636 Hyperbaric Oxygen Therapy Is Effective in the Treatment of Inflammatory Disorders of the Ileal Pouch

Abstract

INTRODUCTION: Inflammatory disorders of ileal pouch-anal anastomosis (IPAA) including chronic pouchitis, Crohn's Disease (CD) of the pouch and cuffitis are common and their management can be challenging. Hyperbaric oxygen (HBO) has been used for the treatment of ulcerative colitis (UC) and CD; however, its use in pouchitis has not been systemically evaluated. The aim of our study was to assess the response to HBO therapy in patients with inflammatory diseases of the pouch. METHODS: In this retrospective case series, we included all patients above the age of 18, with history of IPAA and medically refractory pouchitis. HBO was executed with standard protocol with 2.4 to 3.0 PSI with a total of 30 sessions over 2 months. A modified Pouchitis Disease Activity Index (mPDAI) was used to quantify symptom and endoscopy sub-scores. The Wilcoxon Signed Rank test was used to compare the results. A P value of < 0.05 was taken to be significant. RESULTS: A total of 21 patients were included in the study, 52.4% (n = 11) of these were males. The mean age of our sample was 40.4 ± 12.3 years. The indications of HBO were pouchitis (n = 18), fistulae (n = 9), surgical site/anastomotic ulcers (n = 7), active cuffitis (n = 6), ischemic ulcers (n = 4); most patients had more than one indication (Table 1). Thirteen patients (61.9%), reported subjective symptomatic improvement in stool frequency, bleeding, urgency and fevers. Of these, six patients (28.5%) reported complete remission of symptoms (Figure 1). Seventeen patients (80.9%) had endoscopic improvement. Among these 2 (10%) showed endoscopic remission (Figures 1 and 2). Of the 9 patients who had fistulae, 7 (77.8%) showed healing of the fistula tract. Overall, 19 (90.5%) patients had improvement in their mPDAI. Mean mPDAI of our cohort prior to therapy was 8.71. Of those who showed response, the mPDAI improved by a median of 3 (IQR 2-3) points. No side effects were seen in our cohort. The mean mPDAI was significantly better after HBO therapy (P < 0.05). CONCLUSION: Hyperbaric oxygen therapy led to symptomatic and endoscopic improvement, as noted by the mPDAI, in majority of patients. Most patients with fistulae had significant endoscopic improvement.