Glyceryl trinitrate treatment of chronic fissure in ano: one year's experience with 0.5% GTN paste

OBJECTIVE: Assessment of the efficacy of topical 0.5% glyceryl trinitrate (GTN) paste in the treatment of chronic fissures in ano. PATIENTS AND METHODS: Forty-five patients were treated with 0.5% GTN paste and reviewed at 3, 6 and 12 weeks to assess symptoms, side effects and fissure healing. RESULTS: At 6 weeks, 73% of patients had no fissures. In 27% of cases treatment was unsuccessful. At three month follow up there was no early recurrence. The prevalence of headaches was 84% with 11% headache related non-compliance. CONCLUSIONS: The use of 0.5% GTN induces rapid healing of chronic anal fissures with a 73% healing rate in this study. Successful treatment may come at the expense of a high incidence of headaches and a lower compliance than found in studies involving a lower concentration of GTN. A balance is required between fissure healing and headache intolerance.