Controlled dose delivery in topical treatment of anal fissure: pilot study of a new paradigm

Diseases of the Colon and Rectum
Luis Torrabadella, Gervasio Salgado

Abstract

Topical nitroglycerin has been widely used as a means for avoiding surgery in patients with anal fissure. However, nitroglycerin has not been universally accepted for this application because of inconsistency of efficacy and side effects. This study compares conventional digital application with precise intra-anal dosing of nitroglycerin using a specialized dose-delivery device and anal cannula. Twenty-six consecutive patients (13 males) with chronic anal fissure and no previous treatment were randomly allocated to receive 0.75 ml of 0.3 percent nitroglycerin ointment (2.25 mg nitroglycerin) t.i.d. intra-anal using the cannula (Group A) or perianally with the gloved finger (Group B). Nitroglycerin dosage was controlled in Group A by the dose-delivery device connected to the cannula and by single-dose preloaded syringes in Group B. Anal manometry: pressure reduction after application of nitroglycerin was 47 +/- 18.6 in Group A and 20.7 +/- 13.4 percent in Group B (P < 0.01). Headaches were reported by 1 of 10 patients in Group A and 10 of 12 patients in Group B (P = 0.0027). Seven patients of Group B had to be crossed to intra-anal treatment as a result of intensity of headaches. Pain relief was noted by 8 of 10 and 9 of 12 pati...Continue Reading

References

Oct 26, 1995·The New England Journal of Medicine·S R Gorfine
Sep 1, 1994·The British Journal of Surgery·P B LoderR K Phillips
May 1, 1994·Diseases of the Colon and Rectum·R FaroukD C Bartolo
Jan 22, 1998·The New England Journal of Medicine·R D Madoff
Aug 24, 1999·Diseases of the Colon and Rectum·G SalgadoI R Berman
Mar 3, 2004·Diseases of the Colon and Rectum·Richard Nelson

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Citations

Feb 18, 2012·The Cochrane Database of Systematic Reviews·Richard L NelsonAbigail Jones
Aug 11, 2017·Techniques in Coloproctology·R L NelsonA Yeboah-Sampong

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