Pathophysiological aspects and clinical outcome of intra-anal application of isosorbide dinitrate in patients with chronic anal fissure

Schouten, W. R.; Briel, J. W.; Boerma, Marjan; Auwerda, J. J. A.; Graatsma, B. H.; Wilms, Ellen

doi:10.1016/0300-2977(95)97011-d

Cited by 38 publications

(63 citation statements)

References 4 publications

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“…The male: female ratio was 1: 0.52. This is in accordance with study conducted by Schouten [3] Divino [4]. But female patients were found more in study conducted by Christie [5] and Richard [6].…”

Section: Age Groupssupporting

confidence: 82%

“…It decreases anal tone and ultimately heals the anal fissure [1,2]. Glyceryl Trinitrate is a cost effective first line treatment strategy for the management of chronic anal fissure [3]. Hence the present study is the attempt to know the efficacy of 0.2% Glyceryl Trinitrate ointment versus fissurectomy with lateral internal sphincterotomy and fissurectomy with posterior internal sphincterotomy in the management of chronic anal fissure.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Study of Glyceryl Trinitrate Ointment Versus Surgical Management of Chronic Anal Fissure

et al. 2011

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Chronic Anal Fissure (CAF) is common perineal condition and well-known painful entity. Standard surgical treatment even though available, may require long hospital stay and sometimes have worrying complications like anal incontinence. So non-surgical treatment, Glyceryl Trinitrate has been shown to be an effective for chronic anal fissure. It decreases anal tone and ultimately heals the anal fissure. The present study is the attempt to know the efficacy of 0.2% Glyceryl Trinitrate ointment in the treatment of chronic anal fissure and to compare the effectiveness of 0.2% Glyceryl Trinitrate ointment (GTN) versus fissurectomy with lateral internal sphincterotomy (LIS) and fissurectomy with posterior internal sphincterotomy (PIS) in the management of chronic anal fissure. This is a prospective comparative study of management of chronic anal fissure done in our hospital during the period of one and half year from October 2005 to March 2007. Thirty patients treated with 0.2% Glyceryl Trinitrate ointment and 30 patients treated with fissurectomy and lateral internal sphincterotomy and 30 patients treated with posterior internal sphincterotomy, for chronic anal fissure were selected for study. A single brand of 0.2% Glyceryl Trinitrate ointment (Nitrogesic) used for trial arm. Dose of administration was 1.5 cm to 2 cm in the anal canal with device provided by manufacturers of the proprietary preparation and applied twice a daily for 12 weeks. Patients were followed up for 12 weeks and thereafter evaluated for relief of symptoms in all three groups. Observations were recorded at 2 weeks; 6 weeks and 12 weeks of follow up period, regarding symptoms like pain and bleeding during defecation, healing of CAF and also for side effects like headache in GTN group and flatus, fecal incontinence in surgical groups. Data collected in proforma and analyzed. Study revealed CAF was more in male 59 patients (66%) than the female 31 patients (34%), the ratio being 1: 0.52. The maximum number of patients was encountered in the age group of 20 to 40 years with mean duration of age 34.14 years. In all three groups symptoms like pain, bleeding, constipation and sphincter spasm were present. Sentinel pile was present in 56% of the patients. Common site of fissure was found to be posterior in 94% of patients. Observations with respect to relief of pain, no bleeding and healing were recorded at 2, 6 and 12 weeks of duration. Lateral sphincterotomy remains effective but should be reserved for the patients who fail to respond to initial chemical sphincterotomy or GTN therapy. GTN is good alternative mode of therapy for patients who refuse surgery and prefer medical line of treatment.

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Section: Age Groupssupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Comparative Study of Glyceryl Trinitrate Ointment Versus Surgical Management of Chronic Anal Fissure

et al. 2011

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“…21 Topical Diltiazem and GTN (Glyceryl trinitrate) are other pharmacological agents from which chemical sphincterotomy can be achieved. [22][23] Glyceryl trinitrate (GTN) causes an increase in local blood flow by vasodilatation of vessels supplying anal musculature and by reducing spasm of internal sphincter by reducing the intra anal pressure. Whilst GTN is effective in treating anal fissures but evidences are there that it is ineffective altogether.…”

Section: Figure 10: Percentage Of Recurrence After Treatment In Dtz Amentioning

confidence: 99%

Study on Use of Topical Diltiazem Versus Topical Glyceryl Trinitrate (Gtn) in the Treatment of Chronic Anal Fissure: A Retrospective Study

Rana¹,

Singh²,

Bansal³

et al. 2014

jemds

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OBJECTIVE:To compare the efficacy, associated side effects in short term as well as long term use of topical Diltiazem and topical GTN in the management of chronic anal fissure. MATERIAL AND METHODS: Out patients records of 231 patients with chronic anal fissure who reported to hospital from August 2011 to August 2014 and treated were randomly selected for both types of management of which 118 patients had received topical 2% diltiazem and 113 were treated with 0.2% glyceryl trinitrate topical ointment thrice daily for 6 weeks. They were assessed at the time of presentation, then at the end of 1st week, 3rd week and at the end of 6 th week of treatment. Records of patients with anal fissure due to other diseases like inflammatory bowel disease, malignancy, sexually transmitted diseases, previous treatment with local ointment or surgery, patients who required anal surgery for any concurrent disease like hemorrhoids, pregnant women, patients with significant cardiovascular conditions and patients who did not turned up for follow up were excluded. Signs and symptoms and side-effects were noted at the given time. RESULTS: The study results are comparable to national figures and other studies. CONCLUSION: Topical application of both the ointments, 2% Diltiazem and 0.2% Glyceryl trinitrate observed to be quite effective in treatment of chronic fissure in Ano. However, topical Diltiazem is preferred to topical glyceryl trinitrate due to its lesser side effects and long term better control.

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“…Уже сейчас используют топические донаторы NO у пациентов, перенесших ретроградную холангиопанкреатографию, для релаксации сфинкте-ра Одди и блокирования дуоденальной моторики [27]. А мазь изосорбида динитрат (Isosorbide dinitrate, ISDN) локально применяют для расслабления анального сфин-ктера при лечении анальных трещин [28]. Более того, внутривенное введение ингибитора NOS (N-monomethyl-L-arginine) у здоровых добровольцев вызывало повыше-ние тонуса гладкой мускулатуры желудка, увеличивало амплитуду и скорость сокращения мышц пищевода.…”

Section: The Important Part In the Group Of Biological Compounds Parunclassified

Nitric Oxide and Endothelin-1 in Children With Digestive Disorders

Панова¹,

Дудникова²

2012

Vopr. sovr. pediatr.

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Pathophysiological aspects and clinical outcome of intra-anal application of isosorbide dinitrate in patients with chronic anal fissure

Cited by 38 publications

References 4 publications

Comparative Study of Glyceryl Trinitrate Ointment Versus Surgical Management of Chronic Anal Fissure

Comparative Study of Glyceryl Trinitrate Ointment Versus Surgical Management of Chronic Anal Fissure

Study on Use of Topical Diltiazem Versus Topical Glyceryl Trinitrate (Gtn) in the Treatment of Chronic Anal Fissure: A Retrospective Study

Nitric Oxide and Endothelin-1 in Children With Digestive Disorders

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