title: Topical mononitrate treatment in patients with anal fissure.
abstract: OBJECTIVE
  To assess the efficacy and patient compliance of topical mononitrate hydrogel for the treatment of anal fissure.
  
  
  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.
authors.affiliation: Clinical Centre of Gastroenterology, State University Hospital Queen Joanna, Sofia, Bulgaria.
authors.forename: L
authors.initials: L
authors.lastname: Tankova
authors.forename: K
authors.initials: K
authors.lastname: Yoncheva
authors.forename: M
authors.initials: M
authors.lastname: Muhtarov
authors.forename: H
authors.initials: H
authors.lastname: Kadyan
authors.forename: V
authors.initials: V
authors.lastname: Draganov
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D020100:Hydrogels; D007548:Isosorbide Dinitrate / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000494:pharmacology*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010349:Patient Compliance; D010919:Placebos; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D020100:Hydrogels; D010919:Placebos; D014665:Vasodilator Agents; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate