Abstract:
AIMS:We aim to test and compare the effects of Flavonoids (Fs) and Centella asiatica (Ca), and the traditional treatment to find out which best deals with healing time, bleeding and pain in the treatment of chronic Anal Fissure (AF). Materials of Study: 98 outpatients were divided randomly into treated (either Fs or Ca) and control group. The control group (Group C, n=32) received the traditional treatment along with the other two subgroups which were treated, additionally, with Fs (Group A, n=30) or Ca (Group B, n=36). Patients were observed once weekly over 8 consecutive weeks. RESULTS:The median time to stop bleeding in the group A was 1 week, in the Group B was 3 weeks and in the group C was 4 weeks. There were significant differences between Groups in terms of time to end bleeding (A vs B: p-value= 0.022; A vs C: p-value<0.001; B vs C: p-value=0.070). As for pain score from baseline to the 2nd week were statistically different between Groups A and B on the one hand and Group C on the other hand (A vs C: p-value=0.004; B vs C: p-value 0.035). All patients healed within 8th week. DISCUSSION:Either patients treated with Fs or Ca experienced early pain disappearance. Fs and Ca did not show side effects CONCLUSIONS: The treatment with Fs is the most effective for bleeding. Patients additionally treated with either Fs or Ca experienced an earlier healing and disappearance of pain in comparison with patients underwent to the traditional treatment. KEY WORDS:Anal bleeding, Anal fissure, Defecation pain. OBIETTIVO:Il presente studio longitudinale randomizzato si è proposto di valutare comparativamente l’efficacia dell’impiego di Flavonoidi (Fs) e di estratti di Centella asiatica (Ca) studiando il tempo di scomparsa del sanguinamento, dolore, sensazione di peso e tenesmo, in pazienti affetti da ragade anale cronica (RA). MATERIALE DELLO STUDIO:98 pazienti ambulatoriali sono stati divisi in 2 bracci: trattati (Gruppo A e Gruppo B) e controlli (Gruppo C). Tutti i pazienti ambulatoriali partecipanti hanno ricevuto lo stesso trattamento tradizionale consistente in dieta specifica, dilatatori anali, e cure igieniche. Utilizzando una tavola di randomizzazione parte dei pazienti è stata collocata nel Gruppo C (n = 32). I pazienti assegnati al Gruppo A (n = 30) hanno ricevuto aggiuntivamente anche Fs e quelli allocati nel Gruppo B (n = 36) hanno ricevuto aggiuntivamente Ca. Tutti i pazienti ambulatoriali hanno eseguito il trattamento con dilatatori per le prime 4 settimane e sono stati ricontrollati settimanalmente per 8 settimane consecutive, tutti sono guariti entro la settima settimana. La dieta consigliata è ricca di fibra alimentare cotta per bollitura (fino a 500 grammi al giorno e 4 frutti), acqua non gassata (fino a 2000 cc al giorno) e priva di sale da cucina, spezie, piccanti, alcolici e cioccolato. La procedura igienica consiste nell’uso di un sapone medicato, asciugatura del perineo per tamponamento, senza stropicciare, evitando l’uso della carta igienica. RISULTATI:Il tempo medio di scomparsa del sanguinamento durante defecazione nel Gruppo A è stato di 1 settimana (IC 95% 1-4 settimane), nel gruppo B è stato di 3 settimane (IC 95% 2-3 settimane) e nel gruppo C è stato di 4 settimane (IC 95% 4-5 settimane). Il comportamento della VAS è stato studiato per la valutazione del dolore defecatorio dalla rilevazione basale e alla 2a settimana, risultando differenze statisticamente significative nei tre sottogruppi (A vs C: valore p-value = 0,004; B vs C: valore p-value = 0,035, ma non A vs B p-value=0.665 perché entrabi ugualmente efficaci). Per quanto riguarda la sensazione di peso e il tenesmo non sono emerse differenze significative tra i sottogruppi. DISCUSSIONE:Questo studio evidenzia che il trattamento tradizionale per la RA (Gruppo C) non è efficace quanto il trattamento sinergico combinato con Fs (Gruppo A) oppure Ca (Gruppo B). I pazienti ambulatoriali dei sottogruppi Fs e Ca hanno avuto, infatti, una precoce scomparsa del sanguinamento e del dolore defecatorio ottenendo un rapido e notevole miglioramento della loro qualità di vita. CONCLUSIONI:Nel trattamento della RA cronica è importante il superamento della costipazione. Il protocollo tradizionale con regime dietetico, dilatatori, e procedura igienica è efficace nel ridurre il sanguinamento e il dolore (Gruppo C) ma nei pazienti che hanno ricevuto la supplementazione con Fs (Gruppo A) oppure Ca (Gruppo B) abbiamo osservato una efficace azione sul dolore con la scomparsa in tempi significativamente più brevi ed un rapido recupero della qualità della vita. I Fs sono risultati più efficaci nel trattamento del sanguinamento.
journal_name
Ann Ital Chirjournal_title
Annali italiani di chirurgiaauthors
Chiaretti M,Fegatelli DA,Ceccarelli G,Carru GA,Pappalardo G,Chiaretti AIsubject
Has Abstractpub_date
2018-01-01 00:00:00pages
330-336eissn
0003-469Xissn
2239-253Xpii
S0003469X18028737journal_volume
89pub_type
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journal_title:Annali italiani di chirurgia
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journal_title:Annali italiani di chirurgia
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journal_title:Annali italiani di chirurgia
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