Hyperbaric Oxygen Treatment (HBOT) for Inflammatory Bowel Disease (IBD)
Hyperbaric Oxygen Treatment is a technique famously used to heal decompression sickness or “the bends.” In the last decade it emerged as a safe treatment with success treating Crohn’s, Ulcerative Colitis, and IBS for many individuals.
A New Approach to Healing: Dead Sea Crohn’s Experiment
In 1995, a study was published in the Journal of Clinical Gastroenterology in which researchers from Tel Aviv University and Rabin Medical Center1 investigated whether the unique environment of the Dead Sea would affect complications from Crohn’s disease. The reasoning was simple: higher pressure is known to help with the healing of wounds, and what are UC and Crohn’s disease? Wounds in the gut.
The Dead Sea sits 402 meters below sea level, the lowest point on earth. It’s known for the fantastical healing properties of its water and mud, but is more notable for us because of the barometric pressure of 1.05 atmospheres, or atmosphere absolute (ATA). That’s 5% higher than at normal altitude.
The researchers chose six patients with Crohn’s disease that had been unresponsive to medical treatment and relocated them to the Dead Sea for a period of one to three weeks. They utilized the Clamp-Softley modification2 of the Harvey-Bradshaw Crohn’s disease activity index3 to assess the patients at weekly intervals. The results were striking. Two patients showed significant improvement and two others were able to stop all medication. Most impressively, one patient completely healed a perianal fistula after only two of the three weeks of observation.
This was only one early study about the effectiveness of a high-pressure environment on one small uncontrolled group of six people. It was promising and interesting, but not conclusive. Research has pointed towards a more focused and potentially more effective option, hyperbaric oxygen treatment (or therapy), also known as HBOT.
What is HBOT?
Hyperbaric simply means more pressure than usual. In hyperbaric oxygen treatment, a patient is placed in a hyperbaric compression chamber and exposed to 100% oxygen at an ambient pressure higher than one ATA. The patient is exposed to more oxygen than usual and the pressure of the chamber encourages more efficient entry into the bloodstream. It is a medical treatment that is most famous for healing decompression sickness, commonly known as the bends. But in this case, HBOT allows the body to absorb more oxygen than is normally possible and that extra oxygen encourages the body to heal.
HBOT isn’t just for divers and submarine crews anymore. It’s also regularly used by athletes to promote regeneration and speed up recovery time. The oxygen enriched blood increases performance by allowing the cells to create more adenosine triphosphate (ATP), a molecule that stores and releases energy for the body to use in physical activity. It increases oxygen to the brain, which heightens senses and synapses to facilitate superior decision-making. Most importantly, HBOT makes red blood cells more flexible, which increases their ability to penetrate blood vessels and speeds the healing process to prevent career-ending injuries and remove athletes from the injured list more quickly.
Studies on HBOT have proven that it decreases the production of pro-inflammatory cytokines,4 reducing inflammation in humans and animals. It shares this property with biological therapies commonly prescribed for the treatment of IBD as well as immunomodulators, amino salicylates, and corticosteroids. By increasing anti-inflammatory properties and increasing efficiency of red blood cells, HBOT encourages the healing of wounds, both singular and chronic. In addition, HBOT is effective at killing anaerobic bacteria, which research suggests are potential causes of Crohn’s disease.5 Its application in the treatment of UC, Crohn’s, and pancolitis is highly promising.
Studies and Results for Crohn’s and Ulcerative Colitis
Hyperbaric Oxygen Treatment for Inflammatory Bowel Disease: A Systematic Review and Analysis, published in 2012, performed comprehensive searches through eight scientific databases for studies of HBOT on IBD. They identified 13 studies involving Crohn’s and six involving UC. Most of these studies reported improvements during and after treatment.
The studies reported a decrease in inflammation and reduction of tissue edema as well as histopathological changes.6 There was also a decrease in TNF-alpha, IL-1 and IL-6. Interestingly, they reported that HBOT can stimulate stem cells that migrate to the sites of the wound and inflammation to provide enhanced results of stem cell therapy.
Only two of these 13 studies reported adverse effects, with ten reporting no negative effects and three specifying that no issues were encountered. There was one case of ear drum perforation and one case of psychological intolerance related to the increased pressure. Both issues were temporary and vanished when treatment was stopped.
