Optimal treatment duration of glyceryl trinitrate for chronic anal fissure: results of a prospective randomized multicenter trial.

Techniques in Coloproctology
G GagliardiA Bove

Abstract

Chronic anal fissure (CAF) is a painful condition that is unlikely to resolve with conventional conservative management. Previous studies have reported that topical treatment of CAF with glyceryl trinitrate (GTN) reduces pain and promotes healing, but optimal treatment duration is unknown. To assess the effect of different treatment durations on CAF, we designed a prospective randomized trial comparing 40 versus 80 days with twice daily topical 0.4% GTN treatment (Rectogesic, Prostrakan Group). Chronicity was defined by the presence of both morphological (fibrosis, skin tag, exposed sphincter, hypertrophied anal papilla) and time criteria (symptoms present for more than 2 months or pain of less duration but similar episodes in the past). A gravity score (1 = no visible sphincter; 2 = visible sphincter; 3 = visible sphincter and fibrosis) was used at baseline. Fissure healing, the primary endpoint of the study, maximum pain at defecation measured with VAS and maximum anal resting pressure were assessed at baseline and at 14, 28, 40 and 80 days. Data was gathered at the end of the assigned treatment. Of 188 patients with chronic fissure, 96 were randomized to the 40-day group and 92 to the 80-day group. Patients were well matched...Continue Reading

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Citations

May 4, 2011·Techniques in Coloproctology·D F AltomareR D Villani
Sep 14, 2013·Drug and Therapeutics Bulletin
Apr 25, 2012·World Journal of Surgery·K ArslanA Atay
Nov 28, 2013·Gastroenterology Clinics of North America·Sherief Shawki, Meagan Costedio
May 10, 2015·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·Andreas Ommer
Oct 13, 2014·Journal of Visceral Surgery·T Higuero
May 1, 2013·Nature Reviews. Drug Discovery·Alimuddin ZumlaStewart T Cole
Aug 11, 2017·Techniques in Coloproctology·R L NelsonA Yeboah-Sampong
Jul 20, 2018·Techniques in Coloproctology·S A PilkingtonK P Nugent
Sep 18, 2021·World Journal of Emergency Surgery : WJES·Antonio TarasconiFausto Catena
Oct 8, 2021·The American Journal of Gastroenterology·Arnold WaldMassarat Zutshi

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