Topical mononitrate treatment in patients with anal fissure

Abstract

Aim: To assess the efficacy and patient compliance of topical mononitrate hydrogel for the treatment of anal fissure. Materials and methods: Nineteen patients with symptomatic chronic anal fissures were randomly allocated to receive either active (10 patients) or placebo (nine patients) gel treatment. Rectal administration of hydrogel containing 0.2% isosorbide‐5‐mononitrate was prescribed. Patients were instructed on its application to the anal canal twice daily for 3 weeks. A questionnaire was used to determine patient compliance with therapy. Anal manometry was performed before and after therapy. Results: At the end of therapy, the fissures were healed in 80% of actively treated patients compared with 22% of the control group. There was a mean reduction of 28% in mean resting anal pressure. Two actively treated patients (20%) suffered from mild headache relieved with oral analgesics and menthol lozenges. Faecal incontinence was not observed. There were no recurrences during at least 3 months of follow‐up. Conclusions: Topical mononitrate gel therapy of anal fissures is an effective and safe approach. In this study, the few cases of headache were rapidly relieved with oral analgesia and menthol lozenges.

Fissure anale. Quel traitement de première intention ?

“…La recherche bibliographique a retrouvé deux méta-analyses sur le traitement chirurgical [1] et sur le traitement médical [2], sept essais randomisés comparant différents type de traitement médical et non inclus dans la méta-analyse [3][4][5][6][7][8][9], et deux études de cohorte sur les résultats à long-terme de la chirurgie [10,11]. Les deux méta-analyses [1,2] (ainsi que l'analyse détaillée sur les données des essais inclus) montrent que la sphinctérotomie interne a été comparée aux dérivés nitrés dans quatre essais et à la toxine botulique dans un essai.…”

“…Le taux de récidive à moyen terme atteint selon les études 30-50 %. Les résultats des essais randomisés récents [4,5] rejoignent ceux de ma méta-analyse [2].…”

Preparation and Evaluation of Isosorbide Mononitrate Hydrogels for Topical Fissure Treatment

“…Isosorbide mononitrate (ISMN) is another nitrate derivative, which is also considered as a candidate for the topical fissure treatment. It was reported that the topical application of ISMN facilitated the healing of chronic fissure producing fewer side effects [8]. However, the question about the suitable drug delivery formulation has not been discussed.…”

Efficacy of lanolin and bovine type I collagen in the treatment of childhood anal fissures: A prospective, randomized, controlled clinical trial

“…1 The etiology remains controversial, but chronic constipation, anodermal ischemia, and hypertonicity of the internal anal sphincter (IAS) have all been implicated. 2,3 In recent years various substances such as glycerol trinitrate, diltiazem hydrochloride, botulinum toxin, and bethanechol have all been used for the treatment of chronic anal fi ssure.…”