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Complications or dysfunction of an ileoanal pouch are not uncommon and may be related to chronic hypoxia. Investigators at Cleveland Clinic retrospectively assessed response to off-label hyperbaric oxygen in 21 patients with medically refractory pouchitis or fistula associated with a pouch. Up to 30 sessions of hyperbaric oxygen were administered over 8 weeks. Following treatment, the median modified Pouchitis Disease Activity Index score dropped from 9 to 5, with the endoscopic subscore also declining. Seven of nine patients had complete resolution of fistulae on imaging.