Fistulizing Crohn’s / Ulcerative Colitis & Hyperbarics

Fistulizing Crohn’s disease

occurs when chronic inflammation causes abnormal tunnels (fistulas) between the bowel and other organs, skin, or anus, affecting up to 30% of patients. Symptoms include severe pain, abscesses, and drainage (pus/stool). Treatment involves a multidisciplinary approach combining biologics (e.g., infliximab), antibiotics (metronidazole/ciprofloxacin), and surgery (seton placement) to manage symptoms and close tracks.

​

Key Aspects of Fistulizing Crohn's Disease

• Types of Fistulas: Commonly, these are perianal (around the anus) or enterocutaneous (between the intestine and skin).

• Symptoms: Persistent pain (often throbbing, worsens with sitting/moving), skin irritation, and discharge of stool or pus near the anus.

• Diagnosis: Often diagnosed via physical examination by a specialist, MRI, ultrasound, or examination under anesthesia.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) causing long-lasting inflammation and ulcers in the innermost lining of the large intestine (colon) and rectum. It causes symptoms like bloody diarrhea, abdominal cramps, and urgent bowel movements. While there is no cure, it is managed with medications and, in severe cases, surgery.

Symptoms of Ulcerative Colitis
Symptoms can appear gradually, vary by severity, and include periods of active flares and remission:

• Diarrhea: Often with blood, pus, or mucus.

• Abdominal Pain: Severe cramping or pain.

• Rectal Symptoms: Urgent need to defecate, rectal pain, or bleeding.

• Systemic Symptoms: Fatigue, weight loss, loss of appetite, and fever.

• Extra-intestinal symptoms: Joint pain, skin issues, or eye inflammation.

What Causes Ulcerative Colitis
The exact cause is unknown, but researchers believe it is a combination of factors:

• Immune System Dysfunction: An immune response mistakenly attacks the cells in the digestive tract.

• Genetics: It tends to run in families.

• Environmental Factors: Bacteria, viruses, or environmental factors may trigger the immune response, although diet and stress are not primary causes, but can worsen symptoms.

Risk Factors for Ulcerative Colitis

• Age: Usually diagnosed before age 30, though it can occur at any age.

• Ethnicity: Higher risk in white individuals, especially those of Ashkenazi Jewish descent.

• Family History: Higher risk if a first-degree relative has the disease.

Stages and Types of Ulcerative Colitis
UC is categorized by the area of the colon affected:

• Ulcerative Proctitis: Affects only the rectum (mildest form).

• Proctosigmoiditis: Involves the rectum and the lower end of the colon (sigmoid colon).

• Left-Sided Colitis: Affects the rectum and the left side of the colon.

• Pancolitis: Affects the entire colon.

• Fulminant Colitis: A rare, severe form affecting the whole colon, causing severe pain and diarrhea.

Hyperbaric Oxygen Therapy (HBOT) is an effective adjunctive treatment for severe or fistulizing Crohn’s disease and Ulcerative Colitis (UC), with studies showing 78–80% of patients experiencing symptom improvement. It works by delivering concentrated oxygen in a pressurized chamber, reducing inflammation, healing tissue, and closing fistula tracts.

​

Key Benefits for IBD (Crohn's & Colitis):

• Reduced Inflammation: HBOT decreases inflammatory cytokines (like TNF-α) and markers of immune dysfunction.

• Fistula Healing: Highly effective for perianal and enterocutaneous fistulas in Crohn’s, with one study showing an 87% clinical response rate.

• Tissue Oxygenation: Increases oxygen supply to the bowel, reversing the tissue hypoxia often found in active UC and Crohn’s.

• Reduced Surgery/Medication Dependency: Helps avoid rescue therapies in hospitalized UC patients.

Key Considerations:

• Not a Standalone Treatment: HBOT is used alongside traditional medication, not as a replacement.

• Effectiveness: Studies suggest 78% of Crohn's patients and up to 100% of some studied UC patient cohorts show improvement.

• Side Effects: Generally safe, with rare, minimal side effects, though ear barotrauma or fatigue can occur.