Chronic anal fissure (CAF) is a common anorectal disorder associated with severe pain and impaired quality of life. Botulinum toxin A (BTA) injection has emerged as a minimally invasive alternative to lateral internal sphincterotomy; however, data regarding high-dose Dysport® protocols and the clinical relevance of booster injections remain limited. This retrospective single-center observational study was conducted at the General Surgery Clinic of Mersin City Training and Research Hospital. Patients treated for CAF between January 1, 2025, and December 1, 2025, were identified through institutional medical records. Sixty consecutive patients were screened; 10 were excluded because they did not attend follow-up visits, and 50 patients with complete follow-up data were included in the final analysis. All patients received a standardized 75 IU Dysport® injection targeting the internal anal sphincter. At the first follow-up reassessment, a booster injection was considered when either <50% reduction in visual analog scale (VAS) pain score or incomplete fissure healing was present. Pain severity was assessed using the VAS, and fissure healing was evaluated clinically and anoscopically. Outcomes were analyzed. The mean age was 45.8 ± 12.3 years, and 28 patients (56%) were men. The mean VAS pain score decreased from 7.80 ± 0.99 (95% confidence interval [CI]: 7.52-8.08) at baseline to 3.18 ± 0.85 (95% CI: 2.94-3.42) at 1 month and 1.00 ± 0.67 (95% CI: 0.81-1.19) at 3 months. Repeated-measures analysis of variance demonstrated a statistically significant reduction in pain over time (F[2, 98] = 1512.68, P < .001, partial η2 = 0.969). Healing was observed in 34/50 patients (68.0%, 95% CI: 54.2-79.2) at 1 month and 45/50 patients (90.0%, 95% CI: 78.6-95.7) at 3 months. Booster injections were required in 30/50 patients (60.0%, 95% CI: 46.2-72.4). Recurrence was observed in 5/50 patients (10.0%, 95% CI: 4.3-21.4) during follow-up; these patients subsequently underwent lateral internal sphincterotomy. Transient mild incontinence occurred in 3/50 patients (6.0%, 95% CI: 2.1-16.2) and resolved with conservative management. High-dose Dysport® injection appears to be a safe and effective minimally invasive option for the short-term treatment of CAF. A booster-based stepwise strategy may improve outcomes in selected patients before escalation to surgery.

Background/Objectives: The objective of this study was to evaluate the efficacy of a rectal cream containing tribenoside and lidocaine (TL) in a rat model of anal fissure (AF) and to investigate the potential mechanisms of its therapeutic action compared with those of a standard care rectal cream containing 2% diltiazem (D). Methods: Treatment efficacy was assessed via macroscopic methods. The levels of the inflammatory factors IL-6 and IL-10 in the tissues were measured via ELISA. Histology assessment was performed with standard hematoxylin/eosin stain, Masson's trichrome method and picrosirius stain. The levels of NF-κB, VEGF, TGF-beta 1, HIF-1α and E-cadherin were measured via densitometric immunoblot analysis. Results: The results of this study show that the medical product TL has therapeutic efficacy in a preclinical model of acute complicated AF, which is likely related to its complex composition. The severity of pathology in the TL group was significantly lower than that in the control pathology (CP) group on the eighth day of treatment and remained significantly lower on the 11th and 12th days. There was no statistically significant difference between the TL group and the CP group (p = 0.186 for IL-6 and p = 0.078 for IL-10). The efficacy of TL and D groups showed no statistically significant difference. At the end of the experiment, after 12 days of treatment, the level of the proinflammatory marker NF-κB in the CP group was greater than that in the intact control (IC) group. In turn, the NF-κB level in the TL group was lower than that in the CP group and significantly lower than that in the D group. Other important markers evaluated in this study demonstrated a similar tendency. The histopathological analysis showed that TL ointment promoted superior tissue repair, resulting in healthier anodermal architecture with minimal scarring and reduced fibrosis. Conclusions: This study confirms the potential for conducting further pharmacological studies of the mechanism of action and further clinical trials of the rectal cream TL, which has certain advantages in terms of effectiveness in a model of acute complicated AF.

