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International Journal of Colorectal Disease

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01-08-2007 | Original Article

Endosonographic and manometric evaluation of internal anal sphincter in patients with chronic anal fissure and its correlation with clinical outcome after topical glyceryl trinitrate therapy

Authors: Marta Pascual, Miguel Pera, Ricard Courtier, Mariá José Gil, David Parés, Sonia Puig, Montserrat Andreu, Luis Grande

Published in: International Journal of Colorectal Disease | Issue 8/2007

Abstract

Background and aims

Anorectal pressure studies have demonstrated internal anal sphincter (IAS) hypertonia in patients with chronic anal fissure. It is unknown however, if these changes in IAS function are associated with any abnormality in sphincter morphology. The first aim was to investigate the clinical characteristics and the manometric and endosonographic findings of the IAS in a cohort of patients with chronic anal fissure. The second aim was to investigate the association between these findings and the outcome with topical Glyceryl trinitrate (GTN) therapy.

Materials and methods

All patients who presented with chronic anal fissure from November 1999 to May 2004 were included after failure of conservative therapy. Anorectal manometry and anal endosonography were performed before treatment with 0.2% GTN ointment twice daily was initiated. Patients were evaluated after 8 weeks.

Results

One hundred and twenty-four patients (66 women, mean age, 45.2 ± 14.8 years) were included. Hypertonia of the IAS was found in 84 (68%) patients. The mean maximum IAS thickness was 3.6 ± 0.76 mm (1.6–5.5). An abnormally thick IAS, adjusted by age, was observed in 113 (91.1%) patients. We found no correlation between resting pressure and IAS thickness (r = 0.074; p = 0.41). At 8 weeks, 52 patients (42%) had healed with complete symptoms resolution. No statistically significant differences were observed when clinical features and manometric and endosonographic findings were compared between healing and no-healing fissures.

Conclusion

The majority of patients with chronic anal fissure present an abnormally thick IAS. Clinical, manometric and endosonographic features had no association with outcome after GTN treatment.

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Title: Endosonographic and manometric evaluation of internal anal sphincter in patients with chronic anal fissure and its correlation with clinical outcome after topical glyceryl trinitrate therapy
Authors: Marta Pascual
Miguel Pera
Ricard Courtier
Mariá José Gil
David Parés
Sonia Puig
Montserrat Andreu
Luis Grande
Publication date: 01-08-2007
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 8/2007
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-006-0251-1

At a glance: The STEP trials

Springer Medicine

Endosonographic and manometric evaluation of internal anal sphincter in patients with chronic anal fissure and its correlation with clinical outcome after topical glyceryl trinitrate therapy

Abstract

Background and aims

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background and aims

Materials and methods

Results

Conclusion

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