Health-related quality of life in patients with anal fissure: effect of type D personality

Safety and efficacy of Levorag emulgel in the treatment of anal fissures using a validated scoring system

Introduction

Anal fissure is one of the most common anal disease characterized by intense anal pain, and deterioration of patients quality of life. Treatment is mainly based on the topical administration of calcium antagonist or nitric oxide ointments, and in cases refractory to medical treatment patients can undergo surgery. This study aims to assess the efficacy and safety of Levorag emulgel in the treatment of acute and chronic fissures using of a validated scoring system.

Material and Methods

A prospective observational study was carried out on patients with anal fissures between February and May 2022. The efficacy of the treatment was evaluated using the REALISE score, a new validated scoring system that rates VAS for pain, NSAID use, pain duration, bleeding, and quality of life (QoL), recorded after 10, 20 and 30 days from the beginning of treatment.

Results

Forty patients (median age 46 years, IQR 29-57, 70% women) with acute (22, 55%) or chronic (18, 45%) anal fissures entered the study. The median anal pain score according to the VAS scale decreased significantly from 7 (IQR 4.7-8) at baseline to 1 (IQR 0-3.2, p = 0.05) after 20 days. At the 30-day proctological examination, 22 patients (61%) were pain free (median VAS of 0, IQR 0-1.2, p < 0.05). Pain duration after defecation measured according to the REALISE score, showed a significant decrease after 10 days, from a median value of 2 (IQR 1-4) to 1 (IQR 1-1.2) (p < 0.005). The median value of the REALISE score decreased significantly, from 15 (IQR 11-19.25) at first proctological evaluation to 4 (IQR 4-6, p = 0.139) after 30 days of treatment. At day 30, complete fissure healing was achieved in 30 patients (80%). The healing rate was 82% and 78% in patients with acute and chronic anal fissures, respectively.

Conclusion

The use of Levorag® Emulgel may represent a safe and effective non-invasive first line treatment in patients affected by acute or chronic anal fissure.

Management options for chronic anal fissure: a systematic review of randomised controlled trials

INTRODUCTION

Anal fissure is the most common cause of severe anorectal pain in adults, contributing significantly to coloproctology workloads. There are a wide variety of management options available, including topical nitrites, calcium channel blockers, botulinum toxin injection and sphincterotomy. The aim of this study was to review current options for the treatment of chronic anal fissure.

METHODS

A comprehensive search identifying randomized controlled trials comparing treatment options for anal fissure published between January 2000 and February 2020 was performed. The primary outcome assessed was healing at 8 weeks post commencing treatment. Secondary outcomes included recurrence, intolerance of treatment and complications.

RESULTS

A total of 2822 studies were identified. After removal of duplicates and non-relevant studies, we identified nine randomized controlled trials which met pre-defined criteria. There was a total of 775 patients. At 8 weeks, healing rates were 95.13% in those treated with sphincterotomy, 66.7% in the botulinum toxin group, 63.8% in the nitrate group, 52.3% for topical diltiazem and 50% for topical minoxidil. Recurrence was highest amongst those treated with botulinum toxin injection (41.7%) and lowest for sphincterotomy (6.9%). Although the absolute number is low, there was a risk of permanent incontinence with sphincterotomy.

CONCLUSION

This review of the randomized control data demonstrates that healing was significantly higher amongst those treated with sphincterotomy versus more conservative modalities. Topical nitrites had similar outcomes to botulinum toxin injection but were poorly tolerated in comparison to other treatments. The benefit of sphincterotomy was at a cost of increased complications, notably permanent incontinence.

Impact of Anal Fissure on Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness: A Case-Control Study

Introduction

Scientific literature on determining patterns of personality traits in patients with anal fissure is limited.

Objectives

To determine whether certain common psychological traits are associated with anal fissure.

Methods

A case-control study was carried out in Spain in 2016-2017. Patients with acute or chronic idiopathic anal fissure (n = 35) and controls (n = 32) were recruited. The main outcome measures were those defined in the NEO-FFI questionnaire, validated in Spain, which was administered to all the participants. This questionnaire evaluates the following traits: neuroticism, extraversion, openness, agreeableness, and conscientiousness.

Results

Three significant traits were noted: (1) greater neuroticism in the cases (OR 1.19, 95% CI 1.08-1.32, p < 0.001, AUC 0.77), (2) greater openness to experience in the controls (OR 0.90, 95% CI 0.83-0.98, p = 0.015, AUC 0.69), and (3) greater conscientiousness in the controls (OR 0.91, 95% CI 0.83-1.00, p = 0.049, AUC 0.69).

Conclusions

The cases mainly presented higher levels of neuroticism and lower levels of openness to experience and conscientiousness. Further studies are needed to corroborate our results.

[Lipid profile and psychometric traits in patients with psychosomatic disorders and chronic cerebral ischemia]

AIM

To explore the correlation of serum cholesterol and triglycerides with psychometric traits in patients with psychosomatic disorders and chronic cerebral ischemia (CCI).

MATERIAL AND METHODS

One hundred and ten patients with CCI, aged from 46 to 76 years, were examined. Total cholesterol and triglycerides were measured in the blood. A battery of tests for assessment of cognitive functions and neurotic traits was used.

