Hyperbaric oxygen treatment for inflammatory bowel disease: a systematic review and analysis

Daniel A Rossignol

• Correspondence: Daniel A Rossignol rossignolmd@gmail.com

Medical Gas Research 2012, 2:6 doi:10.1186/2045-9912-2-6

Published: 15 March 2012

Abstract (provisional)

Background

Traditionally, hyperbaric oxygen treatment (HBOT) has been used to treat a limited repertoire of disease, including decompression sickness and healing of problem wounds. However, some investigators have used HBOT to treat inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis.

Methods

Comprehensive searches were conducted in 8 scientific databases through 2011 to identify publications using HBOT in IBD. Human studies and animal models were collated separately.

Results

Thirteen studies of HBOT in Crohn's disease and 6 studies in ulcerative colitis were identified. In all studies, participants had severe disease refractory to standard medical treatments, including corticosteroids, immunomodulators and anti-inflammatory medications. In patients with Crohn's disease, 31/40 (78%) had clinical improvements with HBOT, while all 39 patients with ulcerative colitis improved. One study in Crohn's disease reported a significant decrease in proinflammatory cytokines (IL-1, IL-6 and TNF-alpha) and one study in ulcerative colitis reported a decrease in IL-6 with HBOT. Adverse events were minimal. Twelve publications reported using HBOT in animal models of experimentally-induced IBD, including several studies reporting decreased markers of inflammation or immune dysregulation, including TNF-alpha (3 studies), IL-1beta (2 studies), neopterin (1 study) and myeloperoxidase activity (5 studies). HBOT also decreased oxidative stress markers including malondialdehyde (3 studies) and plasma carbonyl content (2 studies), except for one study that reported increased plasma carbonyl content. Several studies reported HBOT lowered nitric oxide (3 studies) and nitric oxide synthase (3 studies) and one study reported a decrease in prostaglandin E2 levels. Four animal studies reported decreased edema or colonic tissue weight with HBOT, and 8 studies reported microscopic improvements on histopathological examination. Although most publications reported improvements with HBOT, some studies suffered from limitations, including possible publication and referral biases, the lack of a control group, the retrospective nature and a small number of participants.

Conclusions

HBOT lowered markers of inflammation and oxidative stress and ameliorated IBD in both human and animal studies. Most treated patients were refractory to standard medical treatments. Additional studies are warranted to investigate the effects of HBOT on biomarkers of oxidative stress and inflammation as well as clinical outcomes in individuals with IBD.

Words, Beautiful Words

Have not updated on Chandler's progress in a long time and it is long overdue.

So recently we started doing hard tank hyperbaric oxygen therapy with Harold Grams and we have been seeing some pretty big wows.

Chandler's progress had been really flat since last summer, kind of disheartening after all the gains he had made in previous years, and so we decided to give it a shot. We had tried soft tank HBOT a few years back, thought we saw some small gains, but it was the same month he had a huge lead exposure (did you know dirt is yummy) so if it was helping him, it may have been canceled out.

This has been quite a different experience. After the forth session, we started to see some really cool language. More words, more flowing language, less scripting, more jokes, more engagement... just more Chandler.

The first fun little wow happened on the way home. If we are out and he wants to go home, he says one of two things, "Mommy, do you want to go home now?" or "Go to 34 Maple Street?" He has done that for years. Imagine my happiness to hear, "Mom, how long until we get to Brunswick?" I didn't even know that he knew we lived in Brunswick!

Two days later when I went to pick him up from school, I get an email in the middle of the morning from his teacher at school. She has never emailed me in the middle of the day to tell me things, much less after school:

Ginger,

Something amazing happened with Chandler this morning. We were having morning meeting and the greeting was Buenos Dias. We usually just say good morning or hello to him. I don’t remember if we assumed another language would confuse him or if he was not responding. That’s what we have been doing all year. Anyway this morning when we came to Chandler he very appropriately said "Buenos Dias Holly" before Amy could even greet him. We were all so shocked, it was the coolest thing. James said, “He’s becoming more normal.” It was precious! He had also asked me earlier this morning, “Mrs. Williams, how do you spell Mrs. Williams? Thought you would want to know.

Jane

Gotta love James! When mom's crow about their children making big gains with biomedical intervention, sometimes they are written off as seeing what they want to see, teachers might just want to have high hopes for the child, but second grade boys are immune to treatment bias, especially when they don't know there is any treatment going on!

That afternoon his aid met me in the lobby of the school for the hand off and with tears in her eyes she gushed about Chandler's day.

"In music class he was perfect, he did everything he was instructed to do, was completely attentive and I didn't even have to repeat an instruction for him!" I've got to look up this... what is it called... hyperbaric?

We just met with his school team and everyone was telling stories about his new skills. They decided they wanted to hold off making plans for him for the summer and fall until the end of the year to see how far he goes with this.

It has only been upward from there. And have not seen any significant down side. He was a little hyperactive for the first two days, but that went away and it has been all good since. His great in the tank and the pressure has never bothered him.

We have had to take a bunch of breaks due to illness and broken cars and unfaxed prescriptions and life, but have started up again this week and hope to do another six sessions in a row and will see what happens. It is a thrill to see him making gains again.

Amazing that just giving the brain more oxygen can do this kind of healing. I will keep ya posted on how this goes.

Hyperbaric Treatment for Children With Autism

Conclusion: "Children with autism who received hyperbaric treatment at 1.3 atm and 24% oxygen for 40 hourly sessions had significant improvements in overall functioning, receptive language, social interaction, eye contact, and sensory/cognitive awareness compared to children who received slightly pressurized room air."

