January 24, 2023
2 min read
Dokmak A, et al. Poster P002. Presented at: Crohn’s and Colitis Congress; January 19–21, 2023; Deventer.
Dokmak does not report relevant financial disclosures.
DENVER – Hyperbaric oxygen therapy yielded an 87% clinical response rate in fistulizing Crohn’s disease patients with few side effects, according to systematic review data presented at the Crohn’s and Colitis Congress.
“Fistulas are a common complication of Crohn’s disease, occurring in up to 50% of patients,” Amr Dock makdoctor, a hospital physician at the Catholic Medical Center in Manchester, New Hampshire, told Helio. “Despite the significant expansion of IBD therapeutics, especially biologics and innovations in treatment strategy, a significant gap remains in achieving long-term fistula healing. Hyperbaric oxygen therapy has gained interest as a possible adjunctive therapy for refractory IBD.”
To determine whether there is sufficient evidence in the literature for the effective and safe use of hyperbaric oxygen in fistulizing CD, Dokmak and colleagues performed a systematic review of EMBASE, Web of Science, PubMed, and Cochrane Library databases. The investigators included published articles and abstracts if they met the study design criteria, evaluated hyperbaric oxygen efficiency in patients with fistulizing CD, and reported adequate outcome data, which were measured clinically, radiographically, and/or endoscopically.
Dokmak and colleagues included 16 studies in their analysis, comprising 164 patients who underwent 5,125 hyperbaric oxygen therapy sessions. Their primary interest was overall clinical response – defined as clinical remission or partial response – to hyperbaric oxygen therapy. The investigators specified clinical remission as closure of the fistula and complete cessation of drainage, and partial response as improvement in fistula drainage.
“Our systematic review showed a pooled overall clinical response rate of 87%, suggesting that hyperbaric oxygen therapy may be an effective treatment option for fistula formation,” Dokmak said. “[However] rectovaginal fistulas were the fistula subtype least responsive to hyperbaric oxygen therapy.”
In addition, the researchers reported a pooled clinical remission rate of 59% (95% CI, 0.35-0.8) in patients receiving hyperbaric oxygen therapy. The pooled rate of adverse events was minimal with 51.7 per 10,000 hyperbaric oxygen therapy sessions for all fistula types (95% CI, 16.8-159.3).
However, as Dokmak noted, overall clinical response varied by subtype, with perianal fistulas responding most (89%) to therapy, followed closely by enterocutaneous fistulas (84%); patients with rectovaginal fistulas experienced the lowest response to therapy (29%).
The researchers reported that hours in the oxygen chamber or the number of hyperbaric oxygen therapy sessions were not associated with improved clinical response.
“Hyperbaric oxygen therapy is a safe and potentially effective treatment option for Crohn’s disease with fistulas,” Dokmak told Healio. “[However,] randomized control trials are needed to substantiate the benefit of hyperbaric oxygen therapy in fistulizing Crohn’s disease.”