Botox and CCBs were equivalent to GTN in efficacy with fewer adverse events .
No medical therapy came close to the efficacy of surgical sphincterotomy , though none in these RCTs was associated with the risk of incontinence .
Medical therapy for chronic anal fissure , acute fissure and fissure in children may be applied with a chance of cure that is marginally better than placebo , and , for chronic fissure in adults , far less effective than surgery
BACKGROUND Because of the disability associated with surgery for anal fissure and the risk of incontinence , medical alternatives for surgery have been sought .
Most recently , pharmacologic methods that relax the anal smooth muscle , to accomplish reversibly what occurs in surgery , have been used to obtain fissure healing .
OBJECTIVES To assess the efficacy and morbidity of various medical therapies for anal fissure .
Double-blind manometric assessment of two topical glyceryl trinitrate formulations in patients with chronic anal fissures.
BACKGROUND Chronic anal fissure is a frequent and troubling condition , that may need surgical sphincterotomy for relief of symptoms . However , this approach may yield minor incontinence in up to 30 % of cases . Interest has , therefore , recently increased in " chemical sphincterotomy " by using topical glyceryl trinitrate ointment . Unfortunately , there is , to date , no specific pharmaceutical preparation of such compound . AIMS To compare , according to a r and omized double-blind crossover study , the effects of a pharmaceutical preparation of a specific 0.2 % glyceryl trinitrate ointment ( PMF 303 ) and of the common preparation reported in the literature on the anal resting pressure in patients with anal fissure . PATIENTS AND METHODS Twelve patients with chronic anal fissure ( 6 males and 6 females , age range 23 - 60 years ] were recruited for the study . Two paired manometric studies were carried out at one-week intervals . After the basal anal pressure had been assessed , the patients were r and omized to receive either one of the two preparations , and manometric measurements were repeated at 20 , 40 and 60 minutes . RESULTS No differences were found between anal resting pressure in the basal study . Both preparations were able to significantly decrease ( p=0.001 ) anal pressure throughout the study period . No significant differences were found between the two preparations . CONCLUSIONS PMF 303 is able to decrease anal pressure in patients with anal fissure , to a similar extent to the widely tested ( galenic ) literature preparation . Availability of a specific formulation for the treatment of this condition may be clinical ly useful
Botox and CCBs were equivalent to GTN in efficacy with fewer adverse events .
No medical therapy came close to the efficacy of surgical sphincterotomy , though none in these RCTs was associated with the risk of incontinence .
Medical therapy for chronic anal fissure , acute fissure and fissure in children may be applied with a chance of cure that is marginally better than placebo , and , for chronic fissure in adults , far less effective than surgery
BACKGROUND Because of the disability associated with surgery for anal fissure and the risk of incontinence , medical alternatives for surgery have been sought .
Most recently , pharmacologic methods that relax the anal smooth muscle , to accomplish reversibly what occurs in surgery , have been used to obtain fissure healing .
OBJECTIVES To assess the efficacy and morbidity of various medical therapies for anal fissure .