Use of glyceryl trinitrate ointment in the treatment of anal fissure

Lund, Jonathan N.; Armitage, N. C.; Scholefield, J H

doi:10.1002/bjs.1800830615

Cited by 100 publications

(40 citation statements)

References 10 publications

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“…This age group seems to have higher predilection for development of chronic fissure in ano. This in accordance with study conducted by Christie [7] and Richard [6] where mean age was 35,39,39,44 and 34.7 years respectively. But mean age was 44 and 55 years in study conducted by Palazzo and Schouten [8] respectively.…”

Section: Age Groupssupporting

confidence: 92%

Comparative Study of Glyceryl Trinitrate Ointment Versus Surgical Management of Chronic Anal Fissure

et al. 2011

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Chronic Anal Fissure (CAF) is common perineal condition and well-known painful entity. Standard surgical treatment even though available, may require long hospital stay and sometimes have worrying complications like anal incontinence. So non-surgical treatment, Glyceryl Trinitrate has been shown to be an effective for chronic anal fissure. It decreases anal tone and ultimately heals the anal fissure. The present study is the attempt to know the efficacy of 0.2% Glyceryl Trinitrate ointment in the treatment of chronic anal fissure and to compare the effectiveness of 0.2% Glyceryl Trinitrate ointment (GTN) versus fissurectomy with lateral internal sphincterotomy (LIS) and fissurectomy with posterior internal sphincterotomy (PIS) in the management of chronic anal fissure. This is a prospective comparative study of management of chronic anal fissure done in our hospital during the period of one and half year from October 2005 to March 2007. Thirty patients treated with 0.2% Glyceryl Trinitrate ointment and 30 patients treated with fissurectomy and lateral internal sphincterotomy and 30 patients treated with posterior internal sphincterotomy, for chronic anal fissure were selected for study. A single brand of 0.2% Glyceryl Trinitrate ointment (Nitrogesic) used for trial arm. Dose of administration was 1.5 cm to 2 cm in the anal canal with device provided by manufacturers of the proprietary preparation and applied twice a daily for 12 weeks. Patients were followed up for 12 weeks and thereafter evaluated for relief of symptoms in all three groups. Observations were recorded at 2 weeks; 6 weeks and 12 weeks of follow up period, regarding symptoms like pain and bleeding during defecation, healing of CAF and also for side effects like headache in GTN group and flatus, fecal incontinence in surgical groups. Data collected in proforma and analyzed. Study revealed CAF was more in male 59 patients (66%) than the female 31 patients (34%), the ratio being 1: 0.52. The maximum number of patients was encountered in the age group of 20 to 40 years with mean duration of age 34.14 years. In all three groups symptoms like pain, bleeding, constipation and sphincter spasm were present. Sentinel pile was present in 56% of the patients. Common site of fissure was found to be posterior in 94% of patients. Observations with respect to relief of pain, no bleeding and healing were recorded at 2, 6 and 12 weeks of duration. Lateral sphincterotomy remains effective but should be reserved for the patients who fail to respond to initial chemical sphincterotomy or GTN therapy. GTN is good alternative mode of therapy for patients who refuse surgery and prefer medical line of treatment.

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Section: Age Groupssupporting

confidence: 92%

Comparative Study of Glyceryl Trinitrate Ointment Versus Surgical Management of Chronic Anal Fissure

et al. 2011

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“…But in the study conducted by Lock & Thombson et al (1977) [3] the posterior fissure were in 75 % of cases, anterior and lateral in 14 % and 3 % respectively. They have found the incidence of sentinel piles to be 38 % .But in the study conducted by Lund [4] the posterior anal fissure was found in 76 % of patients and anterior fissure in 24 % of patients. The proportion of anterior anal fissures is much higher in female patients being 21 % compared with only 9 % in male population [Lock & Thombson et al (1977) [3].…”

Section: Discussionmentioning

confidence: 92%

Comparative Study of Lateral Sphincterotomy versus Local 2 % Diltiazem Ointment for the Treatment of Chronic Anal Fissure