RESULTS

The level of cholesterol was higher in patients with post-infarction cardiosclerosis (PICS) compared to patients with CCI without psychosomatic disorders but did not differ from that in patients with gastric ulcer (GU). The level of triglycerides was higher in both groups with psychosomatic disorders, patients with PICS had higher levels compared to patients with GU. No differences between total cholesterol and triglycerides and assessment of cognitive functions in patients of different age were observed.

CONCLUSION

Patients with psychosomatic disorders had lower cognitive function and higher level of neuroticism. Results of regression analysis indicate that blood contents of cholesterol and triglycerides can be considered as a prognostic factor for cognitive decline.

Botulinum Toxin Injection for Treatment of Chronic Anal Fissure: Is There Any Dose-Dependent Efficiency? A Meta-Analysis

BACKGROUND

Chronic anal fissure (CAF) is a linear split of the anoderm. The minimally invasive management of CAF such as botulinum toxin (BT) injection is recommended. However, the exact efficient dose of BT, number of injections per session and the injection sites are still debatable. The aim of this analysis was to assess the dose-dependent efficiency of botulinum toxin injection for CAF.

METHODS

PubMed and Web of Science databases were searched for terms: "anal fissure" AND "botulinum toxin." Studies published between October 1993 and May 2015 were included and had to meet the following criteria: (1) chronic anal fissure, (2) prospective character of the study, (3) used simple BT injection without any other interventions and (4) no previous treatment with BT.

RESULTS

A total of 1577 patients from 34 prospective studies used either Botox or Dysport formulations were qualified for this meta-analysis. A total number of BT units per session ranged from 5 to 150 IU, whereas the efficiency across analyzed studies ranged from 33 to 96 %. Surprisingly, we did not observe a dose-dependent efficiency (Spearman's rank correlation coefficient, ρ = 0.060; p = 0.0708). Moreover, there were no BT dose-dependent postoperative complications or fecal incontinence and significant difference in healing rates compared BT injection into the anal sphincter muscles.

CONCLUSIONS

BT injection has been an accepted method for the management of CAF. Surprisingly, there is no dose-dependent efficiency, and the postoperative incontinence rate is not related to the BT dosage regardless the type of formulation of botulinum neurotoxin used. Moreover, no difference in healing rate has been observed in regard to the site and number of injections per session.

Prospective multicenter observational trial on the safety and efficacy of LEVORAG® Emulgel in the treatment of acute and chronic anal fissure

Background

Anal fissure (AF) is a common cause of anal pain with a tendency not to heal spontaneously because of ischemia of the anoderm caused by sphincter spasm. Lateral internal sphincterotomy, while very effective, can cause fecal incontinence and chemical sphincterotomy by application of cream may have discouraging side effects and/or low efficacy. The aim of this prospective multicenter study was to evaluate the safety and effectiveness of a new medical treatment based on Emulgel cream, with emollient, soothing and protective agents, on AF healing.

Methods

Consecutive patients with AF treated in nine coloproctology units during 6 months entered the study on topical treatment with Levorag^® Emulgel (THD S.p.A Correggio (RE), Italy). Before treatment, they had a proctologic examination and pain was measured using a visual analog scale. THD Levorag^® Emulgel was applied every 12 h for 40 days. Monitoring was scheduled at 10, 20 and 40 days. At time 0 and at the end of treatment, patients underwent anorectal manometry, if possible.

Results

Two hundred eighty-four AF patients were recruited (171 acute fissures). Complete healing was achieved in 47.9 % of the cases, an improvement in 31.0 % (global efficacy 78.9 %). In patients with acute fissure, the rate of efficacy was 89.4 % (complete healing: 64.3 %, improvement: 25.1 %), in those with chronic fissure the rate of efficacy was 62.8 % (complete healing: 23 %, improvement: 39.8 %), p < 0.001. Pain and resting anal pressure decreased significantly after treatment.

Conclusions

Treatment with THD Levorag^® Emulgel proved to be effective for the reepithelization of AF and the reduction of pain in the short term in about 80 % of patients.

[The lipid profile and psychometric assessments in patients with psychosomatic illnesses and chronic cerebral ischemia]

OBJECTIVE

To explore the correlations between plasma cholesterol and triglyceride levels and psychometric assessments in patients with psychosomatic illnesses and chronic cerebral ischemia (CCI).

MATERIAL AND METHODS

One hundred and ten patients (51% women, 49% men), aged from 46 to 76 years (mean 65.1 years) with CCI were examined. The study included cholesterol and triglyceride tests and a battery of tests for assessment of cognitive functions and neurotization level.

RESULTS

Cholesterol levels were higher in patients with post-infarct cardiosclerosis (PICS) compared to the comparison group but did not differ from those of patients with peptic ulcer disease (PUD). Triglyceride levels were high in both psychosomatic groups, with higher levels in the patients with PICS compared to the patients with PUD. Plasma cholesterol and triglyceride levels were not correlated with assessments of cognitive functions in patients of different age.

CONCLUSION

Cognitive impairment and higher level of neurotization were characteristic of patients with psychosomatic illnesses. Regression analysis has demonstrated that plasma cholesterol and triglyceride levels may be a prognostic factor for cognitive impairment.