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P373 Adjunctive hyperbaric oxygen therapy promotes successful healing in patients with refractory Crohn’s disease

M. Ribeiro Feitosa1, R. S. Parra*1, O. Feres Filho2, J. J. Ribeiro da Rocha1, O. Féres1

1University of Sao Paulo, Surgery and Anatomy, Ribeirao Preto SP, Brazil, 2University of Sao Paulo, Department of Surgery and Anatomy, Ribeirao Preto SP, Brazil

Background

Purpose: to investigate the de-adjunctive effect of hyperbaric oxygen therapy (HBOT) in a group of patients with refractory Crohn’s disease (CD).

Methods

In total, 29 patients with refractory CD were submitted to daily sessions of HBOT, in a 2800 Sechrist Monoplace Hyperbaric Chamber (Sechrist, USA) pressurised to 2.4 antibodies to adalimumab (ATA). Each session lasted 2 hours. The endpoint was closure of enterocutaneous fistulas and partial or complete healing of pyoderma gangrenosum and perineal CD.

Results

The most common indication for HBOT was perineal CD (n = 15/51.7%) followed by enterocutaneous fistulas (n = 8/27.5%) and pyoderma gangrenosum (n = 3/10.3%). An association between enterocutaneous fistula and perianal CD was noted in 1 case. Concomitant enterocutaneous fistula and pyoderma gangrenosum were found in 1 patient. One patient exhibited all 3 complications. The median number of sessions was 20 (range, 10–86). A total of 829 HBOT sessions were performed and no complications were noted. Short-term results show an overall success rate of 76% (22 cases). Pyoderma gangrenosum and enterocutaneous fistulas had the better results (partial or complete healing of 100% and 91%, respectively). Perineal CD healing rate was 65%. The remaining patients had an unsatisfactory response and needed major surgery surgeries (intestinal diversion with proctectomy or abdominal-perineal amputation of the rectum). Some examples of patients treated with HBOT are shown in Figure 1.

Figure 1. Patients submitted to hyperbaric oxygen therapy (before and after).

Conclusion

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.1,2

References:

[1] Lezzi LE, Feitosa MR, Medeiros BA, et al. Crohn’s disease and hyperbaric oxygen therapy. Acta Cir Bras. 2011;26(Suppl 2):129–32.

[2] Vieira WA, Barbosa LR, Martin LM. Hyperbaric oxygen therapy as an adjuvant treatment for pyoderma gangrenosum. An Bras Dermatol 2011;86(6):1193–96.