Pouchitis has a historically poor prognosis. HBOT may help turn it around.
What is pouchitis? And how can hyperbaric help?
Pouchitis is the inflammation of an intestinal pouch created during surgery. Some individuals need their entire large intestine and rectum removed. Even without a colon, the bowel’s waste needs to exit the body.
One option is a J-pouch. This is where a surgeon creates a j-shaped pouch made of some of the small intestines. It’s connected to your anus and acts as a surgically-made rectum. This pouch surgery is an alternative to getting a long-term colostomy or ileostomy, where the bowel’s waste is collected in a bag outside the body.
This bowel removal is the most common surgery for ulcerative colitis patients. A whopping 30% of people with ulcerative colitis will need this colectomy.1 In some cases, people with colorectal cancer will need a colectomy as well.
It’s a high-risk area for surgery and healing. The digestive tract is notoriously full of bacteria that can cause infection. The surgery can be also done in one or multiple steps. In the multiple-step version, the patient temporarily has an ileostomy while the bowel somewhat heals. But having to undergo multiple surgeries increases the risk of infection as well.
In the common one-step version, the colon and rectum are taken out and the small intestine is connected right to the anus—all in one surgery. That means the J-pouch will come into contact with fecal matter while it’s still healing. It poses a huge risk for infection.2 The pouch often does get inflamed and infected. And for people that have ulcerative colitis, their digestive tract is already in a frequently inflamed state.
Unfortunately, pouchitis is a shockingly common complication. One-quarter to one-half of everyone who gets a J-pouch develops pouchitis. Medication treatment is often unsuccessful. The infections causing pouchitis can be extremely resistant to antibiotics.
Pouchitis can lead to troubling symptoms:3
- Bowel leakage, even at night
- Abdominal pain
- Trouble controlling bowel movements
- More bowel movements than usual
- Fever and joint pain
Ulcerative colitis has grim outcomes. For many, it’s a discouraging path of failing treatment, which usually needs resection surgery. Risky surgery has a high rate of infection. And if the patient ends up having pouchitis, the infection may be resistant to the antibiotics.
Understandably, scientists in the ulcerative colitis IBS community are extremely interested in anything that can improve healing and outcomes.
Enter hyperbaric oxygen therapy (HBOT). A patient simply relaxes in a clear chamber of pressurized 100% oxygen for several sessions. The treatment started as a way to decompress divers that have the bends. It’s progressed to help people with other issues, like slow healing wounds, bone infections, carbon monoxide poisoning, and much more.
What could hyperbaric oxygen therapy do for pouchitis?
- It speeds healing. This is one of the main uses of HBOT. Challenging areas to heal are great candidates for HBOT. Patients are amazed when their exposed bone and tendon, wounds that haven’t healed in years, or massive surgical wounds start to improve with HBOT.
- It reduces inflammation. Inflammation of any kind—post-surgical, infection-related, chronic—benefits from HBOT. The hyper-oxygenated environment helps slow the inflammation cascade. And the therapy uses pressure to drive the oxygen into all the body’s tissues—even a J-pouch. Unlike many treatments for colorectal health problems, it doesn’t require medication or invasive treatment.
- It can help with stubborn infections that aren’t responding well to antibiotics. Bone infections are some of the most difficult and unsuccessful infections to treat. But with HBOT, their chance of healing gets much better. More research is needed, but HBOT could be appropriate for combatting challenging pouchitis infections.
- It’s easy to tolerate, has very few side effects, very few contraindications. Safety measures are heavily implemented, making accidents very rare. In the world of colorectal diseases, it’s uncommon to have therapies that aren’t invasive or involve medications. But HBOT is easy, non-invasive, and works well in tandem with most other treatments
One study that had patients with pouchitis complications showed significant improvement with hyperbaric oxygen therapy. The 21 participants hadn’t responded well to other therapies. But after the study, three-quarters of the participants with inflamed and fistulizing pouches were are healed in 8 weeks.4
Another study had similar incredible results. The patients’ Pouchitis Disease Activity Index score was nearly halved at the end of the treatment.5
One case study showed marked improvement even with 20 sessions. This is a relatively small number of hyperbaric treatments, considering many patients need 40 or more sessions.6
Why isn’t there more research done on this?
With the benefits we’ve seen in the available studies, why hasn’t more research been done? Clinicians look to the evidence to help guide their treatment plans. More research with positive results helps clinicians consider new therapies.
Part of the problem is that studies on HBOT and pouchitis are currently limited. Also, many of the ones available don’t have a large sample. The studies often only involve one individual.
There are several reasons for this. HBOT, without insurance coverage, can be extremely expensive. Medicare only covers 15 specific diagnoses. Coverage from other insurance companies can be unpredictable. HBOT is also a time commitment. It can require at least 20 treatments and each treatment is over an hour long.
HBOT is rarely an emergency treatment. If pouchitis has progressed to needing emergency care, HBOT is not going to be considered.
Hyperbaric facilities also have a limited capacity. Only one person can use a single tank at a time, and a technician must monitor the patient during the entire therapy. One facility might have only one or two chambers. These are all safety measures. That’s why many studies of HBOT and pouchitis are on a single person or a very small group of people.
Want to treat your pouchitis with hyperbaric oxygen therapy?
Pouch surgery is often necessary, but extremely risky. HBOT offers benefits that combat the core problems of pouchitis.
If you’re ready to give your J-pouch the extra boost it needs to beat pouchitis, consider HBOT. To see if HBOT is right for your needs and insurance, we encourage you to give Hyperbaric Physicians of Georgia a call at 770-422-0517. Your best J-pouch outcomes are our goal.
[None of this article should be taken as medical advice, or be used to predict a patient’s outcome if they choose HBOT. Please talk to your doctor if you’re considering this treatment or any others for your health.]