Document Detail

Endosonographic and manometric evaluation of internal anal sphincter in patients with chronic anal fissure and its correlation with clinical outcome after topical glyceryl trinitrate therapy.
MedLine Citation:
PMID:  17216217     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIMS: Anorectal pressure studies have demonstrated internal anal sphincter (IAS) hypertonia in patients with chronic anal fissure. It is unknown however, if these changes in IAS function are associated with any abnormality in sphincter morphology. The first aim was to investigate the clinical characteristics and the manometric and endosonographic findings of the IAS in a cohort of patients with chronic anal fissure. The second aim was to investigate the association between these findings and the outcome with topical Glyceryl trinitrate (GTN) therapy. MATERIALS AND METHODS: All patients who presented with chronic anal fissure from November 1999 to May 2004 were included after failure of conservative therapy. Anorectal manometry and anal endosonography were performed before treatment with 0.2% GTN ointment twice daily was initiated. Patients were evaluated after 8 weeks. RESULTS: One hundred and twenty-four patients (66 women, mean age, 45.2 +/- 14.8 years) were included. Hypertonia of the IAS was found in 84 (68%) patients. The mean maximum IAS thickness was 3.6 +/- 0.76 mm (1.6-5.5). An abnormally thick IAS, adjusted by age, was observed in 113 (91.1%) patients. We found no correlation between resting pressure and IAS thickness (r = 0.074; p = 0.41). At 8 weeks, 52 patients (42%) had healed with complete symptoms resolution. No statistically significant differences were observed when clinical features and manometric and endosonographic findings were compared between healing and no-healing fissures. CONCLUSION: The majority of patients with chronic anal fissure present an abnormally thick IAS. Clinical, manometric and endosonographic features had no association with outcome after GTN treatment.
Marta Pascual; Miguel Pera; Ricard Courtier; Mariá José Gil; David Parés; Sonia Puig; Montserrat Andreu; Luis Grande
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-01-10
Journal Detail:
Title:  International journal of colorectal disease     Volume:  22     ISSN:  0179-1958     ISO Abbreviation:  Int J Colorectal Dis     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-06-14     Completed Date:  2008-01-03     Revised Date:  2008-07-17    
Medline Journal Info:
Nlm Unique ID:  8607899     Medline TA:  Int J Colorectal Dis     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  963-7     Citation Subset:  IM    
Colorectal Surgery Unit, Department of Surgery, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.
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MeSH Terms
Administration, Topical
Anal Canal / drug effects*,  physiopathology,  ultrasonography
Chronic Disease
Fissure in Ano / drug therapy*,  physiopathology,  ultrasonography
Middle Aged
Nitroglycerin / administration & dosage*
Prospective Studies
Treatment Outcome
Vasodilator Agents / administration & dosage*
Reg. No./Substance:
0/Ointments; 0/Vasodilator Agents; 55-63-0/Nitroglycerin
Comment In:
Int J Colorectal Dis. 2008 May;23(5):555   [PMID:  17690893 ]

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