• Acute severe ulcerative colitis (ASUC)
• Biologic therapy
• Hospitalized patients
• Inflammatory Bowel disease (IBD)
• Intravenous corticosteroids
• Janus kinase (JAK) inhibitors
• Steroid refractory

• Humans
• Colitis, Ulcerative/drug therapy
• Colitis, Ulcerative/diagnosis
• Gastrointestinal Agents/therapeutic use
• Gastrointestinal Agents/adverse effects
• Acute Disease
• Severity of Illness Index
• Biological Products/therapeutic use
• Biological Products/adverse effects
• Hospitalization
• Treatment Outcome
• Colectomy
• Infliximab/therapeutic use
• Cyclosporine/therapeutic use
• Immunosuppressive Agents/therapeutic use

• Croatia
• Crohn’s disease
• hyperbaric oxygen therapy
• inflammation
• inflammatory bowel disease

• Avascular necrosis
• Corticosteroids
• Inflammatory bowel disease

• PASC
• PCC
• calciphylaxis
• facial filler
• frostbite
• hyperbaric oxygen
• hypospadias
• infected implanted hardware
• inflammatory bowel disease
• postacute sequelae of COVID-19
• post–COVID-19 condition
• pyoderma gangrenosum

• crohn’s disease
• hyperbaric medicine
• hyperbaric oxygen treatment
• inflammatory bowel disease
• perianal fistula

• Crohn’s disease
• Fecal microbiota transplantation
• Gut microbiota
• Hyperbaric oxygen therapy
• Inflammation

• Crohn Disease/therapy
• Crohn Disease/microbiology
• Humans
• Dysbiosis/therapy
• Dysbiosis/microbiology
• Hyperbaric Oxygenation
• Gastrointestinal Microbiome
• Animals
• Female
• Male
• Inflammation/therapy
• Adult
• Intestines/microbiology
• Middle Aged
• Fecal Microbiota Transplantation
• Mice
• Mice, Inbred C57BL
• Young Adult

• 82230019 National Natural Science Foundation of China
• 82170599 National Natural Science Foundation of China
• 82070651 National Natural Science Foundation of China

• Hyperbaric Oxygenation/methods
• Reperfusion Injury/therapy
• Humans
• Intestines/blood supply
• Animals

• hyperbaric oxygen therapy
• inflammatory bowel disease
• mucosal inflammation

• Tai Shan Young Scholar Foundation of Shandong Province
• National Natural Science Foundation of China

• Female
• Humans
• Crohn Disease/therapy
• Fistula/therapy
• Hyperbaric Oxygenation/adverse effects
• Oxygen/therapeutic use
• Treatment Outcome

• Adult
• Humans
• Child
• Crohn Disease/drug therapy
• Tumor Necrosis Factor-alpha
• Remission Induction
• Necrosis

• Humans
• Crohn Disease/therapy
• Crohn Disease/surgery
• Quality of Life
• Rectal Fistula/therapy
• Rectal Fistula/surgery
• Fecal Incontinence/complications
• Abscess/etiology
• Treatment Outcome

• Efficacy
• Hyperbaric oxygenation
• Inflammatory bowel disease
• Recurrence
• Systematic review

Crohn's disease (CD) is a chronic nonspecific intestinal inflammatory disease. The aetiology and pathogenesis of CD are still unclear. Anal fistula is the main complication of CD and is a difficult problem to solve at present. The main limitation of developing new therapies is bound up with the short of preclinical security and effectiveness data. Therefore, an ideal animal model is needed to establish persistent anal fistula and an inflamed rectal mucosa.

To improve the induction method of colitis and establish a reliable and reproducible perianal fistulizing Crohn’s disease animal model to evaluate new treatment strategies.

Twenty male New Zealand rabbits underwent rectal enema with different doses of 2,4,6-trinitrobenzene sulfonic acid to induce proctitis. Group A was treated with an improved equal interval small dose increasing method. The dosage of group B was constant. Seven days later, the rabbits underwent surgical creation of a transsphincteric fistula. Then, three rabbits were randomly selected from each group every 7 d to remove the seton from the fistula. The rabbits were examined by endoscopy every 7 days, and biopsy forceps were used to obtain tissue samples from the obvious colon lesions for histological analysis. The disease activity index (DAI), colonoscopy and histological scores were recorded. Perianal endoscopic ultrasonography (EUS) was used to evaluate the healing of fistulas.

