Hyperbaric Oxygen Therapy for Crohn’s Disease and IBD

Important: Hyperbaric oxygen therapy is not FDA-approved for Crohn’s disease, ulcerative colitis, or inflammatory bowel disease. This is an investigational use. Evidence is preliminary. Insurance will not cover HBOT for this condition. All costs are out-of-pocket.

Among the off-label uses for HBOT, inflammatory bowel disease has one of the stronger evidence bases. That’s worth saying clearly — but so is this: stronger than most off-label conditions still means preliminary. No large phase 3 trial has established HBOT as a standard treatment for IBD.

Here’s what the research actually shows.

Crohn’s Disease vs. Ulcerative Colitis

IBD covers two related but distinct conditions. Crohn’s disease can affect any part of the gastrointestinal tract, from mouth to anus. It tends to affect all layers of the bowel wall and can cause fistulas, strictures, and abscesses. Ulcerative colitis is limited to the colon and rectum, affecting the inner lining.

Both involve chronic, abnormal immune responses that damage the gut. Standard treatments include aminosalicylates, corticosteroids, immunomodulators, and biologics (anti-TNF agents like infliximab, adalimumab). When those fail, surgery is sometimes the next step.

The HBOT research has focused largely on patients who’ve already failed standard treatments — the refractory population.

What the Meta-Analysis Found

Dulai et al. (2014) is the key study. Published in the journal Alimentary Pharmacology and Therapeutics, it pooled data from 7 studies involving 266 patients with refractory Crohn’s disease. Across those studies, 78% of patients showed clinical improvement after HBOT. PMID: 24953833.

78% is a notable number. It’s also a pooled result from studies of varying quality, and the patient population — refractory Crohn’s who hadn’t responded to other treatments — self-selects in ways that complicate interpretation. Still, it’s the kind of signal that has pushed researchers toward phase 2 trials.

Safdi et al. (2009) looked at ulcerative colitis specifically. This was a randomized trial that found significant symptom reduction in the HBOT group compared to controls. PMID: 19536035.

University of Miami Research Program

The University of Miami has run multiple phase 2 trials examining HBOT for IBD. Their gastroenterology department has produced a more substantial body of research on this topic than most U.S. academic centers. Phase 2 trials test efficacy in a defined patient population — they’re a step up from the small case series that dominate most off-label HBOT literature.

This institutional research investment matters. It reflects genuine scientific interest, not just anecdote.

How HBOT Is Thought to Work

The bowel is an oxygen-intensive tissue. In active IBD, inflamed bowel tissue becomes hypoxic — oxygen-deprived — which worsens the inflammatory cycle. HBOT addresses this directly by delivering oxygen at pressure, significantly increasing tissue oxygen levels.

Three mechanisms are proposed. HBOT reduces pro-inflammatory cytokines, which are the signaling molecules that drive IBD flares. It promotes mucosal healing — the repair of the gut lining that’s damaged in active disease. And it reduces reactive oxygen species in the bowel, which contribute to tissue damage in IBD.

These mechanisms are supported by both the clinical data and laboratory studies. They’re not speculative in the way some HBOT mechanisms are for other conditions. That’s part of why the IBD evidence base is relatively credible.

Who the Research Applies To

The studied population matters. The Dulai meta-analysis and most supporting research enrolled patients with refractory, moderate-to-severe IBD — people who had already failed biologics and other standard treatments. The findings don’t apply to patients with mild IBD or those who haven’t yet tried standard therapies.

If you have mild-to-moderate IBD that’s managed with medication, the evidence doesn’t support bypassing standard treatment for HBOT.

Protocol and Cost

The protocols used in published studies typically ran 40 sessions. At $250-450 per session, that’s $10,000-18,000 out of pocket. Insurance will not cover HBOT for IBD. It’s not a covered indication.

Some academic centers have offered access through clinical trials. If you’re in a major metro area near a university medical center with a GI research program, asking about enrolling in a trial is worth a conversation with your gastroenterologist.

FAQ

Is HBOT FDA-approved for Crohn’s or IBD? No. It’s investigational. Insurance won’t cover it.

What did the 2014 meta-analysis find? Dulai et al. (2014) pooled 7 studies and 266 refractory Crohn’s patients. 78% showed clinical improvement. It’s one of the stronger evidence bases for off-label HBOT. PMID: 24953833.

Who is this research for? Patients with refractory IBD — those who haven’t responded to standard treatments including biologics. Not patients with mild or well-controlled disease.

How many sessions are typical? Published protocols generally used 40 sessions. Specific numbers vary by facility and trial.

Will insurance cover it? No. All costs are out of pocket.

References

• Dulai et al. (2014). Systematic review: the safety and efficacy of hyperbaric oxygen therapy for inflammatory bowel disease. Alimentary Pharmacology and Therapeutics. PMID: 24953833
• Safdi et al. (2009). A double-blind controlled trial of hyperbaric oxygen in the treatment of ulcerative colitis. PMID: 19536035

Related Pages

• What Is Hyperbaric Oxygen Therapy?
• How Much Does HBOT Cost?
• HBOT Insurance Coverage Guide
• Find an HBOT Provider

Medical Disclaimer: This page is for informational purposes only. It does not constitute medical advice. Hyperbaric oxygen therapy for inflammatory bowel disease is investigational and not FDA-approved. Consult a licensed physician before making any treatment decisions. Individual outcomes vary. This site does not establish a doctor-patient relationship.