Nitroglycerin Best Treatment for Chronic Anal Fissure

Cheaper and less invasive than botulinum toxin A, but more side effects

MONDAY, Sept. 25 (HealthDay News) -- Nitroglycerin ointment is more effective, cheaper and less invasive than botulinum toxin A in treating chronic anal fissure, but it causes more mild side effects, according to a study published in the September issue of the American Journal of Gastroenterology.

Heiko Fruehauf, M.D., of the University Hospital Zurich in Switzerland, and colleagues randomized 50 patients with chronic anal fissure to receive a single injection of 30 IU of the botulinum toxin A (Botox) or topical nitroglycerin ointment (0.2 percent) for two weeks. Among those patients for whom the therapy failed, they were re-assigned to the other treatment group for an additional two weeks.

Among the group initially treated with nitroglycerin, 13 out of 25 (52 percent) healed after two weeks of therapy, compared with just 6 out of 25 (24 percent) in the botulinum toxin A group. A further two weeks of treatment healed an additional three patients who had begun therapy in the botulinum group and then switched to nitroglycerin. Most of the side effects were among those in the nitroglycerin group; all but one of the 13 out of 50 patients (26 percent) who reported mild side effects were in this group.

"Nitroglycerin ointment is superior to the more expensive and invasive treatment with botulinum toxin A injection for initial healing of chronic anal fissure, in particular for larger fissures," the authors conclude.

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