A double‐blind randomized placebo‐controlled trial of oral indoramin to treat chronic anal fissure

Pitt, J; Dawson, Peter; Hallan, R. I.; Boulos, P B

doi:10.1046/j.1463-1318.2001.00227.x

Cited by 35 publications

(23 citation statements)

References 19 publications

(17 reference statements)

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“…Its use in a small trial showed that after 8 weeks, in 9 of 15 (60%), the fissure had healed with no side effects. After an initial encouraging study with oral indoramin as an α 1 -adrenoceptor antagonist which reduced maximum resting anal canal pressure, 43 Pitt et al 44 proceeded to conduct a double-blind, randomised, placebocontrolled trial of oral indoramin to treat 23 patients with Table 1 Effect of injection of botulinum toxin type A injected into the external anal sphincter in patients with anal fissures chronic anal fissure. Nine subjects withdrew within the first 2 weeks of treatment due to side effects which included fatigue, dizziness, headache, dry mouth, nasal congestion and retrograde ejaculation.…”

Section: Muscarinic Agonists and Sympathetic Neuromodulatorsmentioning

confidence: 99%

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Modern Perspectives in the Treatment of Chronic Anal Fissures

Bhardwaj

Parker

2007

annals

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INTRODUCTION Anal fissures are commonly encountered in routine colorectal practice. Developments in the pharmacological understanding of the internal anal sphincter have resulted in more conservative approaches towards treatment. Simple measures are often effective for early fissures. Glyceryl trinitrate is well established as a first-line pharmacological therapy. The roles of diltiazem and botulinum, particularly as rescue therapy, are not well understood. Surgery has a defined role and should not be discounted completely.METHODS Data were obtained from Medline publications citing 'anal fissure'. Manual cross-referencing of salient articles was conducted. We have sought to highlight various controversies in the management of anal fissures.FINDINGS Acute fissures may heal spontaneously, although simple conservative measures are sufficient. Idiopathic chronic anal fissures need careful evaluation to decide what therapy is suitable. Pharmacological agents such as glyceryl trinitrate (GTN), diltiazem and botulinum toxin have been subjected to most scrutiny. Though practices in the UK vary, GTN or diltiazem would be suitable as first-line therapy with botulinum toxin used as rescue treatment. Sphincterotomy is indicated for unhealed fissures; fissurectomy has been revisited and advancement flaps have a role in patients in whom sphincter division is not suitable.

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Section: Muscarinic Agonists and Sympathetic Neuromodulatorsmentioning

confidence: 99%

“…At 6 weeks, the fissure healed in only one (7%) compared with two (22%) in the placebo group. 44 The trial was terminated.…”

Section: Muscarinic Agonists and Sympathetic Neuromodulatorsmentioning

confidence: 99%

Modern Perspectives in the Treatment of Chronic Anal Fissures

Bhardwaj

Parker

2007

annals

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“…Oral indoramin (α 1 -adrenoceptor antagonist) and salbutamol (β-receptor agonist) have both been shown to reduce resting anal pressure in healthy controls and patients with fissure. However, indoramin failed to relieve pain and to heal CAF [8]. Injection of botulinum toxin into the intersphincteric space of the internal sphincter was associated with a reduction in resting anal pressure [9].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore the compliance of patients to the therapy applied is also important. Other nonsurgical treatments used in CAF include the cholinergic agonist bethanecol [7]and the α-adrenoceptor antagonist indoramin [8]and the botulinum toxin [9, 10]. …”

Section: Introductionmentioning

confidence: 99%

Oral Nifedipine in the Treatment of Chronic Anal Fissure

Ağaoğlu¹,

Cengiz²,

Arslan³

et al. 2003

Dig Surg

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Background: The purpose of this study was to demonstrate the effect of oral nifedipine on maximal resting anal pressure (MRAP) in healthy volunteers and to evaluate its role in the treatment of chronic anal fissure (CAF). Methods: MRAP was measured in 10 healthy volunteers and 10 patients with CAF before and after oral nifedipine (20 mg b.i.d.). Patients were assessed on the first visit and every fortnight for measurement of MRAP, pain scores, blood pressure, pulse rate, healing of the fissure and adverse effects. Treatments were continued until healing had occurred or for up to 8 weeks. Results: MRAP values before and after nifedipine were 73.2 and 49.3 cm H₂O, respectively, in healthy volunteers (p < 0.001). Nifedipine caused a reduction in mean MRAP from 105.2 to 74.0 cm H₂O (p < 0.001) in patients with CAF. Pain scores were significantly reduced after 2 weeks of treatment with nifedipine (p < 0.001) and continued throughout the treatment period. At the end of the study 6 of the 10 patients treated with nifedipine were deemed to be healed (n = 5) or improved (n = 1). Headache occurred in 1 patient. Conclusion: We conclude that oral nifedipine is effective in reducing MRAP and should become the first-line treatment for CAF.

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“…Trotz der Nebenwirkungen und der hoher Rezidivrate bei reversibiler Wirkung ist dies,bei fehlendem Inkontinenzrisiko, weil überdies kostengünstig, ein "first line treatment" vor chirurgischer Intervention [6].Einhellig positiv,den Nitrokörpern sogar überlegen, stellen erste vergleichende Studien die Ergebnisse nach Botulismustoxininjektionen dar [5,19]. Auch hier,wie zu den ersten Mitteilungen zur Behandlung mit Adrenozeptorenantagonisten,braucht es größere Fallzahlen und valide Langzeitergebnisse [34].…”

Section: Alternativenunclassified