Overall, Rossignal found that HBOT certainly reduced symptoms and lowered inflammation and biomarkers of inflammation as well as oxidative stress with minimal adverse effects, but studies were sometimes inconclusive, lacked a control, included a small number of participants and potentially included publication biases. Further research was suggested.
A 2014 publication, Systematic Review: The Safety and Efficacy of Hyperbaric Oxygen Treatment for Inflammatory Bowel Disease, references the 2012 paper and processes significantly more information, yielding 42 studies after eliminating 271 others that lacked well-controlled, blind, and randomized trials. These final 42 studies consisted of 613 patients with either Crohn’s or UC with an average response rate of 86%. For Crohn’s the rate was 88% with 18 out of 40 patients reporting complete healing and 17 reporting partial healing.
This review identified nine instances of adverse effects, with six resulting in discontinuation of HBOT. Two patients again reported issues with the eardrum. One encountered ear drum perforation early on and discontinued therapy, while the other had difficulty equalizing pressure and discontinued with no other adverse results. Six other patients reported psychological intolerances, four within the first few sessions and two within 33 and 36 sessions. All patients reported at least some positive effects, and the two who stopped midway reported complete healing of perineal lesions.
The researchers concluded that HBOT is a safe and potentially effective treatment for IBDs, but still requires additional trials with the same level of methodology to thoroughly understand the benefits.
Overall, these publications yielded largely safe and highly positive results, with adverse effects limited to adverse responses to pressure in the inner ear and general psychological issues related to the procedure. HBOT was found to have a high potential to effectively ameliorate and heal Crohn’s, ulcerative colitis, and pancolitis.
Positive Experiences of Recovery from IBD
Individual testimonials we found reported similar results after finding, at best, temporary healing with other more standard treatment methods.
One woman with UC went through several procedures, ending with proctocolectomy with ileal pouch–anal anastomosis (IPAA) that resulted in a pain-free three years before her symptoms returned. The results of a pouchoscopy at the Cleveland Clinic showed that her J-pouch was dying and the tissue was severely inflamed from poor diet and stress causing it to receive ineffectual blood flow and oxygen, with severe pouchitis. Her doctor prescribed an antibiotic for pouchitis, Canasa (mesalamine), hydrocortisone, and improvements in diet and fitness, along with 30 two-hour sessions of HBOT five days a week for six weeks.
For the first two weeks she felt extremely exhausted and had blurry eyesight after each session but felt fine after the third. After completing all 30 sessions she reported for a follow-up scope and her doctor was amazed by the improvement, suggesting that she would not require another pouchoscopy for two years. She attributed the success to the HBOT, saying that “without the therapy, my body would not have healed as quickly as it did.”
Crohn’s forum member BoyMama2000 reported that her son was prescribed 30 sessions of HBOT after a fistulotomy, so it was inconclusive whether it healed the fistula because the surgery had already. However, “He had a very large wound unearthed during the fistulotomy from the recurring abscess.”
After 18 sessions she reported that his wound and fistulotomy region wear healing “really well” and that the outer layer of skins was almost covering the wound. Doctors discontinued his treatment after 20 of the prescribed 30 sessions because the results were so positive. “This Friday will be 4 weeks since his surgery. … It has been worth the time and effort to get to (HBOT).”
Will HBOT Work for Your IBD?
User Phillycrohns, on the Crohn’s Forum, considered himself to be in remission for over a year after completing HBOT, although he noted that an SCD diet including removal of sugar and increase in fiber could have also been responsible, ultimately Phillycrohns said that he doesn’t “regret for one instance having tried it. I was willing to try and do anything in order to avoid Imuran and Remicade and these other strong drugs.”
The first systematic review and analysis above found that 78% of Crohn’s patients and all UC patients in the reviewed studies showed improvement at pressures two times or more than normal. However, all of these patients had largely failed to respond to medical treatment, and the studies were small and not controlled. These limitations mean the results may not apply to all IBD patients.
Interestingly, Rossignal also suggested the possibility that early HBOT treatment could be even more effective in preventing symptoms from becoming severe.
