The use of glyceryl tri-nitrate ointment in treatment of chronic fissure in ano

Abstract EN

Background: 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.

Objective: Assessment of the efficacy of topical 0.2% glyceryl trinitrate (GTN) ointment in the treatment of chronic anal fissure.

Design: Prospective uncontrolled clinical study.

Setting: Surgical polyclinic, Bahrain.

Method: 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.

Result: 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.

Conclusion : 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