Kuiri¹,

Saha²,

Ghosh³

et al. 2014

IOSRJDMS

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A chronic anal fissure is a non-healing linear tear in the distal anal mucosa below the dentate line and is a painful entity. A fissure is defined as chronic when it fails to heal within Keywords-Lateral internal sphincterotomy, 2 % Diltiazem ointment, chronic anal fissure. I.INTRODUCTION A chronic anal fissure is a crack in the distal anal mucosa which often does not heal after an acute attack. Apart from it being a painful condition it has different modes of presentation such as bleeding per rectum, pain during defecation and pain during defecation with constipation. There are several factors for the development of chronic anal fissure like internal sphincter hypertonia, trauma due to passage of hard stools or diarrhoea episodes, paucity of blood supply, especially the posterior commissure, by the compression of inferior rectal artery. The paucity of blood flow prevents healing of anal fissure until the cycle of internal sphincter hypertonia and decreased blood flow is broken by muscle relaxants or surgery. There are different non-surgical treatments for chronic anal fissure including 2 % Diltiazem ointment topical application and also there are different surgical interventions including lateral internal sphincterotomy. The study was designed to compare the effect of medical management with topical 2 % Diltiazem ointment and surgical treatment by lateral internal sphincterotomy in case of chronic anal fissure with regards to ulcer healing, pain reduction, cessation of bleeding per rectum and incontinence.

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“…Results of the present were similar to study conducted Lund et al where 18 out of 21 patients were asymptomatic after second week of treatment and Mann et al where 15 out of 16 patients were asymptomatic after four weeks. 6,7 Lund and Scholefield conducted a randomized, prospective, double-blinded, placebo controlled trial of GTN ointment and found that there is marked pain relief after using GTN ointment in comparison to placebo. 8 After six weeks healing was seen in 28 patients out of 50 patients in lignocaine group and 44 patients out of 50 patients in combination group.…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of 5% lignocaine ointment and a combination of 0.2% glyceryl trinitrate and 5% lignocaine in management of acute fissure in ano.

et al. 2017

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Background: Anal fissure is one of the most common anorectal problem and presents as a tear in the anoderm distal to the dentate line. It is a common proctologic problem and accounts for 10-15% of proctological consultations and seen frequently in young and middle-aged patients. Presently wide range of medical and surgical treatment options were available. Present study was aimed to evaluate the therapeutic efficacy of 5% lignocaine ointment and a combination of 0.2% glyceryl trinitrate and 5% lignocaine in management of acute fissure in ano.Methods: In the present study, a total of 100 patients diagnosed with acute fissure in ano were randomly allocated into two groups (I, II) of 50 patients each and were managed by local application of 5% Lignocaine (LIG) ointment and a combination of both 0.2% Glyceryl trinitrate (NTG) and 5% Lignocaine (LIG) ointment respectively.Results: In the present study, the incidence of anal fissure was higher in males than in females with mean age of occurrence of 35.12 years. Pain was the most common symptom to present with. After six weeks, complete pain relief was seen in most of the patients and was comparable in both the groups but healing was superior in group II when compared to group I. Headache and dizziness were the side effects only noticed in group II.Conclusions: To conclude the study, we can say that the treatment of anal fissure is becoming increasingly medical as it can be carried out on outpatient basis and is cost effective and there is no loss of man hours. Lignocaine may be preferred as the first line treatment as there are no side effects and if there is failure to heal then we can prescribe the combination of both drugs owing to their risk benefit ratio.

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Use of glyceryl trinitrate ointment in the treatment of anal fissure

Cited by 100 publications

References 10 publications

Comparative Study of Glyceryl Trinitrate Ointment Versus Surgical Management of Chronic Anal Fissure

Comparative Study of Glyceryl Trinitrate Ointment Versus Surgical Management of Chronic Anal Fissure

Comparative Study of Lateral Sphincterotomy versus Local 2 % Diltiazem Ointment for the Treatment of Chronic Anal Fissure

Comparative evaluation of 5% lignocaine ointment and a combination of 0.2% glyceryl trinitrate and 5% lignocaine in management of acute fissure in ano.

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