Overall, trials and testimonials have reported results but have been inconclusive. Phillycrohns says: “Since the disease presents itself differently in every case, it may not work for everyone.” For those of you that suffer chronic pain and have seen few results with other treatment options, or simply want to avoid more dangerous medications or complicated surgery, it is certainly a procedure worth trying.
Equipment and Experience
A hyperbaric compression chamber is a hard-shell glass tube with a hospital bed that slides out of an opening at the bottom. Chambers are snug, but comfortable, and allow the patient to sit up and lie down, as well as listen to music or read a book, and even watch television through a speaker inside. During treatment you cannot wear makeup, deodorant, hair products, jewelry, electronics, or anything other than a hospital gown inside the chamber. Anti-anxiety medication is permitted. The process of undergoing the treatment is called a “dive” because it is the same pressure that is experienced by a scuba diver. Research has shown that patients with Crohn’s, UC, or pancolitis should be exposed to at least two ATA’s with 100% oxygen for at least 90 minutes to see significant improvement.
Not at all painful, the experience has instead been described as pleasant, calming or even euphoric and potentially worth attempting for those effects alone.
Things to Be Careful
Research and testimony are adamant that you stay away from inflatable chambers in favor of FDA approved hard-shells. For safety concerns and results, you should also find a clinic that is in a hospital, run by a physician, follows safety procedures at all times, and has constant monitoring by staff.
As mentioned above, the largest issue with HBOT treatment is ear pressure. Although it is unlikely, if you have sensitive ears you may require further steps, such as the insertion of tubes, in order to reduce the pressure.
The Price of Pain-Free
HBOT can be expensive, and with the present state of research it’s unlikely to be covered by insurance because it is not yet approved by the FDA for use with IBD. Many reports range from $1,200 USD to $2500 USD per person per session, with a general prescription of 30 to 50 sessions. However, doctors agree that if you do not see significant results within ten sessions, you are not likely to see more, and they will discontinue treatment to save your money.
Many IBD sufferers have successfully reduced costs with different strategies. While it is still highly suggested that you receive your treatment in a hospital, often you can find clinics inside that are not directly affiliated and are significantly cheaper. If you’re lucky, the clinic or hospital may reduce the cost for you, otherwise speak to your doctor and ask him to write a letter to your insurance company compelling them to cover your treatment because it could be your last option after other treatments have failed or life threatening if left untreated.
Meta Analysis of Studies
|Hyperbaric Oxygen Treatment for Inflammatory Bowel Disease: A Systematic Review and Analysis||Daniel A Rossignol||Comprehensive Study||2012||IBD||Positive||"HBOT lowered markers of inflammation and oxidative stress and ameliorated IBD in both human and animal studies. Most treated patients were refractory to standard medical treatments. Additional studies are warranted to investigate the effects of HBOT on biomarkers of oxidative stress and inflammation as well as clinical outcomes in individuals with IBD."|
|Systematic review: the safety and efﬁcacy of hyperbaricoxygen therapy for inﬂammatory bowel disease||P. S. Dulai, M. W. Gleeson, D. Taylor, S. D. Holubar, J. C. Buckey, C. A. Siegel||Comprehensive Study||2014||IBD||Positive||"Hyperbaric 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."|
|New Therapeutic Avenues in Ulcerative Colitis: Thinking Out of the Box||Joana Torres, Silvio Danese, Jean-Frédéric Colombel||Research||2013||IBD||N/A||"Many of the current strategies being developed in UC such as small molecules and new biological therapies focus on targeting the blockade or enhancement of soluble and cellular proteins and associated signalling mechanisms. However, thinking outside the box, looking at other components of UC pathophysiology and improving our understanding of some distinctive clinical and epidemiological features of disease may lead to the development of novel approaches and therapies."|
