Dear editor, Armuzzi and Pugliesi have recently published an editorial about the HOT-TOPIC trial. 1 In the current study, Lansdorp et al. reported the long-term (week 60) follow-up of 20 Crohn's disease patients with perianal fistulas treated with 40 daily sessions of hyperbaric oxygen therapy, for a total of 8 weeks. 2 The authors raised some questions, such as: (I) the direct cost for the health/insurance system; (II) the indirect cost for patients, treated for 40 working days; and (III) the