Hyperbaric oxygen for toxic megacolon

Abstract

Author'reply Sir—Mark Welfare and colleagues describe limitations in the diagnosis of toxic megacolon and the advantages of surgical treatment. With respect to diagnosis in our patient, clinical symptoms, colonoendoscopic findings, and negative stool tests suggested severe ulcerative colitis. After diagnosis, treatment with an intensive intravenous regimen with steroids was started immediately. Blood tests and radiography were done twice a week. 4 days after treatment, fever lessened and stool frequency was slightly improved. We therefore continued intravenous steroid injections. However, abdominal swelling was pronounced 9 days after treatment. Abdominal radiography showed gas filling the transverse colon. This finding and clinical symptoms suggested toxic megacolon. The patient was a medical practitioner. We explained that surgical treatment would be required when the risk of perforation increased. However, the patient did not consent to this suggestion and expressed a strong desire for conservative treatment. We had previously given hyperbaric oxygen to 127 patients with ileus, 80% of whom showed improvement: otalgia and a sensation of blocked ear, which seemed to be compression disorders, were noted in 15 patients. There were no other-serious complications suggesting oxygen intoxication in any patient. We therefore, explained to-our patient that hyperbaric oxygen was indicated to achieve decompressive effects and anti-inflammatory actions.1Weisz G Modification of in vivo and in vitro TNF-alpha, IL-1, and IL-6 secretion by circulating monocytes during hyperbaric oxygen treatment in patients with perianal Crohn's disease.J Clin Immunol. 1997; 17: 154-159Crossref PubMed Scopus (110) Google Scholar, 2Brady CE Coley BJ Davis JC Healing of severe perineal and cutaneous Crohn's disease with hyperbaric oxygen.Gastroenterology. 1989; 97: 756-760PubMed Google Scholar, 3Davis JC Enhancement of healing.in: Camporesi EM Barker AC Hyperbaric oxygen therapy: a critical review. Undersea and Hyperbaric Medical Society, Bethesda1991: 127-140Google Scholar, 4Hohn DC Mackay RD Halliday B Hunt TK Effect of 02 tension on microbicidal function of leukocytes in wounds and in vitro.Surg Forum. 1976; 27: 18-20PubMed Google Scholar The patient consented to this treatment, and treatment was started within 48 h of diagnosis of toxic megacolon. In our institution, colonoscopy is undertaken in more than 2500 patients per year. We have seen the exacerbation of ulcerative colitis with the use of colonoscopy in severe disease. 15 treatments with hyperbaric oxygen rapidly improved this patient's symptoms. Transverse colonic mucosal findings were endoscopically confirmed after informed consent was obtained. To examine further therapeutic strategies, colonoscopy was done without pretreatment. The present case was classified as total colitis. For surgical treatment, total colectomy and ileostomy or ilealpouch anal anastomosis are needed. In surgical cases, a reduction in quality of life cannot be avoided.5Weinryb RM Gustavsson JP Liljeqvist L Poppen B Rossel RJ A prospective study of the quality of life after pelvic pouch operation.J Am Coll Surg. 1995; 180: 589-595PubMed Google Scholar As Welfare and colleagues indicated, total colectomy and ileostomy may facilitate early discharge, but the time required for rehabilitation and the patient's return to their previous occupation will be further prolonged. I confirm that hyperbaric oxygen shows strong anti-inflammatory activity and striking effects in toxic colitis due to severe ulcerative colitis. I conclude that it is the safest and most reliable non-surgical method for toxic colitis. Hyperbaric oxygen for toxic megacolonKatsuro Kuroki and colleagues (Sept 5, p 782)1 claim that hyperbaric oxygen was effective in the treatment of one case of toxic megacolon. We are worried that readers may have been misled about the usual treatment of this condition and that the facts of the case do not support the claim. We are also concerned that such an experimental treatment should be published when there is little biological laboratory evidence to support its efficacy. Full-Text PDF