Nadia Khitab, Nisar Ahmad, Abid Hussain, Mahmud Aurangzeb.
Efficacy and safety of glyceryl trinitrate (gtn) in the treatment of chronic anal fissure.
Gomal J Med Sci Jan ;15(4):161-4.

Background: Anal fissure is a commonly distressing disease. The objective of the study was to determine clinical presentation and efficacy of Glyceryl trinitrate (GTN) in chronic anal fissure. Material & Methods: It is a descriptive study that was conducted in the department of surgery District Headquarter Teaching Hospital D.I.Khan from January 2015 to August 2015. A total of 60 consecutive patients with chronic anal fissure were selected. Demographic variables were gender and age. The research variables were painful defecation, bleeding per rectum, duration of symptoms, presence of skin tags and efficacy of GTN. All patients were treated with 0.2% GTN ointment applied three times a day to the anus. These patients were followed at 2 and 6 weeks to assess symptomatic relief and adverse effects. Data was collected on Proforma and was analysed on SPSS version 11.0. Results: By 14 days of treatment, 8 patients were pain-free, While 30 out of them were pain-free by end of 6 weeks of treatment. Out of 18 patients, who presented with bleeding per rectum (P/R), 14 were still having bleeding P/R by the end of 2 weeks that improved to 6 by the end of 6 weeks. And 8 patients were in severe pain even by end of 6 weeks. None of the patients had to discontinue treatment with GTN due to side effects. Conclusions: The symptomatic relief occurred at a slower pace in patients receiving topical 0.2% Glyceryl trinitrate ointment. However, it can be used as first-line of treatment in patients who are not fit for surgery.

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