title: Oligo-antigenic diet in the treatment of chronic anal fissures. Evidence for a relationship between food hypersensitivity and anal fissures.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Internal Medicine, Hospital of Sciacca, ASP Agrigento, University of Palermo, Palermo, Italy. acarroccio@hotmail.com
authors.forename: Antonio
authors.initials: A
authors.lastname: Carroccio
authors.forename: Pasquale
authors.initials: P
authors.lastname: Mansueto
authors.forename: Giuditta
authors.initials: G
authors.lastname: Morfino
authors.forename: Alberto
authors.initials: A
authors.lastname: D'Alcamo
authors.forename: Valentina
authors.initials: V
authors.lastname: Di Paola
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Iacono
authors.forename: Maurizio
authors.initials: M
authors.lastname: Soresi
authors.forename: Gregorio
authors.initials: G
authors.lastname: Scerrino
authors.forename: Emiliano
authors.initials: E
authors.lastname: Maresi
authors.forename: Gaspare
authors.initials: G
authors.lastname: Gulotta
authors.forename: Giovambattista
authors.initials: G
authors.lastname: Rini
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Bonventre
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003248:Constipation / Q000150:complications* / Q000209:etiology / Q000517:prevention & control*; D004311:Double-Blind Method; D004804:Eosinophils; D005247:Feeding Behavior; D005260:Female; D005401:Fissure in Ano / Q000209:etiology*; D005512:Food Hypersensitivity / Q000150:complications* / Q000178:diet therapy* / Q000276:immunology; D006801:Humans; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008365:Manometry; D008875:Middle Aged; D016269:Milk Hypersensitivity / Q000150:complications / Q000178:diet therapy; D008894:Milk Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*; D012008:Recurrence; D016896:Treatment Outcome; D014908:Triticum / Q000009:adverse effects / Q000276:immunology*
chemical_list: D008894:Milk Proteins