What Is Ulcerative Colitis?
Ulcerative colitis is a chronic autoimmune inflammatory disease confined exclusively to the mucosa of the large intestine. It differs from Crohn’s disease in both the depth of tissue involvement, being superficial rather than transmural, and its location, affecting the colon rather than the entire gastrointestinal tract.
It presents with bloody diarrhoea, tenesmus and abdominal pain. Severe forms may also cause systemic manifestations and carry a risk of toxic megacolon.
The autoimmune mechanism involves an abnormal immune response against the intestinal microbiota and epithelial antigens, with a predominant role played by Th2 cytokines, including IL-5 and IL-13, which compromise the integrity of the intestinal barrier.
Unlike Crohn’s disease, ulcerative colitis is limited to the mucosal and submucosal layers and typically follows a continuous pattern of involvement extending upwards from the rectum.
Characteristics of Ulcerative Colitis
The pathology of ulcerative colitis has a critical feature that directly relates to the effects of hyperbaric oxygen therapy: the damaged mucosal layer exists in a state of local hypoxia, which inhibits the natural healing capacity of the intestinal epithelium.
The enterocytes that form the intestinal lining require adequate oxygenation in order to proliferate and restore the damaged barrier.
In addition, the high concentration of inflammatory cytokines within the inflamed mucosa, including IL-5, IL-13 and TNF, creates a self-perpetuating inflammatory environment that conventional pharmacological treatment cannot always control effectively.
Clinical Studies
Clinical studies and case series have evaluated the use of hyperbaric oxygen therapy in patients with ulcerative colitis, with particular emphasis on refractory exacerbations.
The findings have included reductions in disease activity, as measured by the Mayo score, improvements in endoscopic appearance and lower levels of systemic inflammatory markers in patients who received hyperbaric oxygen therapy alongside standard treatment.
The proposed mechanism of action combines restoration of oxygenation within the intestinal mucosa, allowing healing processes to resume, suppression of the Th2 cytokines that drive mucosal inflammation and enhancement of regulatory T-cell activity to support a more balanced immune response.
The Role of Hyperbaric Oxygen Therapy
In ulcerative colitis, hyperbaric oxygen therapy may be used as an adjunctive option, primarily in refractory exacerbations that do not respond fully to standard treatment or in patients seeking to reduce their overall medication burden.
It should never replace gastroenterological monitoring or prescribed pharmacological treatment.
Restoring oxygenation within the mucosa creates more favourable conditions for epithelial regeneration, while the immunomodulatory effects of hyperbaric oxygen therapy may help correct the abnormal immune balance associated with recurrent disease activity.
A typical treatment course consists of 20 to 30 sessions, planned in collaboration with the gastroenterologist.