title: Efficacy of egg yolk and nitroglycerin ointment as treatments for acute anal fissures: A randomized clinical trial study.
abstract: BACKGROUND
  Acute anal fissure as a common disease in society has several etiologies and manifestations such as severe anal pain and bleeding. Nitroglycerin ointment 0.2% is the most common topical treatment used. The most common side effect of nitroglycerin is headache, which is annoying for patients and often leads to discontinuation of the drug.
  
  
  OBJECTIVE
  Comparison of egg yolk as a natural substance with analgesic and anti-inflammatory properties and minimal side effects with nitroglycerin ointment in the treatment of acute anal fissure.
  
  
  METHODS
  This randomized clinical trial was carried out during a 10-day period in the Gastroenterology clinic of Ghaem Hospital, Mashhad, Iran (year 2015). 126 patients who filled the inclusion criteria were enrolled. The patients were randomly divided into two groups. Nitroglycerin ointment (0.2%) was applied by patients in the first group, twice daily for 10 days. For the second group, one egg yolk once a day was administered rectally up to 10 days. The pain and bleeding severity were recorded every two days up to 10 days after finishing the treatment course, based on visual scale.
  
  
  RESULTS
  The results showed that egg yolk caused a significant reduction in pain and bleeding compared with nitroglycerin (p<0.05). At the beginning of the study, the difference in pain intensity between the two groups was not statistically significant (p-value = 0.25). However, it became significant in the following days. Changes in the frequency of rectorrhagia were also significant in both groups, showing a major decrease in the number of rectorrhagia cases (p<0.001).
  
  
  CONCLUSIONS
  Egg yolk is more efficient than nitroglycerin in the treatment of acute anal fissure. In addition, lack of any side effects results in the completion of the treatment course by the patients.
  
  
  BACKGROUND
  The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015050718915N3.
  
  
  BACKGROUND
  This work was supported by a grant from the Vice Chancellor of Research of Mashhad University of Medical Sciences.
authors.affiliation: M.D., Internist, Assistant Professor, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Masoumeh
authors.initials: M
authors.lastname: Salari
authors.affiliation: Ph.D. of Drug Control, Assistant Professor, Department of Traditional Persian Pharmacy, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Roshanak
authors.initials: R
authors.lastname: Salari
authors.affiliation: M.D., Assistant Professor, Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Maliheh
authors.initials: M
authors.lastname: Dadgarmoghadam
authors.affiliation: M.D., Community Medicine Specialist, Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Majid
authors.initials: M
authors.lastname: Khadem-Rezaiyan
authors.affiliation: M.D., Gastroenterologist, Assistant Professor, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Mousalreza
authors.initials: M
authors.lastname: Hosseini
keywords: Anal fissure; Egg yolk; Headache; Nitroglycerin