The effects of hyperbaric treatment on perianal fistula activity in patients with Crohn’s disease Original paper

What was studied?

The study explores the use of hyperbaric oxygen therapy (HBOT) as an adjunctive treatment for perianal fistulas in patients with Crohn’s disease (CD). The primary objective was to assess the efficacy of HBOT combined with conventional therapies in reducing fistula activity, as well as to evaluate its impact on disease activity indices and biomarkers. The effects were assessed through various parameters, including the Crohn’s Disease Activity Index (CDAI), Simple Endoscopic Score for Crohn’s Disease (SES-CD), Perianal Crohn’s Disease Activity Index (PDAI), and laboratory tests like faecal calprotectin and CRP levels.

Who was studied?

The study enrolled 11 patients diagnosed with Crohn’s disease and active perianal fistulas. These patients had a minimum disease duration of three years and had a history of recurrent disease episodes and fistula activity. All participants underwent conventional therapies, including immunosuppressive treatments, biological drugs (in some cases), and surgery for fistula management. Hyperbaric oxygen therapy was introduced as a supplementary treatment, with participants receiving 30 sessions over six weeks. The cohort consisted of a small group of patients, aged around 30 years, with a mix of male and female participants.

Most important findings

The study found that HBOT, when combined with conventional therapies, resulted in substantial clinical improvements. The CDAI scores showed an 81.8% improvement in disease activity. Fistula healing, as assessed by the PDAI, showed a 54.5% remission rate, with patients showing marked reduction in fistula activity. The clinical effects were sustained over a 9-month follow-up period, with significant improvements in endoscopic scores (SES-CD) and faecal calprotectin levels. These findings suggest that HBOT contributes not only to reducing fistula activity but also to overall disease management in Crohn’s disease patients.

Key implications

This study highlights the potential of HBOT as a therapeutic adjunct for patients with Crohn’s disease complicated by perianal fistulas. The findings suggest that HBOT may offer a new treatment option, especially for those with recurrent fistula activity unresponsive to conventional treatments. Moreover, the combination of HBOT with biologic therapies may enhance therapeutic outcomes, though larger studies are needed to confirm these results and establish optimal treatment regimens. The significant improvements in disease markers such as faecal calprotectin and CRP suggest that HBOT may also play a role in modulating inflammation and supporting mucosal healing.