Hyperbaric oxygen therapy for the treatment of perianal fistulas in 20 patients with Crohn's disease: Results of the HOT‐TOPIC trial after 1‐year follow‐up

Abstract

Background: Previously published short-term results (week 16) of this trial showed a significant improvement in clinical, radiologic and biochemical outcomes in Crohn's disease patients with therapy-refractory perianal fistulas after treatment with hyperbaric oxygen therapy.Objective: To assess the long-term (week 60) efficacy, safety and feasibility of hyperbaric oxygen therapy in perianal fistula in Crohn's disease.Methods: Crohn's disease patients with high perianal fistula(s) failing conventional treatment >6 months were included. Exclusion criteria were presence of a stoma, rectovaginal fistula(s) and recent changes in treatment regimens. Patients received 40 hyperbaric oxygen sessions and outcomes were assessed at week 16 and week 60.Results: Twenty patients were included (median age 34 years). At week 16, median scores of the perianal disease activity index and modified Van Assche index (coprimary outcomes) decreased from 7.5 (95% CI 6-9) to 4 (95% CI 3-6, p < 0.001) and 9.2 (95% CI 7.3-11.2) to 7.3 (95% CI 6.9-9.7, p = 0.004), respectively. At week 60, the respective scores remained significantly lower than baseline: 4 (95% CI 3-7, p < 0.001) and 7.7 (95% CI 5.2-10.2, p = 0.003). Perianal disease activity index score of 4 or less (representing inactive perianal disease) was observed in 13 patients at week 16 and 12 patients at week 60. Using fistula drainage assessment, 12 and 13 patients showed a clinical response at week 16 and 60, respectively, and clinical remission was achieved in four patients for both time points. At week 16, a statistically significant biochemical improvement (C-reactive protein and faecal calprotectin levels) was found, but this effect was no longer significant at week 60. Conclusions:The clinical and radiologic improvement of perianal fistula in Crohn's disease, that was found at week 16 after treatment with hyperbaric oxygen therapy, is maintained at 1-year follow-up.

Approaches in the treatment of perianal fistula in Crohn disease

“…7 After 1 year of follow-up, the clinical and radiological improvements in the 20 patients with pfCD were similar to those seen at 16 weeks. 43 This demonstrated the effectiveness of hyperbaric oxygen for long-term improvement of pfCD. The main adverse effect of hyperbaric oxygen was pneumatic injuries, but these were mostly resolved after treatment.…”

Crohn’s Disease-Associated and Cryptoglandular Fistulas: Differences and Similarities

“…Additionally, Lansdorp and colleagues found that hyperbaric oxygen therapy (HBOT) was beneficial for refractory CD-associated fistulas. Compared to the baseline, they achieved clinical and radiological improvement after one-year follow-up [ 87 ]. This might open new opportunities for the treatment of CD-associated fistulas.…”

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