The Role of Hyperbaric Oxygen Therapy in Pneumatosis Cystoides Intestinalis—A Scoping Review

Abstract

Pneumatosis cystoides intestinalis (PCI) is characterized by gas-filled cysts within gastrointestinal tract wall from esophagus to rectum, with preferential involvement of large and small intestine. PCI is rare with an estimated incidence of 0.03 to 0–2% in general population. PCI can be distinguished into idiopathic (15%) or secondary (85%) and the clinical picture ranges from completely asymptomatic to life-threatening intraabdominal complications. Although etiology of PCI appears to be multifactorial, the exact pathophysiology is poorly understood and two main theories have been proposed (mechanical and bacterial). Over the last decades, an enormous therapeutic armamentarium was considered in PCI's management, including hyperbaric oxygen therapy (HBOT). Treatment comprises conservative treatment in mild cases to surgery in highly symptomatic and complicated PCI. In the late 70s, HBOT started to be used in selected cases of PCI not responding to conservative measures. Since then, several case reports, case series, and reviews have been published in the literature with variable outcomes. The overall response rate and complete response were 92.1% (n = 82/89) and 65.2% (n = 58/89), respectively, with a median follow-up of 7 months. Furthermore, HBOT is extremely safe, with few reported complications in the literature when used for PCI. Nevertheless, a randomized, controlled, and double-blind clinical trial is unlikely to occur given the rarity of PCI, logistical issues of HBOT, and methodological considerations related to adequate blinding with a sham-controlled group. HBOT in combination with personalized diet and antibiotics may be beneficial for moderate to severe PCI in patients with no indication for emergency exploratory laparotomy. The purpose of this article is to synthesize the existing data, analyse results of previous studies, identify gaps in knowledge, and discuss PCI' management, including the proposal of an algorithm, with a special focus on HBOT.

A rare case of benign pneumatosis intestinalis in Sjogren’s syndrome

“…For benign PI, treatment is conservative in most cases, and it is crucial to consider other diagnoses, such as small bowel obstruction in the present case, as a cause of the patients’ clinical presentation. Treatment options for benign PI include inspired oxygen therapy, oral metronidazole and elemental diet; fewer than 5% of patients require surgery compared with its emergent role in pathological PI [ 9 , 10 ].…”

Pneumatosis cystoides intestinalis is a special type of pneumatosis intestinalis with benign prognosis but needs to be distinguished from necrotizing pneumatosis intestinalis: a retrospective cohort study

“…In contrast, a majority of patients with NPI (85.7%) underwent surgery, and the mortality rate was as high as 52.4%. Previous studies have also demonstrated that PCI can be treated with conservative therapy such as discontinuation of drugs that may cause PCI, gastrointestinal decompression, elemental diet, antibiotics, and hyperbaric oxygen therapy, [19,[32][33][34] while surgery or endoscopic treatment should only be considered in the presence of complications such as intestinal torsion or intussusception. [35,36] The main limitation of this study is the relatively small sample size of patients with PCI.…”

Hyperbaric oxygen therapy as a complementary treatment in neuroblastoma — a narrative review

“…The word "baric" and its prefix "hyper" define the purpose of HBOT, which consists of breathing 100% of O 2 under hyperbaric conditions, frequently ranging between 2.0 and 2.8 atmospheres absolute (ATA) (14). Its main effect is exerted by the elevation of the inspired gas partial pressure, together with an increase in the fraction of inspired O 2 (15), resulting in the enhanced amount of O 2 dissolved in plasma and an increase in the O 2 delivered to tissues, independently of hemoglobin (4,(16)(17)(18).…”