Combination therapy with symbiotics and local anti-inflammatories for red anusitis

The aim of this study was to compare red anusitis treatment with topical mesalazine alone versus combined treatment with mesalazine plus a symbiotic (zir fos(R), Alfa Wassermann) to determine whether the effect of a therapy combining anti-inflammatory activity with a symbiotic that interferes with intestinal dysbiosis can improve anusitis symptoms.

From May 2004 to December 2005, 24 patients (14 male, 10 female; mean age 46.3 years, range 28-67) with idiopathic red anusitis, without other colo-proctologic diseases, were enrolled in a double blind study on the effect of topical mesalazine alone versus combined mesalazine plus symbiotic treatment.

In the mesalazine monotherapy group, reduction in pain, hyperemia and bleeding was transient and symptoms recurred 1 year after discontinuation of treatment (mean visual analogue scale [VAS] scores: pain 3.1; hyperemia 2; bleeding 2.5. In the combined treatment group, a significant improvement in symptoms was noted (mean VAS scores: pain 1.5; hyperemia 0.5; bleeding 0) at 1 month after discontinuation of treatment.

The results showed a greater long-term benefit of combination therapy mesalazine plus symbiotic (zir fos) in the treatment of red anusitis than with topical mesalazine alone, particularly for pain and bleeding. Further studies on larger series investigating additional subjective and objective variables are needed to confirm these findings.