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- Title
Oligo-Antigenic Diet in the Treatment of Chronic Anal Fissures. Evidence for a Relationship Between Food Hypersensitivity and Anal Fissures.
- Authors
Carroccio, Antonio; Mansueto, Pasquale; Morfino, Giuditta; D'Alcamo, Alberto; Di Paola, Valentina; Iacono, Giuseppe; Soresi, Maurizio; Scerrino, Gregorio; Maresi, Emiliano; Gulotta, Gaspare; Rini, GiovamBattista; Bonventre, Sebastiano
- Abstract
OBJECTIVES:Patients with chronic constipation due to food hypersensitivity (FH) had an elevated anal sphincter resting pressure. No studies have investigated a possible role of FH in anal fissures (AFs). We aimed to evaluate (1) the effectiveness of diet in curing AFs and to evaluate (2) the clinical effects of a double-blind placebo-controlled (DBPC) challenge, using cow's milk protein or wheat.METHODS:One hundred and sixty-one patients with AFs were randomized to receive a 'true-elimination diet' or a 'sham-elimination diet' for 8 weeks; both groups also received topical nifedipine and lidocaine. Sixty patients who were cured with the 'true-elimination diet' underwent DBPC challenge in which cow's milk and wheat were used.RESULTS:At the end of the study, 69% of the 'true-diet group' and 45% of the 'sham-diet group' showed complete healing of AFs (P<0.0002). Thirteen of the 60 patients had AF recurrence during the 2-week cow's milk DBPC challenge and 7 patients had AF recurrence on wheat challenge. At the end of the challenge, anal sphincter resting pressure significantly increased in the patients who showed AF reappearance (P<0.0001), compared with the baseline values. The patients who reacted to the challenges had a significantly higher number of eosinophils in the lamina propria and intraepithelial lymphocytes than those who did not react to the challenges.CONCLUSIONS:An oligo-antigenic diet combined with medical treatment improved the rate of chronic AF healing. In more than 20% of the patients receiving medical and dietary treatment, AFs recurred on DBPC food challenge.
- Subjects
ANAL diseases; DIET therapy; FOOD allergy; CONSTIPATION; SPHINCTERS; TREATMENT effectiveness; PLACEBOS; THERAPEUTICS
- Publication
American Journal of Gastroenterology (Springer Nature), 2013, Vol 108, Issue 5, p825
- ISSN
0002-9270
- Publication type
Article
- DOI
10.1038/ajg.2013.58