Aggressive treatment of acute anal fissure with 0.5% nifedipine ointment prevents its evolution to chronicity.
OBJECTIVE
To investigate the efficacy of topical application of 0.5% nifedipine ointment in healing acute anal fissue and preventing its progress to chronicity.


METHODS
Thirty-one patients (10 males, 21 females) with acute anal fissure from September 1999 to January 2005 were treated topically with 0.5% nifedipine ointment (t.i.d.) for 8 wk. The patients were encouraged to follow a high-fiber diet and assessed at 2, 4 and 8 wk post-treatment. The healing of fissure and any side effects were recorded. The patients were subsequently followed up in the outpatient clinic for one year and contacted by phone every three months thereafter, while they were encouraged to come back if symptoms recurred.


RESULTS
Twenty-seven of the 31 patients completed the 8-wk treatment course, of them 23 (85.2%) achieved a complete remission indicated by resolution of symptoms and healing of fissure. Of the remaining four unhealed patients (14.8%), 2 opted to undergo lateral sphincterotomy and the other 2 to continue therapy for four additional weeks, resulting in healing of fissure. All the 25 patients with complete remission had a mean follow-up of 22.9 +/- 14 (range 6-52) mo. Recurrence of symptoms occurred in four of these 25 patients (16%) who were successfully treated with an additional 4-wk course of 0.5% nifedipine ointment. Two of the 27 (7.4%) patients who completed the 8-wk treatment presented with moderate headache as a side effect of nifedipine.


CONCLUSIONS
Topical 0.5% nifedipine ointment, used as an agent in chemical sphincterotomy, appears to offer a significant healing rate for acute anal fissure and might prevent its evolution to chronicity.
Katsinelos
Panagiotis
P
Department of Endoscopy and Motility Unit, Central Hospital, Ethnikis Aminis 41, TK 54635, Thessaloniki, Greece. akis_katsinelos@yahoo.gr
Kountouras
Jannis
J
Paroutoglou
George
G
Beltsis
Athanasios
A
Chatzimavroudis
Grigoris
G
Zavos
Christos
C
Katsinelos
Taxiarchis
T
Papaziogas
Basilis
B
D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000517:prevention & control; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000008:administration & dosage*; D009824:Ointments / Q000008:administration & dosage / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000008:administration & dosage*
D009824:Ointments; D014665:Vasodilator Agents; D009543:Nifedipine