Top

International Journal of Colorectal Disease

Published in:

01-04-2009 | Original Article

Topical anal fissure treatment: placebo-controlled study of mononitrate and trinitrate therapies

Authors: Ludmila Tankova, Krassimira Yoncheva, Daniel Kovatchki, I. Doytchinova

Published in: International Journal of Colorectal Disease | Issue 4/2009

Abstract

Aim

The present study aims to evaluate and compare the efficacy of two nitrate gels, containing isosorbide-5-mononitrate (ISMN) or glyceryl trinitrate (GTN), in the therapy of chronic anal fissure.

Materials and methods

The patients were randomly assigned to three groups: 0.1% ISMN gel (21 patients), 0.1% GTN gel (21 patients) and a placebo group (ten patients). The ethic committee of our hospital approved the protocol and informed consent was obtained from all participants. All patients underwent clinical examination, visual inspection of the fissure and anal manometry prior to and after therapy.

Results

The chronic anal fissure was completely healed in 71% of the patients treated with ISMN, 67% with GTN and in 30% from the placebo group. One patient in the ISMN group reported mild headache. Three patients in the GTN group had anal burning.

Conclusion

Both topical nitrate treatments (ISMN and GTN) were effective for chronic anal fissures. The reduction of the anal pressure was slightly higher after ISMN treatment (28%) than the treatment with GTN (23%). However, the statistical difference was not significant (p > 0.05).

Dhawan S, Chopra S (2007) Nonsurgical approaches for the treatment of anal fissures. Am J Gastroenterol 102:1312–1321PubMedCrossRef

Jost JH (1997) One hundred cases of anal fissures treated with botulin toxin: early and long-term results (see comments). Dis Colon Rectum 40:1029–1032PubMedCrossRef

Bacher H, Mischinger H, Werkgartner G, Cerwenka H, El-Shabrawi A, Pfeifer J, Schweiger W (1997) Local nitroglycerin for treatment of anal fissures: an alternative to lateral sphincterotomy? Dis Colon Rectum 40:840–845PubMedCrossRef

Brisinda G, Maria G, Bentivoglio AR, Casseta E, Gui D, Albanese A (1999) A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure. N Engl J Med 341:65–69PubMedCrossRef

Carapeti EA, Kamm MA, McDonald PJ, Chadwick SJD, Melville D, Phillips RKS (1999) Randomized controlled trial shows that glyceryl trinitrate heals and fissures, higher doses are not more effective, and there is a high recurrence rate. Gut 44:727–730PubMedCrossRef

Graziano A, Svidler L, Lencinas S, Masciangioli G, Gualdrini U, Bisisio O (2001) Long-term results of topical nitroglycerin in the treatment of chronic anal fissures are disappointing. Tech Coloproctol 5:143–147PubMedCrossRef

Loder PB, Kamm MA, Nicholls RJ, Phillips RKS (1994) “Reversible chemical sphincterotomy” by local application of glyceryl trinitrate. Br J Surg 81:1386–1389PubMedCrossRef

Lund JN, Scholefield JH (1997) Glyceryl trinitrate is an effective treatment for anal fissure. Dis Colon Rectum 40:468–470PubMedCrossRef

Oettle GJ (1997) Glyceryl trinitrate vs. sphincterotomy for treatment of chronic fissure-in-ano: a randomized, controlled trial. Dis Colon Rectum 40:1318–1320PubMedCrossRef

10.

Tankova L, Yoncheva K, Muhtarov M, Kadyan H, Draganov V (2002) Topical mononitrate treatment in patients with anal fissure. Aliment Pharmacol Ther 16:101–103PubMedCrossRef

11.

Altomare DF, Rinaldi M, Milito G, Arcana F, Spinelli F, Nardelli N, Scardigno D, Pulvirenti A, Bottini C, Pescatori M, Lovreglio R (2000) Glyceryl trinitrate for chronic anal fissure healing or headache? Results of a multicenter, randomized, placebo-controlled, double-blind trial. Dis Colon Rectum 43:174–181PubMedCrossRef

12.

Hyman N, Cataldo P (1999) Nitroglycerin ointment for anal fissures—effective treatment or just a headache? Dis Colon Rectum 42:383–385PubMedCrossRef

13.

Manabe T, Yamamoto A, Satoh K, Ichihara K (2001) Tolerance to nitroglycerin induced by isosorbide-5-mononitrate infusion. Biol Pharm Bull 24:1370–1372PubMedCrossRef

14.

Jonas M, Amin S, Wright JW, Neal KR, Scholefield JH (2001) Topical 0.2% percent glyceryl trinitrate ointment has a short-lived effect on resting anal pressure. Dis Colon Rectum 44:1640–1643PubMedCrossRef

15.

Lund JN, Armitage NC, Scholefield JH (1996) Use of glyceryl trinitrate ointment in the treatment of anal fissure. Br J Surg 83:776–777PubMedCrossRef

Title: Topical anal fissure treatment: placebo-controlled study of mononitrate and trinitrate therapies
Authors: Ludmila Tankova
Krassimira Yoncheva
Daniel Kovatchki
I. Doytchinova
Publication date: 01-04-2009
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 4/2009
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-008-0632-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Topical anal fissure treatment: placebo-controlled study of mononitrate and trinitrate therapies

Abstract

Aim

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Aim

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2009

Enterocolic lymphocytic phlebitis and lymphocytic colitis: drug-related coexistent pathology

Double primary malignancy in colorectal cancer patients—MSI is the useful marker for predicting double primary tumors

Aberrant crypt foci: endoscopic assessment and cell kinetics characterization

The change pattern of SP and NO in the portal vein during the RAIR

Hepatectomy for liver metastasis of colorectal cancer

Expression of tight and adherens junction proteins in ulcerative colitis associated colorectal carcinoma: upregulation of claudin-1, claudin-3, claudin-4, and β-catenin