Overview

Perianal Versus Endoanal Application of Glyceryl Trinitrate 0.4% Ointment for Chronic Anal Fissure

Status:
Completed
Trial end date:
2009-06-01
Target enrollment:
0
Participant gender:
All
Summary
Perianal topical nitroglycerin has been widely used as a means for avoiding surgery in patients with anal fissure. However, nitroglycerin has not been universally accepted for this application because of inconsistency of efficacy and side effects. Recent studies (Dis Colon Rectum. 2007 Apr;50(4):509-16) have demonstrated that nitroglycerin ointment products compounded by pharmacies did not meet the USP specifications for potency and/or content uniformity when filling a prescription for 0.3 percent nitroglycerin ointment. These results raise significant issues as to whether the patient is put at undue risk relative to the relief of their anal fissure pain. In addition, one study (Dis Colon Rectum. 2006 Jun;49(6):865-8) has demonstrated that intra-anal dosing of topical nitroglycerin produces a significantly greater reduction in sphincteric pressure and lower incidence of headaches than with perianal administration of the same dose of ointment. Topical glyceryl trinitrate 0.4% ointment has been developed and tested in clinical trials and is effective in healing chronic anal fissures. It assures exactly dose and concentration of nitroglycerin. Hypothesis: The endoanal application of exactly dose and concentration of nitroglycerin must reduced headache and the final recurrence. The purpose of this study is: 1. Principal end-point: to compare perianal vs endoanal application of Rectogesic and evaluate the different morbidity of the two presentation
Phase:
Phase 3
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
Hospital General Universitario Elche
Treatments:
Nitroglycerin
Criteria
Inclusion Criteria:

- Before a definitive definition of chronic anal fissure and ensuring inclusion in the
study, all patients diagnosed as having chronic anal fissure based on their medical
history and physical exploration were treated for a minimum of six weeks with
conservative medical treatment (high residue diet, analgesics, and warm sitz baths).
Chronic anal fissure was defined by the presence of a fibrous induration or exposed
internal sphincter fibres.

Exclusion Criteria:

- Associated anal pathologies (incontinence, stenosis, abscess, fistula and
haemorrhoids)

- Patients with associated conditions (inflammatory bowel disease, acquired
immunodeficiency syndrome, tuberculosis, sexually transmitted disease and
immunosuppression)

- Cardiopathy

- Headache and pregnancy.