Hyperbaric treatment for children with autism: a multicenter, randomized, double-blind, controlled trial

Daniel A Rossignol1 email, Lanier W Rossignol1 email, Scott Smith1 email, Cindy Schneider2 email, Sally Logerquist2 email, Anju Usman3 email, Jim Neubrander4 email, Eric M Madren5 email, Gregg Hintz6 email, Barry Grushkin7 email and Elizabeth A Mumper8 email

1International Child Development Resource Center, Melbourne, FL, USA
2Center for Autism Research and Education, Phoenix, AZ, USA
3True Health Medical Center, Naperville, IL, USA
4Edison, NJ, USA
5Princess Anne Medical Associates, Virginia Beach, VA, USA
6Therapeutic Pathways, East Troy, WI, USA
7Biognosys, Nanuet, NY, USA
8Rimland Center, Lynchburg, VA, USA


BMC Pediatrics 2009, 9:21doi:10.1186/1471-2431-9-21
Published: 13 March 2009
Abstract
Background

Several uncontrolled studies of hyperbaric treatment in children with autism have reported clinical improvements; however, this treatment has not been evaluated to date with a controlled study. We performed a multicenter, randomized, double-blind, controlled trial to assess the efficacy of hyperbaric treatment in children with autism.
Methods

62 children with autism recruited from 6 centers, ages 2–7 years (mean 4.92 ± 1.21), were randomly assigned to 40 hourly treatments of either hyperbaric treatment at 1.3 atmosphere (atm) and 24% oxygen ("treatment group", n = 33) or slightly pressurized room air at 1.03 atm and 21% oxygen ("control group", n = 29). Outcome measures included Clinical Global Impression (CGI) scale, Aberrant Behavior Checklist (ABC), and Autism Treatment Evaluation Checklist (ATEC).
Results

After 40 sessions, mean physician CGI scores significantly improved in the treatment group compared to controls in overall functioning (p = 0.0008), receptive language (p < 0.0001), social interaction (p = 0.0473), and eye contact (p = 0.0102); 9/30 children (30%) in the treatment group were rated as "very much improved" or "much improved" compared to 2/26 (8%) of controls (p = 0.0471); 24/30 (80%) in the treatment group improved compared to 10/26 (38%) of controls (p = 0.0024). Mean parental CGI scores significantly improved in the treatment group compared to controls in overall functioning (p = 0.0336), receptive language (p = 0.0168), and eye contact (p = 0.0322). On the ABC, significant improvements were observed in the treatment group in total score, irritability, stereotypy, hyperactivity, and speech (p < 0.03 for each), but not in the control group. In the treatment group compared to the control group, mean changes on the ABC total score and subscales were similar except a greater number of children improved in irritability (p = 0.0311). On the ATEC, sensory/cognitive awareness significantly improved (p = 0.0367) in the treatment group compared to the control group. Post-hoc analysis indicated that children over age 5 and children with lower initial autism severity had the most robust improvements. Hyperbaric treatment was safe and well-tolerated. Conclusion Children with autism who received hyperbaric treatment at 1.3 atm and 24% oxygen for 40 hourly sessions had significant improvements in overall functioning, receptive language, social interaction, eye contact, and sensory/cognitive awareness compared to children who received slightly pressurized room air. Trial Registration clinicaltrials.gov NCT00335790

The Effects of Hyperbaric Oxygen Therapy on Oxidative Stress,

The Effects of Hyperbaric Oxygen Therapy on Oxidative Stress,
Inflammation, and Symptoms in Children with Autism: an Open-Label
Pilot Study

Daniel A Rossignol, Lanier W Rossignol1, S Jill James, Stepan Melnyk and
Elizabeth Mumper

International Child Development Resource Center, University of
Arkansas for Medical Sciences, Department of Pediatrics, Arkansas Children's Hospital Research Institute, Advocates for Children

Background: Recently, hyperbaric oxygen therapy (HBOT) has increased in popularity as treatment for autism. Numerous studies document oxidative stress and inflammation in individuals with autism; both of these conditions have demonstrated improvement with HBOT, along with enhancement of neurological function and cognitive performance.
In this study, children with autism were treated with HBOT at atmospheric pressures and oxygen concentrations in current use for this condition. Changes in markers of oxidative stress and inflammation were measured. The children were evaluated to determine clinical effects and safety.

Methods: Eighteen children with autism, ages 3–16 years, underwent 40 hyperbaric sessions of 45 minutes duration each at either 1.5 atmospheres (atm) and 100% oxygen, or at 1.3 atm and 24% oxygen. Measurements of C-reactive protein (CRP) and markers of oxidative stress, including plasma oxidized glutathione (GSSG), were assessed by fasting blood draws collected before and after the 40 treatments. Changes in clinical symptoms, as rated by parents, were also assessed. The children were closely monitored for potential adverse effects.

Results: At the endpoint of 40 hyperbaric sessions, neither group demonstrated statistically significant changes in mean plasma GSSG levels, indicating intracellular oxidative stress appears unaffected by either regimen. A trend towards improvement in mean CRP was present in both groups; the largest improvements were observed in children with initially higher elevations in CRP. When all 18 children were pooled, a significant improvement in CRP was found (p = 0.021). Pre- and post-parental observations indicated statistically significant improvements in both groups, including motivation, speech, and cognitive awareness (p < 0.05). No major adverse events were observed.

Conclusion: In this prospective pilot study of children with autism, HBOT at a maximum pressure of 1.5 atm with up to 100% oxygen was safe and well tolerated. HBOT did not appreciably worsen oxidative stress and significantly decreased inflammation as measured by CRP levels. Parental observations support anecdotal accounts of improvement in several domains of autism. However, since this was an open-label study, definitive statements regarding the efficacy of HBOT for the treatment of individuals with autism must await results from double-blind, controlled trials.