Diet Can Help Heal Chronic Anal Fissures

As published in Reuters Health News, diet may help heal anal fissures. 

Diet Can Help Heal Chronic Anal Fissures

By David Douglas

NEW YORK (Reuters Health) Apr 29 - Along with medical treatment, a diet that curbs food hypersensitivity might help chronic anal fissures to heal, Italian researchers suggest.

Roughly a fifth of patients whose fissures healed with this combined approach had recurrence on double-blind placebo-controlled challenge with wheat and/or cow's milk proteins, but they didn't react to placebo administration, Dr. Antonio Carroccio told Reuters Health by email.

Anal fissures are seen in up to 15% of proctology patients, said Dr. Carroccio of the University of Palermo and colleagues in a paper online April 16th in The American Journal of Gastroentrology. Chronic anal fissure prevalence in the general population isn't clear, but Dr. Carroccio says diseases of the rectum and anus are common, "and the prevalence in the general population is probably much higher than that seen in clinical practice since most patients with symptoms referable to the anorectum do not seek medical attention."

Research has suggested that anal fissures might be at least partly related to a high resting anal pressure due to unrecognized food hypersensitivity.

To investigate, the researchers randomly assigned 161 patients to follow one of two diets for eight weeks. The first was a "true oligo-antigenic diet." It eliminated cow's milk and its derivatives, as well as wheat, egg, tomato, and chocolate. The "sham diet" eliminated rice, potato, lamb, beans, and peas.

All patients also received treatment with sitz baths and bran supplementation during the eight weeks of the study, plus topical nifedipine 0.3 % and lidocaine 1.5% cream three times daily.

By the end, the anal fissures had healed completely in 69% of the "true diet" and 45% of the "sham diet" group (p=0.0002). The intervention group also had a significantly higher number of evacuations per week in the second half of the study.

In a second phase of the study, 60 patients who were cured on the oligo-antigenic diet were challenged with cow's milk protein or wheat, or placebo. They continued to avoid dietary wheat, cow's milk, egg, tomato, and chocolate.

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While no one reacted to the placebo, 13 had fissure recurrence during the two-week cow's milk challenge and seven had recurrence during the wheat challenge. Patients who reacted had significant increases in anal sphincter pressure over baseline. They also had more significantly more eosinophils in the lamina propria, and more intraepithelial lymphocytes, compared to non-reactors.

In all, 65 (40%) of patients remained uncured at the end of the study and underwent lateral internal sphincterotomy.

Dr. Carroccio concludes that "anal fissures could be etiologically related to a food hypersensitivity condition." More work will be needed to confirm that, he admits.