Chili pepper consumption and duration of fissure symptoms onset are associated with perianal fistula development among patients with anal fissure: a case-control study.

Background: Perianal fistula is one of the complications of deepened anal fissure. The present case-control study aimed to assess the risk factors of fissure-associated fistulas due to the limited available evidence.

Methods: Patients with fissure-associated fistulas were considered as case, and patients with anal fissure who were undergoing medical treatment without any previous anorectal surgeries were considered as control group. Data were collected through medical records or by directly contacting patients. Risk factors of fissure-associated fistulas were assessed using a multivariable logistic regression analysis.

Results: The current study included 119 patients, consisting of 54 cases and 65 controls. There were no significant differences between the groups in terms of demographic characteristics. Our analyses revealed that chili pepper consumption (odds ratio [OR] = 2.96, 95% confidence interval [CI]: 1.06-8.31, P-value = 0.039) and the duration of fissure symptoms (OR = 1.03, 95% CI: 1.00-1.05, P-value = 0.035) were associated with perianal fistula in patients with fissure, after adjusting for age and sex as potential covariates.

Conclusions: An independent association was found between chili pepper consumption as well as the duration of fissure symptoms onset with an increased odds of perianal fistula in patients with fissures. Therefore, limiting chili consumption and early management of fissure symptoms are recommended.