Crohn's Disease - Perianal & Cutaneous Fistulas
Adjunctive hyperbaric oxygen therapy for medically refractory perianal and cutaneous fistulizing Crohn's disease.
Mechanism of Action
HBOT drastically increases oxygen delivery to hypoxic and inflamed fistular and intestinal tracts. The ensuing hyperoxygenation reduces local tissue hypoxia, dampens pro-inflammatory cytokines, stimulates fibroblast proliferation, and accelerates collagen synthesis and angiogenesis, thereby promoting fistular tract healing.
Clinical Criteria (OHIP/UHMS)
- Diagnosis of Crohn's disease with complex perianal or cutaneous fistulas
- Refractory to standard medical or surgical therapy (e.g., biologics, immunosuppressants)
- No absolute contraindications for HBOT (e.g., untreated pneumothorax)
Treatment Protocol
2.4 ATA for 90 minutes daily. A full course typically involves up to 40 treatment sessions, following established trial protocols.
Clinical Outcomes
Recent landmark studies, including the HOT-TOPIC trial (Lansdorp et al., 2021), demonstrate robust clinical outcomes. Clinical response (defined as ≥50% reduction in draining fistulas) is observed in approximately 65% of patients after 40 HBOT sessions, with complete cessation of drainage and deep MRI healing in many cases. Long-term follow-up consistently shows maintained healing in a vast majority of responders.
Key References & Evidence
Core Literature
- Lansdorp CA, et al. Hyperbaric oxygen therapy for the treatment of perianal fistulas in Crohn's disease (HOT-TOPIC): a study protocol. BMJ Open. 2021.
- Lansdorp CA, et al. Hyperbaric Oxygen Therapy for the Treatment of Perianal Fistulas in Crohn's Disease. Gastroenterology. 2021.
- Krajnia P, et al. Hyperbaric Oxygen Therapy in the Treatment of Inflammatory Bowel Disease. J Clin Med. 2023.
Referral & Consultation for Crohn's Disease - Perianal & Cutaneous Fistulas
Fully covered by OHIP. Both physician referrals and patient self-referrals are accepted online or via fax at (705) 881-1119. For urgent or time-sensitive indications, please contact our Barrie clinic directly.