Except for the DAI score, the colonoscopy and histological scores in group A were significantly higher than those in group B (P < 0.05). In the ideal model rabbit group, on the 7^th day after the removal of the seton, all animals had persistent lumens on EUS imaging, showing continuous full-thickness high signals. Histological inspection of the fistula showed acute and chronic inflammation, fibrosis, epithelialization and peripheral proctitis of the adjoining rectum.

The improved method of CD colitis induction successfully established a rabbit perianal fistula CD preclinical model, which was confirmed by endoscopy and pathology.

• Crohn’s disease
• Perianal fistula
• Model
• Endoscopy
• Histology

• Animals
• Colitis/complications
• Crohn Disease/drug therapy
• Humans
• Male
• Proctitis/complications
• Rabbits
• Rectal Fistula/diagnostic imaging
• Rectal Fistula/etiology
• Rectal Fistula/surgery
• Treatment Outcome

• Crohn disease
• Hyperbaric oxygen therapy
• Stricturing disease

• Crohn’s disease
• non-pharmacologic
• therapy-refractory
• ulcerative colitis

Previously published short‐term results (week 16) of this trial showed a significant improvement in clinical, radiologic and biochemical outcomes in Crohn's disease patients with therapy‐refractory perianal fistulas after treatment with hyperbaric oxygen therapy.

To assess the long‐term (week 60) efficacy, safety and feasibility of hyperbaric oxygen therapy in perianal fistula in Crohn's disease.

Crohn's disease patients with high perianal fistula(s) failing conventional treatment >6 months were included. Exclusion criteria were presence of a stoma, rectovaginal fistula(s) and recent changes in treatment regimens. Patients received 40 hyperbaric oxygen sessions and outcomes were assessed at week 16 and week 60.

Twenty patients were included (median age 34 years). At week 16, median scores of the perianal disease activity index and modified Van Assche index (co‐primary outcomes) decreased from 7.5 (95% CI 6–9) to 4 (95% CI 3–6, p < 0.001) and 9.2 (95% CI 7.3–11.2) to 7.3 (95% CI 6.9–9.7, p = 0.004), respectively. At week 60, the respective scores remained significantly lower than baseline: 4 (95% CI 3–7, p < 0.001) and 7.7 (95% CI 5.2–10.2, p = 0.003). Perianal disease activity index score of 4 or less (representing inactive perianal disease) was observed in 13 patients at week 16 and 12 patients at week 60. Using fistula drainage assessment, 12 and 13 patients showed a clinical response at week 16 and 60, respectively, and clinical remission was achieved in four patients for both time points. At week 16, a statistically significant biochemical improvement (C‐reactive protein and faecal calprotectin levels) was found, but this effect was no longer significant at week 60.

The clinical and radiologic improvement of perianal fistula in Crohn's disease, that was found at week 16 after treatment with hyperbaric oxygen therapy, is maintained at 1‐year follow‐up.

• Crohn's disease
• fistulising
• hyperbaric oxygen therapy
• inflammatory bowel disease
• perianal fistulas
• therapy-refractory

• Anti-TNF agent
• Mesenchymal stem cell
• Perianal Crohn's disease
• Ustekinumab

• Chronic Disease
• Colitis, Ulcerative/diagnosis
• Colitis, Ulcerative/etiology
• Colitis, Ulcerative/therapy
• Crohn Disease/diagnosis
• Crohn Disease/etiology
• Crohn Disease/therapy
• Humans
• Hyperbaric Oxygenation/adverse effects
• Inflammatory Bowel Diseases/therapy

Crohn’s Disease (CD) is a chronic inflammatory disorder in which up to 50% of patients develop fistula within 20 years after the initial diagnosis, and half of these patients suffer perianal fistulizing disease. The etiopathogenesis of CD-related perianal fistula is still unclear, and its phenotypical and molecular characteristics are even more indefinite. A better understanding would be crucial to develop targeted and more effective therapeutic strategies. At present, the most accredited theory for the formation of CD-related fistula identifies the epithelial-to-mesenchymal transition (EMT) as the driving force. It has been well recognized that CD carries an increased risk of malignancy, particularly mucinous adenocarcinoma is often associated with long-standing fistula in CD patients. Despite the availability of multiple treatment options, perianal fistulizing CD represents a therapeutic challenge and is associated with an important impact on patients’ quality of life. To date, the most effective management is multidisciplinary with the cooperation of gastroenterologists, surgeons, radiologists, and nutritionists and the best recommended treatment is a combination of medical and surgical approaches.

