CD, 327 UC) were included.ResultsThe overall response rate was 86% (85% CD, 88% UC). The overallresponse rate for perineal CD was 88% (18/40 complete healing, 17/40 par tial healing). Of the 40 UC patients with endoscopic follow-up reported, the overall response rate to HBOT was 100%. During the 8924 treatments, there were a total of nine adverse events, six of which were serious. The rate of adverse events with HBOT in IBD is lower than that seen when util ising HBOT for other indications (P < 0.01). The risk of bias across studieswas high.ConclusionsHyperbaric oxygen therapy is a relatively safe and potentially efficacioustreatment option for IBD patients. To understand the true benefit of HBOTin IBD, well-controlled, blinded, randomised trials are needed for both Cro hn’s disease and ulcerative colitis