Department of Gastroenterology, Cleveland Clinic Florida, Weston, FL, USA.
Department of Internal Medicine, AdventHealth, Orlando, FL, USA.
Inflamm Bowel Dis. 2021 Jun 15;27(7):965-970. doi: 10.1093/ibd/izaa245.
Pouchitis can be a chronic complication of ileal pouch-anal anastomosis. We aimed to determine the efficacy and safety of hyperbaric oxygen therapy (HBOT) for chronic antibiotic-refractory pouchitis (CARP) and other inflammatory conditions of the pouch.
This was a retrospective case series of adults with inflammatory bowel disease (IBD) who underwent ileal pouch-anal anastomosis and then developed CARP and received HBOT between January 2015 and October 2019. A modified Pouchitis Disease Activity Index (mPDAI) score was used to quantify subjective symptoms (0-6) and endoscopic findings (0-6) before and after HBOT.
A total of 46 patients were included, with 23 (50.0%) being males with a mean age of 43.6 ± 12.9 years. The median number of HBOT sessions was 30 (range 10-60). There was a significant reduction in the mean mPDAI symptom subscore from 3.19 to 1.91 after HBOT (P < 0.05). The pre- and post-HBOT mean mPDAI endoscopy subscores for the afferent limb were 2.31 ± 1.84 and 0.85 ± 1.28 (P = 0.006); for the pouch body, 2.34 ± 1.37 and 1.29 ± 1.38 (P < 0.001); and for the cuff, 1.93 ± 1.11 and 0.63 ± 1.12 (P < 0.001), respectively. Transient side effects included ear barotrauma in 5 patients (10.9%) and hyperbaric myopic vision changes in 5 patients (10.9%).
Despite minor adverse events, HBOT was well tolerated in patients with CARP and significantly improved symptoms and endoscopic parameters.
pouchitis 是回肠贮袋肛管吻合术后的一种慢性并发症。我们旨在确定高压氧治疗（HBOT）对慢性抗生素难治性 pouchitis（CARP）和贮袋其他炎症性疾病的疗效和安全性。
这是一项回顾性病例系列研究，纳入了 2015 年 1 月至 2019 年 10 月期间患有炎症性肠病（IBD）并接受回肠贮袋肛管吻合术，然后发生 CARP 并接受 HBOT 的成人患者。使用改良 pouchitis 疾病活动指数（mPDAI）评分来量化治疗前后的主观症状（0-6 分）和内镜表现（0-6 分）。
共纳入 46 例患者，其中 23 例（50.0%）为男性，平均年龄为 43.6 ± 12.9 岁。HBOT 治疗的中位疗程为 30 次（范围 10-60 次）。治疗后，mPDAI 症状亚评分的平均值从 3.19 降至 1.91（P < 0.05）。HBOT 治疗前后的回肠贮袋受累部位的 mPDAI 内镜亚评分分别为 2.31 ± 1.84 和 0.85 ± 1.28（P = 0.006）；贮袋体部为 2.34 ± 1.37 和 1.29 ± 1.38（P < 0.001）；吻合口为 1.93 ± 1.11 和 0.63 ± 1.12（P < 0.001）。短暂的副作用包括 5 例（10.9%）患者的耳气压伤和 5 例（10.9%）患者的高压性近视性视力改变。
尽管有轻微的不良反应，但 HBOT 在 CARP 患者中耐受性良好，显著改善了症状和内镜参数。
