Glyceryl trinitrate in the treatment of anal fissure

Topical GTN appears to promote healing of anal fissure, provide relief of pain in patients with anal fissure, and help to avoid surgery, but surgery is more effective than GTN.

A Cochrane review included 77 studies with a total of 5031 patients to assess the efficacy and morbidity of various medical therapies for anal fissure. 49 different comparisons of the ability of medical therapies to heal anal fissure have been reported in 75 RCTs. Alltogether seventeen agents were used. The effect of topical nitroglycerin ointment (GTN) is summarized in Table 1. GTN was found to be marginally but significantly better than placebo in healing anal fissure (48.9% vs. 35.5%, p < 0.0009), but late recurrence of fissure was common, in the range of 50% of those initially cured.

Surgery is more effective than medical therapy; any surgery compared to any medical therapy resulted in significantly less treatment failures (OR 0.11; 95% CI 0.06 to 0.23; 15 studies, n = 979).

A technology assessment report on glyceryl trinitrate (GTN) for chronic anal fissures was abstracted in the Health Technology Assessment Database. Evidence for the use of this treatment comes from two small but good quality randomised trials. 0.2% glyceryl trinitrate ointment was effective and it may avoid need for surgery. GTN is contraindicated for patients with certain conditions and those taking sildenafil.

Comment: The quality of evidence is downgraded by inconsistency of results.

The following decision support rules contain links to this evidence summary:

• Glyceryl trinitrate for anal fissure

Ədəbiyyat

1. Nelson RL, Thomas K, Morgan J et al. Non surgical therapy for anal fissure. Cochrane Database Syst Rev 2012;2:CD003431.
2. Chase D, Milne R. Glyceryl trinitrate for chronic anal fissures. Southampton: Wessex Institute for Health Research and Development (WIHRD). DEC Report No. 96, 1999.