Increasing efficacy and reducing side effects in treatment of chronic anal fissures

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

This is a single institution nonexperimental study intended to analyze the therapeutic efficacy of topical diazepam in treating symptoms of chronic anal fissures.

Anal fissures are a common cause of anal pain. Conventional treatments include nonsteroidal anti-inflammatory drugs, topical creams, such as nitroglycerin and nifedipine, and surgery. However, these treatments are usually suboptimally efficacious or have deterring side effects.

Patients at an outpatient community center with a diagnosis of a chronic anal fissure were prescribed either topical 2% (n = 19) or 4% (n = 18) diazepam cream between January 2013 and February 2015. We retrospectively analyzed their responses to treatment.

All 19 patients using 2% diazepam cream experienced a positive response in pain, whereas 47.4% experienced a complete response, with a numerical rating scale (NRS) score of 0 (0–10). Eighty-eight percent of patients using 4% dose had a positive response in pain, whereas 23.5% experienced a complete response. Ninety-four percent of patients using 2% dose had a positive response in anal bleeding, whereas 68.8% experienced a complete response with an anal bleeding score (ABS) of 2 (2–9). Ninety-four percent of patients using 4% dose had a positive response in anal bleeding, whereas 64.7% experienced a complete response. Only 1 patient reported a side effect from diazepam cream—perianal pruritus.

Both 2% and 4% topical diazepam provided significant pain and bleeding relief from chronic anal fissures that were refractory to conventional therapies. There were insignificant differences when assessing independent comparisons for pain and bleeding between the doses.

Related collections

Most cited references 19

Record: found
Abstract: found
Article: not found

The measurement of pain in intensive care unit: comparison of 5 self-report intensity scales.

Gerald Chanques, Julie Carr, E Viel … (2010)

Unlike wards, where chronic and acute pain are regularly managed, comparisons of the most commonly used self-report pain tools have not been reported for the intensive care unit (ICU) setting. The objective of this study was to compare the feasibility, validity and performance of the Visual Analog Scale (horizontal (VAS-H) and vertical (VAS-V) line orientation), the Verbal Descriptor Scale (VDS), the 0-10 oral Numeric Rating Scale (NRS-O) and the 0-10 visually enlarged laminated NRS (NRS-V) for pain assessment in critically ill patients. One hundred and eleven consecutive patients admitted into a medical-surgical ICU were included as soon as they became alert and were able to follow simple commands. Pain was measured using the 5 scales in a randomized order upon enrollment-(T1) and after-(T2) administration of an analgesic or, in absence of pain upon enrollment, after a nociceptive procedure. The rate of any response obtained both at T1 and T2 (success rate) was significantly higher for NRS-V (91%) compared with NRS-O (83%), VDS (78%), VAS-H (68%) and VAS-V (66%). Pain intensity changed significantly between T1 and T2, showing a good validity and responsiveness for the 5 scales, which correlated well between each other. The negative predictive value calculated from true and false negatives defined by real and false absence of pain was highest for NRS-V (90%). In conclusion, the NRS-V should be the tool of choice for the ICU setting, because it is the most feasible and discriminative self-report scale for measuring critically ill patients' pain intensity. Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

0 comments Cited 77 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Relationship between anal pressure and anodermal blood flow. The vascular pathogenesis of anal fissures.

Boris W V Schouten, J Briel, Johannes Auwerda (1994)