This prospective open-label comparative study evaluated the efficacy of various conservative treatments for acute anal fissure (AAF) in accelerating epithelialization and reducing pain. A total of 120 patients with symptom duration ≤6 weeks were randomized into four groups: control (hygiene only), dietary therapy (fiber-rich diet + psyllium), monotherapy with a sphincter relaxant (0.2% nitroglycerin ointment), and combined therapy (diet + nitroglycerin). The primary outcome was time to complete epithelialization; secondary outcomes included pain dynamics on the Visual Analog Scale (VAS) and incidence of chronic fissure. Results demonstrated that combined therapy achieved the shortest epithelialization time (10.5±1.5 days), which was significantly shorter than both monotherapy groups and the control (p<0.01). The combined regimen also produced the most pronounced pain reduction from day 3 onward and completely prevented the development of chronic fissure. Dietary modification and nitroglycerin alone improved outcomes but were inferior to the combined approach. In conclusion, the combination of dietary intervention and topical nitroglycerin represents the most effective conservative strategy for AAF, promoting faster healing, superior pain control, and prevention of chronicity.

Hemorrhoids are a common problem. The diagnosis and treatment can be challenging. Gastroenterologists have much to offer these patients. The purpose of this American Gastroenterological Association (AGA) Clinical Practice Update Expert Review is to provide best practice advice (BPA) covering the diagnosis and treatment of hemorrhoid disease.

Cutaneous tuberculosis (TB) is a chronic granulomatous infection, constituting 1.5-3% of extrapulmonary cases. Disease manifestation is a result of the intricate interplay between host immunity, bacterial virulence and route of inoculation. Orificial TB, a relatively rare manifestation of cutaneous TB, accounts for 2.7% of the cases. We report a case of orificial TB of the perianal region in a man with underlying pulmonary miliary TB. This case highlights the importance of holistic evaluation, strong clinical suspicion and timely investigations, which can lead to swift resolution of lesions.

Background and Objectives: Anal fissures are a common condition in the general population, for which there are multiple treatment options. It is essential to select the most appropriate treatment for the right patient. This study aimed to observe and evaluate the effect of topical antibiotherapy, which is widely used in the management of wounds and chronic infections, on the healing of acute and chronic anal fissures. Materials and Methods: Hospital records of 625 individuals diagnosed with an anal fissure were reviewed. Previous treatments, including 0.4% glyceryl trinitrate and 5% lidocaine, were recorded. A total of 118 patients were included: 49 patients who received additional topical metronidazole due to inflammation, induration and minimal purulent discharge, in the absence of an abscess; and 69 uncomplicated patients who received only standard treatment, as per the exclusion criteria. Results: The mean age of the participants was 41.06 ± 10.70 years. No significant differences were found between the groups regarding age or sex (p = 0.616 and p = 0.665, respectively). However, prior treatment history and mucosal healing differed significantly between the two groups (p = 0.001 and p = 0.024, respectively). There were no significant differences in follow-up intervals, additional treatment requirements or improvement in VAS scores (p = 0.546, 0.904 and 0.154, respectively). Conclusions: Topical metronidazole may be associated with improved mucosal healing in selected patients with acute anal fissures presenting with clinical features such as local inflammation, minimal discharge or incision-related changes. However, the observed benefit does not appear to be uniform across all patients, and, in the absence of microbiological data, the extent of microbial involvement remains uncertain. Accordingly, topical metronidazole may be considered for carefully selected cases of acute anal fissure based on clinical judgement, while avoiding routine or indiscriminate antibiotic use.

Background Anal fissures (AFs) are common and painful conditions that are frequently managed surgically; however, they are limited by fecal incontinence. Pharmacological management with calcium channel blockers has recently gained acceptance. This study aimed to evaluate the effectiveness and safety of twice-daily nifedipine (0.3% w/w) and lidocaine (1.5% w/w) cream in patients with acute AF (AAF) and chronic AF (CAF). Methods This retrospective, multi-centric, post-marketing surveillance study was conducted over a period of four weeks in the Department of Gastroenterology and Surgery across 46 institutes. The study included data of 431 patients with AAF (n=290) and CAF (n=141). The primary outcome measure was the percentage of patients with healed AFs, assessed at Weeks 1, 4, and 8. The secondary outcome measures were pain relief, evaluated using a 5-point VAS; percentage of patients with bleeding per anus; and adverse events (AEs), assessed at baseline and weekly follow-up intervals for eight weeks. Results At eight weeks, AF resolved significantly compared to the baseline (p<0.0001). During similar intervals, the incidence of bleeding per anus decreased significantly (p<0.0001), coupled with a significant reduction in the VAS score (p<0.0001). Though the resolution of AFs was comparable between AAF and CAF (p>0.05), the patients with AAF had a significantly greater reduction in bleeding per anus at Weeks 7 and 8 (p<0.05), with a significant decrease in the VAS score at Week 8 (p<0.05). All reported AEs were mild and self-limiting. Conclusion Topical nifedipine-lidocaine resulted in significant AF resolution, with significant pain relief and reduction in bleeding per anus, together with excellent tolerability.