use of glycery Tri-nitrate ointment in treatment of chronic fissure in ano

ABSTRACT

Chronic anal fissure is a common painful condition. It is traditionally treated by anal dilatation or by lateral sphincterotomy. However, both of these surgical treatments may cause a degree of incontinence in 35 - 45% of patients. Several recent trials have shown that glyceryl trinitrate [GTN] can reduce sphincter pressure and heal up to 70% of chronic fissures. Assessment of the efficacy of topical 0.2% glyceryl trinitrate [GTN] ointment in the treatment of chronic anal fissure. Prospective uncontrolled clinical study. Surgical polyclinic, Bahrain. Fifty-four patients were diagnosed as having chronic anal fissure and treated with 0.2% GTN ointment during the period from June 2002 to August 2005. They were reviewed at 1, 2, 6-8 and up to 12 weeks to assess symptoms, fissure healing, compliance, duration of symptoms free period after finishing or stopping the course of treatment. At six-eight weeks, the GTN course was completed or taken for longer duration in 34 patients [62.9%]. The course was stopped before 6-8 weeks in 20 patients [37%]. Pain was completely relieved in 25 /34 patients [73.5%] and partially relieved in 5/34 patients [14.7%], bleeding was absent in 32/34 patients [94%], anal tone became normal in 32/34 patients [94%], and 28/34 patients [82.4%] had either healing or healed fissures. Twenty patients stopped GTN course before 6 weeks due to different causes, such as, side effects mainly headache [60%], non compliance [95%], or no response at all [50%]. Recurrence of symptoms in the first six months was seen in 26 patients. There was a highly significant positive relationship between duration of treatment and recurrence of symptoms. The recurrence was treated surgically in 14 patients, traditional ointments in 8 patients, and repeated GTN course in 4 patients. The use of 0.2% GTN induces rapid healing of chronic anal fissures with an 82.4% healing rate in this study. Successful treatment may come at the expense of high incidence of headache although it is lower in our study due to low GTN concentration