A prospective, randomized, double-blind study comparing the efficacy of diltiazem, glyceryl trinitrate, and lidocaine for the treatment of anal fissure in children

Cevik, Muazez; Böleken, Mehmet Emin; Koruk, İbrahim; Öcal, Servet; Balcıoğlu, Mehmet Emin; Aydinoğlu, A. Hakan; Karadağ, Çetin Ali

doi:10.1007/s00383-011-3048-4

Cited by 21 publications

(28 citation statements)

References 18 publications

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“…General surgeons and colon & rectal surgery specialists regard AF as a common problem in adults and children [3,4], but data on the epidemiology of this disease are very rare [5]. In a search of the PubMed database using the key words ‘anal fissure’ and ‘epidemiology’, ‘incidence’, or ‘prevalence’, we could not find any articles published within the last 30 years with population-based data on the incidence of AF.…”

Section: Introductionmentioning

confidence: 99%

The epidemiology and treatment of anal fissures in a population-based cohort

2014

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BackgroundAnal fissure (AF) is regarded as a common problem, but there are no published epidemiologic data, nor information on current treatment. The purpose of this study was to examine the incidence, associated comorbidities, and treatment of AF in a population-based cohort.MethodsWe conducted a retrospective analysis of all persons who were enrolled in one large regional managed care system and treated for AF during calendar years 2005–2011. All persons aged 6 years or older who had a clinic, hospitalization, or surgical procedure associated with AF were identified from utilization data. To identify comorbidities associated with AF, each case was matched by age and gender to 3 controls.ResultsThere were 1,243 AF cases, including 721 (58%) females and 522 (42%) males; 150 (12%) of the cases occurred in children aged 6–17 years. The overall annual incidence was 0.11% (1.1 cases per 1000 person-years), but ranged widely by age [0.05% in patients 6–17 years to 0.18% in patients 25–34 years]. The incidence also varied by sex, and was significantly higher among females 12–24 years, and among males 55–64 years (P < 0.001). Comorbidities associated with AF included chronic constipation (prevalence 14.2% vs 3.6%), hypothyroidism (14.7% vs 10.4%), obesity (13.0% vs 7.7%), and solid tumors without metastasis (5.2% vs 3.7%) (P < 0.001 for all comparisons). A total of 448 were dispensed a topical prescription medication, 31 had botulinum toxin injection, and only 13 had lateral internal sphincterotomy.ConclusionsAF is a common clinical problem, and the incidence varies substantially by age and sex. Constipation, obesity, and hypothyroidism are associated comorbidities. Most patients are prescribed topical treatments, although it appears that many prescriptions are never filled. Surgical interventions for AF including botulinum toxin and lateral internal sphincterotomy are uncommon.

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Section: Introductionmentioning

confidence: 99%

The epidemiology and treatment of anal fissures in a population-based cohort

2014

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“…Studies with contradictory results regarding the clinical use of topical GTN are presented in the medical literature. While some studies have reported the rate of success in treatment as 80%, some others have found no superiority of GTN against placebo [5,11,12,[15][16][17]. We quantitatively showed the relaxation effect of GTN, clinical use of which has such diverse study results, on anal channel muscular tissue "in vitro", and determined that it created more effective relaxation in precontracted muscle tissue.…”

Section: Discussionmentioning

confidence: 81%

“…Also, it has been argued that due to its minimal systemic absorption, it had no side effect [5,15]. Çevik et al in their study have conducted in pediatric patients, reported that nifedipine was significantly more effective than GTN and lidocaine, with fewer side effects and faster regression of the symptoms [16]. Recently conducted studies in both children and adults have also revealed that topical nifedipine use is effective in the healing process of anal fissures with minimal side effects [4,16,18].…”

Section: Discussionmentioning

confidence: 99%

The effects of nifedipine and glyceryl trinitrate on anorectal muscle contractions: an “in vitro” study

