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Evidence summaries

Glyceryl Trinitrate in the Treatment of Anal Fissure

Topical GTN appears to promote healing of anal fissure, provide relief of pain in patients with anal fissure, and help to avoid surgery, but surgery is more effective than GTN. Level of evidence: "B"

A Cochrane review [Abstract] included 77 studies with a total of 5031 patients to assess the efficacy and morbidity of various medical therapies for anal fissure. 49 different comparisons of the ability of medical therapies to heal anal fissure have been reported in 75 RCTs. Alltogether seventeen agents were used. The effect of topical nitroglycerin ointment (GTN) is summarized in Table 1. GTN was found to be marginally but significantly better than placebo in healing anal fissure (48.9% vs. 35.5%, p < 0.0009), but late recurrence of fissure was common, in the range of 50% of those initially cured.

OutcomeNo of Participants (studies)Assumed risk (control)Corresponding risk (GTN versus placebo)Relative effect (95% CI)
Failure of healing of fissure1315 (18 studies)645 per 1000388 per 1000 (256 to 541)OR 0.35 (0.19 to 0.65)

Surgery is more effective than medical therapy; any surgery compared to any medical therapy resulted in significantly less treatment failures (OR 0.11; 95% CI 0.06 to 0.23; 15 studies, n = 979).

Comment: The quality of evidence is downgraded by inconsistency of results.

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References

Primary/Secondary Keywords