|Hyperbaric Oxygen Therapy Stimulates Colonic Stem Cells and Induces Mucosal Healing in Patients With Refractory Ulcerative Colitis: A Prospective Case Series||Mohamed Bekheit, Nahed Baddour, Khaled Katri, Yousry Taher, Khaled El Tobgy, Essam Mousa||Study||2016||UC||Positive||"HBOT is effective in the setting of refractory ulcerative colitis. The described protocol is necessary for successful treatment. HBOT stimulates colonic stem cells to promote healing."|
|Hyperbaric Oxygen Therapy Does Not Improve the Effects of Standardized Treatment on a Severe Attack of Ulcerative Colitis: A Prospective Randomized Study||Maria Pagoldh, Elin Hultgren, Per Arnell, Anders Eriksson||Study||2013||UC||Negative||"The authors found no statistically significant differences between the treatment groups in any of the assessed variables."|
|Crohn's Disease and Hyperbaric Oxygen Therapy||Leonardo Estenio Iezzi, Marley Ribeiro Feitosa, Bruno Amaral Medeiros, Jussara C Aquino, Ana Luiza Normanha Ribeiro de Almeida, Rogério Serafim Parra, José Joaquim Ribeiro da Rocha, Omar Féres||Study||2011||Crohn's||Positive||"Of the 14 patients evaluated, 11 had a satisfactory response. HBO has shown benefits in patients with CD refractory to pharmacologic therapy"|
|Hyperbaric Oxygen Therapy for Chronic Antibiotic-Refractory Ischemic Pouchitis||Custon T Nyabanga, Geeta Kulkarni, Bo Shen||Case Study||2015||IBD||Positive||"In this case, we demonstrated that HBOT aided mucosal healing. This observation suggests a novel and potential adjuvant therapy for individuals with CARP. On the other hand, the beneficial effect of HBOT suggests the role of compromised tissue oxygenation in the pathogenesis of chronic pouchitis."|
|Hyperbaric Oxygen Therapy in Crohn’s Disease and Ulcerative Colitis||Hyperbaric Research & Studies||Case Report||2016||IBD||Positive||"At the end of the therapy course, which included 35 sessions of electrical stimulation as well as application of topical hydrogel dressing, we confirmed closure of all perianal lesions, significant improvement in quality of life presented with PCDI from 13 to 4. She was pain free and stopped with analgetics after 3 years of daily usage. She is able to work full time sedentary job and has recently been promoted. At three months follow-up all wounds remain closed. Conclusion: Hyperbaric oxygen therapy used in conjunction with electrical stimulation provided an effective treatment for severe perianal ulcerative colitis."|
|Hyperbaric oxygen therapy benefits hospitalized UC patients||Peter D. Higgins, MD||Trial||2017||UC||Positive||"This trial had a very small sample size, and while it produced a suggestive signal of efficacy, more research is clearly needed to determine the optimal dose, how often the therapy should be administered, and how quickly it works."|
|Adjunctive Hyperbaric Oxygen Therapy Promotes Successful Healing in Patients With Refractory Crohn’s Disease||M. Ribeiro Feitosa, R. S. Parra, O. Feres Filho, J. J. Ribeiro da Rocha, O. Féres||Study||2016||Crohn's||Positive||"A high short-term healing rate was observed in a group of patients with complicated and refractory CD after HBOT. No complications were found during the procedure. The results suggest that HBOT may have an adjunctive role in CD complications. Further investigation is need to strengthen our findings."|
|Ulcerative Colitis and Crohns||Dr. Jennifer Nardella, Dr. Meghan Haggarty||Research||N/A||IBD||Positive||"Based on recent research, inflammatory bowel diseases responded very well to hyperbaric oxygen therapy (31 studies), The following mechanism and findings explains the role of HBOT in treating such cases"|
HBOT is not for everyone, and potentially expensive, but if you have exhausted other options or are recently diagnosed and want to attempt to heal your IBD before symptoms become more advanced, then it is certainly worth trying and has few minor adverse effects.
- Six Patients Whose Perianal and Ileocolic Crohn??s Disease Improved in the Dead Sea Environment (1995)
- The O.M.G.E. Multinational Inflammatory Bowel Disease Survey 1976-1982. A further report on 2,657 cases. (1984)
- A scale measuring general well-being, abdominal pain, abdominal pain, abdominal mass and complications, assigning a score to each and then a total. The Harvey-Bradshaw Calculator is available here.
- Signaling molecules that regulate immunity and inflammation
- Bacteria in Crohn’s disease: mechanisms of inflammation and therapeutic implications. (2007)
- Observations on a microscopic level of whole tissue for characteristics of disease.