Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Bacher, H; Mischinger, HJ; Werkgartner, G; Cerwenka, H; El-Shabrawi, A; Pfeifer, J; Schweiger, W.
Local nitroglycerin for treatment of anal fissures: an alternative to lateral sphincterotomy?
Dis Colon Rectum. 1997; 40(7):840-845
Doi: 10.1007/BF02055444
Web of Science
PubMed
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- Führende Autor*innen der Med Uni Graz
- Bacher Heinz
- Co-Autor*innen der Med Uni Graz
- Cerwenka Herwig
- Mischinger Hans-Jörg
- Pfeifer Johann
- Werkgartner Georg
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- Abstract:
- PURPOSE: Nitric oxide is an important neurotransmitter mediating internal anal sphincter relaxation. Patients suffering from fissure-ln-ano were treated with topical nitroglycerine. The clinical evidence for therapeutic adequacy was examined in a prospective, randomized study. METHODS: The study included 35 patients with acute and chronic anal fissures. In Group A, including 20 patients with the clinical diagnosis of acute (12 patients) and chronic (8 patients) anal fissures, treatment consisted of topical nitroglycerine. Group B, consisting of 15 patients (10 acute and 5 chronic fissures), received topical anesthetic gel during therapy. Manometry was performed before and on days 14 and 28 in the course of topical application of either 0.2 percent glyceryl trinitrate ointment or anesthetic gel (lignocaine). Anal pressures were documented by recording the maximum resting and squeeze pressures. RESULTS: In 60 percent of cases treated with topical nitroglycerine (Group A, 11 acute (91.6 percent) and 1 chronic (12.5 percent)), anal fissure healed within 14 days, in contrast to Group B in which no healing was observed. The healing rate after one month was 80 percent (11 acute (91.6 percent) 5 chronic (62.5 percent)) in Group A and was significantly superior to Group B (healing rate, 40 percent: 5 acute (50 percent); 1 chronic (20 percent)). DISCUSSION: Previously increased maximum resting pressures decreased from a mean value of 110 to 87 cm H2O. This represents a mean reduction of 20 percent (P = 0.0022). We also noted a significant decrease in squeeze pressures (from 177.8 to 157.9 cm H2O (11 percent)). However, anal pressures did not decrease significantly in the four chronic fissure patients from Group A, whose fissures only healed after 28 days. Similarly to these Group A chronic fissure patients: no significant anal pressure reduction was observed in any Group B patients, Except for mild headache (20 percent), no side effects of treatment were reported. CONCLUSIONS: Topical application of nitroglycerine represents a new, easily handled, and effective alternative in the treatment of anal fissures. Ail of our patients reported a dramatic reduction in acute anal pain. However, it should be noted that a lack of sphincter tone reduction is a likely reason for the great tendency of chronic anal fissures to recur.
- Find related publications in this database (using NLM MeSH Indexing)
- Acute Disease -
- Administration, Rectal -
- Administration, Topical -
- Adult -
- Anal Canal - drug effects Anal Canal - physiology Anal Canal - surgery
- Anesthetics, Local - administration and dosage Anesthetics, Local - therapeutic use
- Chronic Disease -
- Female -
- Fissure in Ano - drug therapy Fissure in Ano - physiopathology Fissure in Ano - surgery
- Follow-Up Studies -
- Gels -
- Headache - chemically induced
- Humans -
- Lidocaine - administration and dosage Lidocaine - therapeutic use
- Male -
- Manometry -
- Middle Aged -
- Muscle Contraction - physiology
- Muscle Relaxation - drug effects
- Neurotransmitter Agents - physiology
- Nitric Oxide - physiology
- Nitroglycerin - administration and dosage Nitroglycerin - adverse effects Nitroglycerin - therapeutic use
- Pressure -
- Prospective Studies -
- Vasodilator Agents - administration and dosage Vasodilator Agents - adverse effects Vasodilator Agents - therapeutic use
- Wound Healing -
- Find related publications in this database (Keywords)
- Anal Fissure
- Topical Glyceryl Trinitrate
- Clinical and Manometric Results