A team from Nottingham, England, evaluated the efficacy of topical glyceryl trinitrate (GTN) for anal fissures in an outpatient setting.
Patients with a diagnosis of anal fissure, who were dispensed 0.2% GTN ointment from a hospital pharmacy over a 2-year period (1996-1998), were included in the study.
The 93 patients (53 male) applied the ointment twice daily to the anoderm.
A case note review and postal questionnaire survey were undertaken in these patients.
The patients were reviewed, on average, 8 weeks later, by which time 61% of fissures had healed, 35% persisted, and 3% of patients were lost to follow up.
The response rate to the questionnaire was 77%.
| Most patients respond to further GTN treatment.
| Colorectal Disease |
The team found that 68% had healed with GTN, but 35% had recurrent symptoms after a median of 6 months.
Of those patients reporting symptomatic recurrence, 16 were prescribed further GTN for a recurrent fissure: 14 (88%) healed, but 2 persisted, and had surgery.
In the other 9 patients, symptoms resolved spontaneously.
It was found that 49% of individuals experienced headaches, 4% discontinuing treatment as a result.
The median follow up was 25 months.
Dr M. Jonas, of the University of Nottingham, said on behalf of fellow colleagues, "0.2% GTN heals 60% of fissures in the outpatient setting, but half the patients develop headaches.
"Up to one third of healed fissures may recur within 18 months but the majority respond to further GTN."
"Only 4% of patients initially healed with GTN later require sphincterotomy for recurrences," it was concluded.