- Fecal Incontinence
|Hyperbaric Oxygen Therapy in Chronic Inflammatory Conditions of the Pouch
Inflamm Bowel Dis. 2021 Jun 15;27(7):965-970. doi: 10.1093/ibd/izaa245.
Badar Hasan 1, Yunjoo Yim 1, Mamoon Ur Rashid 2, Rumman A Khalid 1, Deepika Sarvepalli 2, Daniel Castaneda 1, Asad Ur Rahman 1, Nicole Palekar 1, Roger Charles 1, Fernando J Castro 1, Bo Shen 3
1Department of Gastroenterology, Cleveland Clinic Florida, Weston, FL, USA.
2Department of Internal Medicine, AdventHealth, Orlando, FL, USA.
3Inflammatory Bowel Disease Center, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA.
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.