Hyperbaric oxygen therapy helps hospitalized patients with ulcerative colitis

CHICAGO - People with moderate to severe ulcerative colitis may soon benefit from a treatment that is well known for healing chronic wounds. In a study of patients who were hospitalized due to severe ulcerative colitis symptoms, hyperbaric oxygen therapy resulted in clinical improvements that helped patients avoid surgery and immunosuppressant medication. The study alsodefined the ways hyperbaric oxygen therapy functions to improve inflammation in ulcerative colitis.

Parambir Dulai, MD, gastroenterology at Northwestern Memorial Hospital, said ulcerative colitis is an autoimmune disorder that causes ulcers and inflammation in the colon. Depending on its severity, the disease can cause bloody diarrhea and abdominal pain, or even an uncontrollable urge to use the restroom, which forces patients to be close to a bathroom or results in accidents. It can be debilitating for its sufferers and can dramatically reduce a person’s quality of life.

“People with ulcerative colitis have a breakdown of the lining of the colon, and immune cells come into the colon to try to help it heal,” Dr. Dulai said. “Immune cells consume all the oxygen as they try to fight off bad bacteria, but this eventually leads to a lack of oxygen in the tissue and makes it difficult for the healing process to occur. Hyperbaric oxygen therapy is a way to push oxygen into the colon through its tiny blood vessels. This kills the inflammation-causing bad bacteria that thrive in these low-oxygen environments. It resets the immune system and allows the colon to heal.”
 

For the study, which was detailed in an article published in Cellular and Molecular Gastroenterology and Hepatology, Dr. Dulai and his colleagues placed patients in the hyperbaric chambers for two hours a day on five consecutive days. While in the chamber, patients rested, listened to music or watched movies. They received pressurized 100 percent oxygen, and the results surpassed even the researchers’ expectations.

“Within five days, their bleeding was gone,” Dr. Dulai said. “These patients were the sickest of the sick, and they were just days away from major surgeries to remove their colons. When you get to that point with ulcerative colitis, you’re no longer eligible for pharmaceutical trials, and few treatments have been studied for these patients.”

Later this year, Dr. Dulai hopes to begin an 18-site Phase 3 clinical trial funded by the National Institutes of Health to further study the use of hyperbaric oxygen therapy to treat patients who are hospitalized for ulcerative colitis flares. He will partner with the Northwestern University Data Analysis and Coordinating Center lead Lauren Balmert Bonner, PhD, and with colleagues at Northwestern Medicine Lake Forest Hospital, which is home to the health system’s in-hospital hyperbaric chambers.

Northwestern Medicine offers hyperbaric oxygen therapy at many offsite locations, and more than 1,300 hospitals across the nation have chambers on site.

“This study is especially exciting for patients who are in rural areas that do not have access to world-class physicians who specialize in inflammatory bowel disease,” Dr. Dulai said. “If we can get these patients out of the hospital and home to begin effective treatments, then they will be less likely to need life-changing surgeries. Access to care and financial resources should never be factors that determine why some people get to keep their colons while others don’t.”

The Phase 3 clinical trial will study another element of hyperbaric oxygen therapy: its long-term effectiveness in the treatment of ulcerative colitis.

“Three months after we treated patients in the first study, we realized they weren’t coming back to the hospital, and they were able to spend a couple of months healing and choosing new medication options,” Dr. Dulai said. “It appears that the treatment gave them several months to feel empowered to manage their disease and gave their physicians time to make an informed decision about the next treatment option. The next study will examine how patients are doing 12 months after their initial treatments. It will provide a framework so we can understand the durability of this approach in the outpatient setting. We will also learn more about whether we need to provide outpatient treatments to maintain the response to hyperbaric therapy.”

Dr. Dulai said the idea for his research began during his medical residency program at Dartmouth. He credits two physician mentors – Corey A. Siegel, MD, MS, and Jay C. Buckey Jr., MD – for helping him lay the groundwork for the study and for their ongoing support throughout every phase of the research. They encouraged him to explore new ways to alleviate the suffering of patients with ulcerative colitis. He even became certified in hyperbaric oxygen therapy so he could understand what patients are experiencing during treatment.

“We have great medications for ulcerative colitis, but at the same time, 70 percent of people will lose response to them within a few years,” Dr. Dulai said. “At least half of the people who have ulcerative colitis will be hospitalized at some point in their disease. To realize a simple treatment like hyperbaric oxygen therapy could have life-changing benefits for these patients is very exciting. Many of the patients we treated are still sending us thanks for the care they received.”
For more information, visit nm.org.