Topical Nifedipine 0.3% Plus Lidocaine 1.5% for Uncomplicated Hemorrhoidal Disease

Prospective, observational, single-center study involving the administration of topical nifedipine 0.3% plus lidocaine 1.5%, rectally and perianally twice daily for at least 21 days, in patients with uncomplicated hemorrhoidal disease.

The Primary Objective is to evaluate the real-world effectiveness of topical nifedipine 0.3% + lidocaine 1.5% in acute, uncomplicated hemorrhoidal disease, with particular focus on symptom resolution, assessed through the analysis of changes in the HDSS (Hemorrhoidal Disease Symptom Score) questionnaire. The Secondary Objectives include the assessment of topical combinations effect on reduction of hemorrhoidal prolapse (down-staging), its impact on patients' quality of life and its role in preventing hemorrhoidal thrombosis.

Eligible patients-those who meet inclusion/exclusion criteria, sign informed consent, and receive a clinically indicated therapeutic protocol within 5 days of baseline evaluation (dietary recommendations, hydration, and topical therapy)-will undergo 4 assessments over approximately 30 days:

T0: Baseline visit within 5 days of starting nifedipine 0.3% + lidocaine 1.5% T1: Telephone contact at day 10 T2: In-person visit at day 21 T3: Telephone contact at day 30

The study includes an enrollment period of 10 months, an observation period of ~30 days and total duration of ~12 months

Data will be collected at the study center and entered by the investigator or designated personnel into a web-based electronic database (e-CRF), structured according to the study flow-chart.

The study plans to enroll 80 patients. This number is justified by the expected change in HDSS score between baseline (T-1) and T2 (day 21). Assuming a standard deviation of ~5 points, a sample of 70 patients ensures a precision of 1.2 points for 95% confidence intervals. To account for a 10% drop-out rate, the final sample size is set at 80 patients.

Continuous variables will be described using mean ± SD, quartiles (25%, 50%, 75%), and min/max.

Categorical variables using absolute frequencies and percentages. Statistical analysis will be performed using SAS 9.4.

Inclusion criteria

• Male and female patients aged 18-75 years.
• Clinical or anoscopic diagnosis of acute hemorrhoidal disease with prolapse severity between Grade II and IV (Goligher), possibly associated with external congestion.
• Patients who started treatment with nifedipine 0.3% + lidocaine 1.5% within the past 5 days.
• Availability of clinical evaluations at treatment initiation (proctologic visit and HDSS, SHS-HD, VAS scales).
• Ability to understand the informed consent.
• Signed informed consent.

Exclusion criteria

• Acute hemorrhoidal disease complicated by thrombosis or strangulation.
• Coagulopathies.
• Active neoplastic disease.
• Treatment with anticoagulants and/or chemotherapeutic agents.
• Hypersensitivity to active substances, especially lidocaine (and other amide-type local anesthetics) or excipients.
• Severe hypotensive states or cardiovascular insufficiency.
• Pregnancy or breastfeeding.
• Participation in clinical trials involving investigational drugs.