• Crohn-associated fistula
• epithelial-to-mesenchymal transition
• mucinous adenocarcinoma

IBD (inflammatory bowel disease) characterized by chronic inflammation of the gastrointestinal (GI) tract is one of the chronic diseases the prevalence of which has been increasing globally. In the past few decades, significant improvements were made in the treatments relating to IBD which have reduced the hospitalization and mortality rates; however, there is still room for improvement with other alternative therapies. HBOT (hyperbaric oxygen treatment) is one of the effective therapies used in treating various conditions including wounds, decompression sickness, stroke, etc. Several studies have reported the role of HBOT as an adjunctive treatment to IBD, while adopting conventional treatment procedures. There is an increasing trend of research in this particular area. Studies have shown that HBOT reflects its therapeutic effect by controlling inflammation, reducing oxidation stress, improving the process of cleaning damaged cells and recruiting the cells involved in repair; thereby improving the immunity response system. In this context, the purpose of this review is to summarize past clinical and experimental studies and to understand the role of hyperbaric treatment for IBD. The findings from the review have suggested that hyperbaric therapy can be an effective adjunctive approach for IBD, based on which some ideas for future clinical and research work are provided.

• chronic
• hyperbaric oxygen therapy
• inflammation
• inflammatory bowel disease

• Cost-effectiveness
• Hospitalization
• Natural history

• Colitis, Ulcerative/therapy
• Cost-Benefit Analysis
• Humans
• Hyperbaric Oxygenation/economics
• Inpatients
• Models, Biological
• Quality-Adjusted Life Years

• P30 DK120515 NIDDK NIH HHS

• Crohn’s disease
• Inflammatory bowel disease
• refractory
• ulcerative colitis
• unlicensed medication

• Biological Factors/therapeutic use
• Diet
• Digestive System Surgical Procedures
• Fecal Microbiota Transplantation
• Gastrointestinal Agents/therapeutic use
• Hematopoietic Stem Cell Transplantation
• Humans
• Immunosuppressive Agents/therapeutic use
• Inflammatory Bowel Diseases/diagnosis
• Inflammatory Bowel Diseases/therapy
• Medication Adherence
• Mesenchymal Stem Cell Transplantation
• Patient Care Team
• Remission Induction

• adult gastroenterology
• coeliac disease
• endoscopy
• inflammatory bowel disease

• China
• Colitis, Ulcerative/therapy
• Humans
• Hyperbaric Oxygenation
• Meta-Analysis as Topic
• Research Design
• Systematic Reviews as Topic

• The National Key R&D Program of China

• hyperbaric oxygen therapy
• inflammatory bowel diseases
• total proctocolectomy with ileal pouch anal anastomosis

• Adult
• Anti-Bacterial Agents
• Chronic Disease
• Colitis, Ulcerative/surgery
• Colonic Pouches
• Endoscopy, Gastrointestinal
• Female
• Humans
• Hyperbaric Oxygenation
• Male
• Middle Aged
• Pouchitis/etiology
• Pouchitis/therapy
• Proctocolectomy, Restorative/adverse effects
• Retrospective Studies

Positive effects of hyperbaric oxygen (HBO) on perianal fistulas in Crohn’s disease (CD) have been described, but the effect on rectovaginal fistulas (RVFs) has not yet been studied. The aim was to investigate the efficacy, safety and feasibility of HBO in patients with RVF in CD.

In this prospective study, consecutive CD patients between November 2018 and February 2020 presenting with RVF at the outpatient fistula clinic of the Amsterdam University Medical Centre were included and selected to receive treatment with 30 daily HBO sessions, if fistulas were actively draining and any concomitant treatment regimen was stable at least 6 weeks prior to start of HBO. Patients with a stoma were excluded. The primary endpoint was clinical closure at 3-month follow-up, defined as cessation of complaints and/or closure of the external orifice if visible at baseline. Secondary outcomes were improvement of concomitant perianal fistulas as measured by the perianal disease activity index (PDAI) and fistula drainage assessment (FDA), as well as improvement in patient-reported outcomes (visual analogue scale (VAS), inflammatory bowel disease questionnaire (IBDQ), faecal incontinence quality of life scale (FIQL) and female sexual functioning index (FSFI)) at 3-month follow-up.

Out of 14 eligible patients, nine patients (median age 50 years) were treated, all of whom had previously had one or more unsuccessful medical and/or surgical treatments for their RVF. Clinical closure occurred in none of the patients at 3-month follow-up. There was no improvement in PDAI and patient-reported outcomes (VAS, IBDQ, FIQL and FSFI). Two patients had concomitant perianal fistulas; using FDA, one patient had a clinical response and one patient was in clinical remission 3 months after HBO. There were two treatment-related adverse events during HBO concerning claustrophobia and fatigue. Furthermore, two patients had a surgical intervention due to RVF and two patients were treated with antibiotics for a urinary tract infection during follow-up. One patient had a dose reduction of ustekinumab because of decreased luminal complaints.

