title: Maintenance therapy with partially hydrolyzed guar gum in the conservative treatment of chronic anal fissure: results of a prospective, randomized study.
abstract: OBJECTIVE
  This study was designed to evaluate the role of maintenance therapy with partially hydrolyzed guar gum (PHGG) after topical application of glyceryl trinitrate (GTN) in the conservative treatment of chronic anal fissure (CAF).
  
  
  METHODS
  From all the patients with CAF observed during the study period, 165 subjects with healed CAF after standard therapy with topical GTN 0.4% ointment were randomized to receive (group II) or not (group I) maintenance therapy with PHGG for 10 months. Clinical and manometric followup was carried out 6 and 12 months after treatment.
  
  
  RESULTS
  At six-month followup, median visual analogue scale score was significantly higher in group I if compared with group II. The success and recurrence rate at 12-month followup were, respectively, 38.3% (28/73) in group I versus 58.5% (41/70) in group II (P = 0.019; Fisher's exact test) and 30.2% (13/43) in group I versus 14.5% (7/48) in group II (P = 0.0047; Fisher's exact test).
  
  
  CONCLUSIONS
  The maintenance therapy with PHGG in patients with healed CAF after chemical sphincterotomy by topical application of GTN 0.4% ointment seems associated with a significant reduction of recurrence rate and with a significant increase of success rate at 12-month followup.
authors.affiliation: Surgery Department, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Italy.
authors.forename: Antonio
authors.identifier: 0000-0002-0198-8511
authors.initials: A
authors.lastname: Brillantino
authors.affiliation: Radiology Department, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Italy.
authors.forename: Francesca
authors.identifier: 0000-0003-4604-7384
authors.initials: F
authors.lastname: Iacobellis
authors.affiliation: Surgery Department, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Izzo
authors.affiliation: Surgery Department, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Italy.
authors.forename: Natale
authors.initials: N
authors.lastname: Di Martino
authors.affiliation: Radiology Department, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Italy.
authors.forename: Roberto
authors.identifier: 0000-0002-3587-474X
authors.initials: R
authors.lastname: Grassi
authors.affiliation: "Villa delle Querce" Hospital, Via Battistello Caracciolo 48, 80136 Napoli, Italy.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Renzi
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D019587:Dietary Supplements; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005401:Fissure in Ano / Q000175:diagnosis* / Q000188:drug therapy*; D005685:Galactans / Q000008:administration & dosage*; D006801:Humans; D006868:Hydrolysis; D008297:Male; D008351:Mannans / Q000008:administration & dosage*; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D053149:Plant Gums / Q000008:administration & dosage*; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005685:Galactans; D008351:Mannans; D053149:Plant Gums; C007894:guar gum; D005996:Nitroglycerin
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