The aim of this study was to investigate the relationship between anal pressure and anodermal blood flow. We performed Doppler laser flowmetry of the anoderm combined with anorectal manometry in 178 subjects (87 males and 91 females; median age, 55 (range, 17-87) years). This group consisted of 31 healthy volunteers, 23 patients with fecal incontinence, 17 patients with hemorrhoids, and 9 patients with anal fissure. The remaining 98 patients had other colorectal disorders. In 16 controls we examined anodermal blood flow in the four quadrants of the anal canal. Perfusion of the anoderm at the posterior midline was significantly lower than in the other three segments of the anal canal (posterior midline: 0.74 +/- 0.26 V; left lateral side: 1.68 +/- 0.81 V; right lateral side: 1.57 +/- 0.52 V; anterior midline: 1.48 +/- 0.69 V, P < 0.001). In the overall group, we found a significant correlation between maximum and resting pressure and anodermal blood flow at the posterior midline (r = -0.616, P < 0.001). In the nine patients with chronic anal fissure, the mean maximum anal resting pressure was 125 +/- 26 mmHg, which was significantly higher than in patients with hemorrhoids (82 +/- 15 mmHg), controls (66 +/- 19 mmHg), and patients with fecal incontinence (42 +/- 14 mmHg, P < 0.001), whereas the blood flow at the base of the fissure was significantly lower (0.43 +/- 0.10 V vs. 0.57 +/- 0.19 V vs. 0.75 +/- 0.26 vs. 1.03 +/- 0.34 V). In ten patients we also studied the influence of anesthesia on both anal pressure and anodermal blood flow. During the administration of anesthesia, anal pressure dropped from 63 +/- 21 mmHg to 32 +/- 15 mmHg (P < 0.001), whereas anodermal blood flow at the posterior midline increased from 0.79 +/- 0.22 V to 1.31 +/- 0.35 V (P < 0.001). Anodermal blood flow at the posterior midline is less than in the other segments of the anal canal. The perfusion of the anoderm at the posterior commissure is strongly related to anal pressure. The higher the pressure, the lower the flow. Our findings support the hypothesis that anal fissures are ischemic ulcers.

0 comments Cited 20 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Treatment and prognosis of patients with late rectal bleeding after intensity-modulated radiation therapy for prostate cancer

Shinya Takemoto, Yuta Shibamoto, Shiho Ayakawa … (2012)

Background Radiation proctitis after intensity-modulated radiation therapy (IMRT) differs from that seen after pelvic irradiation in that this adverse event is a result of high-dose radiation to a very small area in the rectum. We evaluated the results of treatment for hemorrhagic proctitis after IMRT for prostate cancer. Methods Between November 2004 and February 2010, 403 patients with prostate cancer were treated with IMRT at 2 institutions. Among these patients, 64 patients who developed late rectal bleeding were evaluated. Forty patients had received IMRT using a linear accelerator and 24 by tomotherapy. Their median age was 72 years. Each patient was assessed clinically and/or endoscopically. Depending on the severity, steroid suppositories or enemas were administered up to twice daily and Argon plasma coagulation (APC) was performed up to 3 times. Response to treatment was evaluated using the Rectal Bleeding Score (RBS), which is the sum of Frequency Score (graded from 1 to 3 by frequency of bleeding) and Amount Score (graded from 1 to 3 by amount of bleeding). Stoppage of bleeding over 3 months was scored as RBS 1. Results The median follow-up period for treatment of rectal bleeding was 35 months (range, 12–69 months). Grade of bleeding was 1 in 31 patients, 2 in 26, and 3 in 7. Nineteen of 45 patients (42%) observed without treatment showed improvement and bleeding stopped in 17 (38%), although mean RBS did not change significantly. Eighteen of 29 patients (62%) treated with steroid suppositories or enemas showed improvement (mean RBS, from 4.1 ± 1.0 to 3.0 ± 1.8, p = 0.003) and bleeding stopped in 9 (31%). One patient treated with steroid enema 0.5-2 times a day for 12 months developed septic shock and died of multiple organ failure. All 12 patients treated with APC showed improvement (mean RBS, 4.7 ± 1.2 to 2.3 ± 1.4, p < 0.001) and bleeding stopped in 5 (42%). Conclusions After adequate periods of observation, steroid suppositories/enemas are expected to be effective. However, short duration of administration with appropriate dosage should be appropriate. Even when patients have no response to pharmacotherapy, APC is effective.

0 comments Cited 19 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: May 2017

Publication date (Electronic): 19 May 2017

Volume: 96

Issue: 20

Electronic Location Identifier: e6853

Affiliations

[a ]Division of Gastroenterology, Department of Internal Medicine, Mercer University School of Medicine, Macon, GA

[b ]Division of Medicine, Medical University of South Carolina, Charleston, SC

[c ]Division of Digestive Diseases, Rush University Medical Center, Chicago, IL.

Author notes

[∗ ]Correspondence: Minh Tuan H. Hang, Gastroenterology Associates of Central Georgia, Macon, GA (e-mail: minhhang197@ 123456gmail.com ).

Article

Publisher ID: MD-D-16-06009 Accession ID: 06853

DOI: 10.1097/MD.0000000000006853

PMC ID: 5440137

PubMed ID: 28514300

SO-VID: 2eb555b3-58c2-450d-ab53-ced666299fec

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0