Treatment with HBO was feasible, but in this therapy-refractory cohort without deviating ostomy no clinical closure of RVF or improvement in quality of life was seen 3 months after HBO. Treatment with HBO alone in this specific group of patients therefore appears to be ineffective.

• hyperbaric oxygen therapy
• protocol
• systematic review
• ulcerative colitis

• Clinical Protocols
• Colitis, Ulcerative/therapy
• Humans
• Hyperbaric Oxygenation/instrumentation
• Hyperbaric Oxygenation/methods
• Hyperbaric Oxygenation/standards
• Meta-Analysis as Topic
• Systematic Reviews as Topic
• Treatment Outcome

• Crohn’s disease
• anti-inflammatory
• anti-oxidation
• clinical and experimental studies
• hyperbaric oxygen therapy
• inflammatory bowel disease
• oxygen
• therapeutic implications
• ulcerative colitis

One of the most challenging phenotypes of Crohn’s disease is perianal fistulizing disease (PFCD). It occurs in up to 50% of the patients who also have symptoms in other parts of the gastrointestinal tract, and in 5% of the cases it occurs as the first manifestation. It is associated with severe symptoms, such as pain, fecal incontinence, and a significant reduction in quality of life. The presence of perianal disease in conjunction with Crohn’s disease portends a significantly worse disease course. These patients require close monitoring to identify those at risk of worsening disease, suboptimal biological drug levels, and signs of developing neoplasm. The last 2 decades have seen significant advancements in the management of PFCD. More recently, newer biologics, cell-based therapies, and novel surgical techniques have been introduced in the hope of improved outcomes. However, in refractory cases, many patients face the decision of having a stoma made and/or a proctectomy performed. In this review, we describe modern surgical management and the most recent advances in the management of complex PFCD, which will likely impact clinical practice.

• Crohn’s disease
• Inflammatory bowel disease
• Surgical treatment
• Perianal fistulas
• Anorectal fistula

• Crohn Disease/diagnosis
• Crohn Disease/surgery
• Fecal Incontinence
• Humans
• Quality of Life
• Rectal Fistula/etiology
• Rectal Fistula/surgery
• Surgical Stomas

• effectiveness
• health data
• hyperbaric oxygenation
• measure
• outcome
• oxygen treatment
• patient reported
• patient-reported outcome measures
• registries
• registry
• treatment

• Inflammatory bowel disease
• cutaneous manifestations
• wound healing

• Adult
• Biopsy
• Crohn Disease/complications
• Crohn Disease/immunology
• Crohn Disease/therapy
• Female
• Follow-Up Studies
• Granuloma/diagnosis
• Granuloma/etiology
• Granuloma/pathology
• Granuloma/therapy
• Humans
• Hyperbaric Oxygenation/methods
• Middle Aged
• Perineum/diagnostic imaging
• Perineum/pathology
• Photography
• Postoperative Complications/diagnosis
• Postoperative Complications/etiology
• Postoperative Complications/pathology
• Postoperative Complications/therapy
• Proctectomy/adverse effects
• Prospective Studies
• Rectal Fistula/immunology
• Rectal Fistula/surgery
• Skin/diagnostic imaging
• Skin/immunology
• Skin/pathology
• Surveys and Questionnaires/statistics & numerical data
• Treatment Outcome
• Wound Healing

Anastomotic leak remains a significant cause of morbidity and mortality after colorectal surgery. Among multiple risk factors considered, hypoxia–ischaemia is considered to be a primary cause of intestinal anastomotic leakage. The aim of this experimental study was to assess safety, usability for surgical tasks, and efficacy of a newly developed oxygen‐producing suture material in the healing of colonic anastomoses under critical conditions.

An oxygen‐producing suture material was produced that is capable of releasing oxygen directly into the surrounding tissue. Off‐the‐shelf sutures loaded with calcium peroxide nano‐crystals and covered with poly(d,l‐lactide‐co‐glycolide) were assessed in vitro and in a rat model of hypoxic colonic anastomosis.

In vitro assessment showed that these sutures can increase oxygen levels in a hypoxic environment. Potential oxygen byproducts did not seem to have a negative impact on the viability of intestinal cells. The use of oxygen‐producing sutures in vivo resulted in increased tissue oxygen saturation, measured by visible light spectroscopy, and increased mechanical stability of the anastomosis.

Oxygen‐producing suture material increased tissue oxygen saturation and mechanical stability of colonic anastomosis in a rat model.