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Topical mononitrate treatment in patients with anal fissure
L Tankova1, K Yoncheva, M Muhtarov
1Clinical Centre of Gastroenterology, State University Hospital Queen Joanna, Sofia, Bulgaria.
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.