J Clin Gastroenterol. 2024 Feb 1;58(2):120-130.doi: 10.1097/MCG.0000000000001905.

Amr Dokmak ¹, Benjamin Sweigart ², Nayantara S Orekondy ³, Sushrut Jangi ³, Joel V Weinstock ³, Shadi Hamdeh ⁴, Gursimran S Kochar ⁵, Bo Shen ⁶, Alexander N Levy ⁷

Author information

¹Department of Hospital Medicine, Catholic Medical Center, Manchester, NH.

²Tufts Clinical and Translational Science Institute.

³Division of Gastroenterology and Hepatology, Tufts Medical Center, Boston, MA.

⁴Division of Gastroenterology, Hepatology and Motility, University of Kansas, Kansas City, KS.

⁵Division of Gastroenterology, Hepatology, and Nutrition, Allegheny Health Network, Pittsburgh, PA.

⁶Center for Interventional Inflammatory Bowel Disease, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY.

⁷Section of Digestive Diseases, Yale School of Medicine, New Haven, CT.Abstract

Abstract

Background: Hyperbaric oxygen therapy (HBOT) delivers 100% oxygen in a pressurized chamber, increasing tissue oxygen levels and regulating inflammatory pathways. Mounting evidence suggests that HBOT may be effective for inflammatory bowel disease. Our systematic review and meta-analysis aimed to quantify the efficacy and safety of HBOT in fistulizing Crohn's disease (CD).

Methods: A systematic review was conducted using the EMBASE, Web of Science, Pubmed, and Cochrane Library databases according to the "Preferred Reporting Items for Systematic Reviews and Meta-analyses" criteria. Study bias was assessed using the Cochrane Handbook guidelines.

Results: Sixteen studies with 164 patients were included in the analysis. For all fistula subtypes, the pooled overall clinical response was 87% (95% CI: 0.70-0.95, I2 = 0) and the pooled clinical remission was 59% (95% CI: 0.35-0.80, I2 = 0). The overall clinical response was 89%, 84%, and 29% for perianal, enterocutaneous, and rectovaginal fistulas, respectively. On meta-regression, hours in the chamber and the number of HBOT sessions were not found to correlate with clinical response. The pooled number of adverse events was low at 51.7 per 10,000 HBOT sessions for all fistula types (95% CI: 16.8-159.3, I2 = 0). The risk of bias was observed across all studies.

Conclusion: HBOT is a safe and potentially effective treatment option for fistulizing CD. Randomized control trials are needed to substantiate the benefit of HBOT in fistulizing CD.