title: Audit of topical glyceryl trinitrate for treatment of fissure-in-ano.
abstract: OBJECTIVE
  To clarify the clinical role of topical glyceryl trinitrate (GTN) in the management of anal fissures.
  
  
  METHODS
  Fifty-six consecutive patients with fissure-in-ano attending a colorectal clinic from April 1997 to May 1998 included 16 acute and 40 chronic anal fissures. Patients were instructed to apply 0.2% 0.5 g of GTN to the painful area of the anus. Patients were followed-up in the clinic at 4, 8 and 12 weeks, and by telephone interviews at a median follow up of 10 months.
  
  
  RESULTS
  Ten of 16 acute fissures (63%) were healed by 4 weeks and 13 (81%) by 8 weeks. Thirteen of 40 chronic fissures (33%) were healed by 8 weeks and 20 (50%) by 12 weeks. Seventeen patients (30%) underwent lateral sphincterotomy and all healed. There were five recurrences within 3 months of treatment with GTN. Thirty-four (61%) suffered from headaches, eight being severe headaches. None of the patients developed incontinence with GTN or lateral sphincterotomy.
  
  
  CONCLUSIONS
  Treatment of fissure-in-ano using GTN ointment was effective in up to 50% of patients with chronic anal fissure, and has the benefit of being repeatable if the fissure recurs. Patients should be aware that treatment is likely to take some months to be effective and is associated with significant side effects in up to 15% of patients.
authors.affiliation: University Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK. L.E.Hopwood@bham.ac.uk
authors.forename: H
authors.initials: H
authors.lastname: Hasegawa
authors.forename: S
authors.initials: S
authors.lastname: Radley
authors.forename: D G
authors.initials: DG
authors.lastname: Morton
authors.forename: N J
authors.initials: NJ
authors.lastname: Dorricott
authors.forename: D J
authors.initials: DJ
authors.lastname: Campbell
authors.forename: M R
authors.initials: MR
authors.lastname: Keighley
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy*; D005500:Follow-Up Studies; D006261:Headache / Q000139:chemically induced; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D005996:Nitroglycerin / Q000009:adverse effects / Q000627:therapeutic use*; D009824:Ointments; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D009824:Ointments; D014665:Vasodilator Agents; D005996:Nitroglycerin