Erdem¹

2019

Ann Clin Anal Med

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Aim: Numerous methods have been tried to reduce the anal sphincter spasm occurring in cases with anal fissure. One of these methods is chemical sphincterotomy performed with various drugs. We aimed to show and compare the "in vitro" effects of glyceryl trinitrate and nifedipine, which are among these drugs, in the organ bath, using the rat anal sphincter muscle. Material and Method: We used 18 Wistar-Albino rats in our experimental study. We used isolated experimental tissue chamber protocol. The sphincteric muscle tissue was placed in the tissue chamber containing Krebs solution, and the degree of contraction was measured as "mg". We evaluated the effects of drugs in both the baseline and the precontracted states. Results: Tissue relaxation response against nifedipine and glycerol trinitrate in both the baseline and the precontracted states were statistically significant. The relaxation response against nifedipine was higher than the one against glycerol trinitrate; however, it was not statistically significant. Discussion: We showed that both nifedipine and GTN were effective " in vitro" on muscle tissue relaxation in the organ bath. Both nifedipine and GTN were found to lead to significant reduction of tension at both the baseline and the precontracted states. Their effects were more significant in the precontracted muscle tissue than the tissue with baseline tension. Although clinical studies have revealed controversial results, since we have proven their efficacies "in vitro", we have the opinion that these two drugs may find more place for themselves in clinical use particularly with the purpose of chemical sphincterotomy, in other words, the relief of sphincter spasm, paying attention to their side effects.

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“…Anal fissür, genellikle anal kenardan dentat hatta kadar uzanan doğrusal veya gözyaşı damlası şeklinde olan mukozal yırtıklar şeklinde gözlenmektedir. Çocukluk çağında özellikle de 6-36 aylar arasında daha sık rastlanmaktadır [1][2][3]. Anal fissürün patofizyolojisi hakkında çeşitli teoriler olmasına rağmen kesin neden halen belirsizliğini korumaktadır [3,4].…”

Section: Introductionunclassified

“…Çocukluk çağında özellikle de 6-36 aylar arasında daha sık rastlanmaktadır [1][2][3]. Anal fissürün patofizyolojisi hakkında çeşitli teoriler olmasına rağmen kesin neden halen belirsizliğini korumaktadır [3,4]. En popüler teorilerden bir tanesi kabızlık ve sert gaytaya sekonder anal kanal travması sonrası mukozal yırtılma ve anal fissürün geliştiğidir [5][6][7].…”

Section: Introductionunclassified

Anal fissür: Kabızlığın bir komplikasyonu mu?

Özen

Eroğlu

2020

Pamukkale Medical Journal

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Özet Amaç: Anal fissürün etiyolojisi hakkında çeşitli teoriler olmasına rağmen genel bir fikir birliği bulunmamaktadır. En popüler teorilerden bir tanesi kabızlık ve sert gaytaya sekonder anal kanal travması ve buna bağlı mukozal yırtılma ile anal fissürün geliştiğidir. Bu çalışmada anal fissür tanısı konulan hastalarda başlangıçta eşlik eden kabızlığı araştırmayı ve anal fissür ile kabızlık arasındaki olası ilişkiyi değerlendirmeyi amaçladık. Gereç ve yöntem: Akut anal fissür tanısı konulan hastalar başvuru yaşları, yakınmaları, anorektal muayene özellikleri, fissür veya fissürlerin anatomik lokalizasyonları bakımlarından değerlendirildi. Anal fissüre eşlik eden fonksiyonel kabızlık Roma IV kriterleri uygulanarak değerlendirildi ve tanı bu şekilde konuldu. Bulgular: En sık başvuru yakınması rektal kanamaydı. Popo temizliği yapılan mendil veya peçetede kan görülmesi olguların %69,6'sında mevcut iken gayta üzerinde kan görülmesi olguların %20,6'sında bulunmaktaydı. Roma IV kriterlerine göre hastaların %8,8'inde kabızlık saptandı. Yapılan fizik muayenede anal fissür, hastaların %10,7'sinde anterior duvarda, %8,8'inde lateral duvarda, %72,5'inde ise posterior duvarda tespit edildi. Sonuç: Bu çalışmada tespit edilen anal fissüre eşlik eden kabızlık oranı mevcut literatürde sağlıklı çocuklarda tespit edilen kabızlık oranlarından daha yüksek değildi. Bu sonuçlar çocuklarda anal fissür etiyolojisini açıklamada kabızlık ve sert gayta teorisinin yetersiz kalabileceğini düşündürmüştür. Bu nedenle anal fissür etiyolojisinde yüksek bazal internal sfinkter basıncı ve buna bağlı iskemi gibi diğer teorileri akılda tutmak gerekir.

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A prospective, randomized, double-blind study comparing the efficacy of diltiazem, glyceryl trinitrate, and lidocaine for the treatment of anal fissure in children

Abstract: Diltiazem application is effective and safe for the treatment of AF in children, and has a low recurrence rate. The smooth dose-concentration curve causes minimal side effects.

Cited by 21 publications

References 18 publications

The epidemiology and treatment of anal fissures in a population-based cohort

The epidemiology and treatment of anal fissures in a population-based cohort

The effects of nifedipine and glyceryl trinitrate on anorectal muscle contractions: an “in vitro” study

Anal fissür: Kabızlığın bir komplikasyonu mu?

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