Hyperbaric oxygen therapy （HBOT） utilizes mechanisms of high-pressure and high-con­cen­tra­tion oxygen supply and is an established treatment for decompression sickness, gas and air embolism, carbon monoxide poisoning, and anaerobic bacterial infections. Additionally, HBOT is indicated for refractory wounds, osteomyelitis, and complications of radiation therapy due to its effects on promoting growth factor synthesis, mobilizing stem cells from the bone marrow, and enhancing angiogenesis. Although not yet an approved indication, in recent years HBOT has been increasingly explored for post-COVID-19 syndrome based on its potential mechanisms, including hypoxia improvement, angiogenesis, inflammation suppression, mitochondrial function recovery, and neural repair. Moreover, HBOT has shown promise in reducing oxidative stress, exerting anti-inflammatory effects, and influencing the gut microbiota, leading to a growing number of reports on its application in inflammatory bowel disease （IBD）.
Beyond high-pressure oxygen supply, HBOT may also modulate oxidative stress, metabolism, immune function, and gut microbiota, suggesting therapeutic potential for various diseases, particularly those linked to dysbiosis. By comparing guidelines between Western countries and recent findings, this study explores the future potential of expanding HBOT indications.

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Cerebral decompression sickness is relatively rare in recreational diving. We report a case of cerebral decompression sickness that occurred on a remote island in Okinawa Prefecture and was successfully treated with recompression therapy following long distance air transport. The patient was a woman in her 30s who developed motor paralysis in her left upper limb, difficulty standing, and dysarthria after repeated deep dives off Minami Daito, Okinawa prefecture. At a local clinic, she was diagnosed with cerebral decompression sickness and determined that emergency recompression treatment was necessary. After long distance transportation via Japanese Ground Self-Defense Force large helicopter, the patient was brought to our hospital. She experienced a decrease in hypoesthesia and dysesthesia in his left upper limb during the recompression therapy. Her symptoms disappeared as a result of multiple recompression treatments. Although recompression therapy is the only definitive treatment for decompression sickness, few facilities can provide it 24 hours a day, 365 days a year. In addition, there are restrictions on the flight altitude when airlifting decompression sickness patients from remote islands. For this reason, transportation can be difficult due to weather and other conditions. Therefore, thorough prevention of the disease is desirable.

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