EFFICACY AND SIDE EFFECTS OF GLYCERYL TRINITRATE IN MANAGEMENT OF CHRONIC ANAL FISSURE

Fazila Hashmi, Muhammad Munir Memon, Abdul Mannan Khan

Abstract


Background: Various options are available for treatment of chronic anal fissure, each with its own
associated complications. This study aimed to evaluate the efficacy of topical Glyceryl Trinitrate
(GTN) for anal fissures in an outpatient setting. Methods: A prospective experimental study was
carried out at the outpatient department of Surgical Unit IV, Liaquat University Hospital from Aug
2004 to Jul 2005. Total 100 patients fulfilling the criteria of chronic anal fissure were included in the
study. Patients presenting with chronic anal fissure but with associated comorbidities were excluded.
Data were collected on a designed questionnaire, and analysed using SPSS-10. Results: Sixty women
and 46 men were included in the study with a mean age of 30 years. After the end of 8 weeks of
treatment, 76 showed healing of fissure and relief in symptoms whereas 20 patients either had
improvement in symptoms or did not heal. The commonest side-effect was headache reported by 21
patients. The minimum period of follow-up was one year, and 7 patients had recurrence. Conclusion:
Topical 0.2% GTN is an effective first-line agent in managing chronic anal fissure. The associated sideeffects and recurrence remains a matter of concern.
Keywords: Anal fissure, GTN, Glyceryl trinitrate, Headache, side-effects

Full Text:

PDF

References


Schouten WR, Briel JW, Auwerda JJ, De Graaf EJ. Ischemic

nature of anal fissure. Br J Surg 1996;83:63–5.

Bhardwaj R, Vaizey CJ, Boulos PB, Hoyle CH. Neuromyogenic

properties of the internal anal sphincter: therapeutic rationale for

anal fissures. Gut 2000;46:861–8.

Frenckner B. Function of the anal sphincters in spinal man. Gut

;16:638–44.

O’Kelly T, Brading A, Mortensen N. Nerve mediated relaxation

of the human internal anal sphincter: the role of nitric oxide. Gut

;34:689–93.

Rattan S, Chakder S. Role of nitric oxide as a mediator of internal

anal sphincter relaxation. Am J Physiol 1992;262,G107–G112.

Cook TA, Humphreys MM, Mortensen NJ. Oral nifedipine

reduces resting anal pressure and heals chronic anal fissure. Br J

Surg 1999;86:1269–73.

Ananel N, Gordon PH. Re-examination of clinical manifestations

and response to therapy of fissure-in-ano. Dis Colon Rectum

;40:229–33.

Richard CS, Gregoire R, Plewes EA, Silverman R, Burul

C, Buie D, et al. Internal sphincterotomy is superior to

nitroglycerine in the treatment of chronic anal fissure: results of

randomized trial, controlled trail by Canadian Colorectal Surgical

Trials Group. Dis Colon Rectum 2000;43:1048–57.

Simpson J, Lund JN, Thompson RJ, Kapila L, Scholefield JH.

The use of glycerol trinitrate (GTN) in the treatment of chronic

anal fissure in children. Med Sci Monit 2003;9(10);123–6.

Manoonkian CM. Fleshner P, Moore B, Teng F, Cooperman

H, Sokol T. Topical nitroglycerine in the management of anal

fissure; an explosive outcome! Am Surg 1998;64(10):962–4.

Thornton MJ, Kennedy ML, King DW. Manometric effects of

topical glyceryl trinitrate and its impact on chronic anal fissure

healing. Dis Colon Rectum 2005;48:207–12.

Shoukat A, Zafar F, Aslam M, Chaudhry AA. Chronic anal

fissure: Role of chemical sphincterotomy. Professional Med J

;13(3):354–7.

Aziz R, Din F, Shoaib M, Kamran M. Non surgical treatment of

chronic anal fissure: one year`s experience with GTN paste. Ann

King Edward Med Uni 2005;11(4):396–7.

Umer S, Manzar S. Effectiveness of topical Diltiazem versus

Glyceryl Trinitrate in the treatment of chronic anal fissure. Pak J

Surg 2003;19(20):62–7.

Kocher HM, Steward M, Leather MJA, Cullen PT. Randomized

clinical trial assessing the side-effects of glyceryl trinitrate and

diltiazem hydrochloride in the treatment of chronic anal fissure.

Br J Surg 2002:89;413–17.

Altomere DF, Rinaldi M, Millito G, Arcana F, Spinelli F,

Nardelli N et al. Glyceryl trinitrate for chronic anal fissure–

fissure healing or headache: Results of amulticentre, randomized,

placebo controlled, double blind trial. Dis Colon Rectum

;43:174–9.

Graziano A, Svidler LL, Lencinas S, Masciangioli G, Guaidrini

U, Bisisio O. Longterm results of topical nitroglycerine in the

treatment of chronic anal fissures are disappointing. Tech

Coloproctol 2001;5:143–7.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]