Document Detail


Manometric study of topical sildenafil (Viagra) in patients with chronic anal fissure: sildenafil reduces anal resting tone.
MedLine Citation:
PMID:  15073662     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Topical therapies for anal fissure have largely focused on nitric-oxide donors (e.g., nitroglycerin), sometimes with undesirable side effects or inconsistent benefits. Topical phosphodiesterase inhibitors have theoretical merit but have never been reported in treatment of anal fissure. This article describes manometric analysis of the effects of a phosphodiesterase-5 inhibitor, topical sildenafil (Viagra) in 19 consecutive patients with chronic anal fissure with no previous treatment history. METHODS: Station pullthrough manometry was performed with patients in the left-lateral position. Maximum resting pressure (MRP1) was recorded, and 0.75 ml of 10 percent sildenafil was then instilled in the anal canal. Maximum resting pressure was repeated at the same distance from the anal verge. Thereafter, pressure was measured continuously. Time for initial relaxation (T1) and time to maximal relaxation (T2) were recorded. Average resting pressure (MRP2) was calculated. Results were analyzed by Student's t-test. RESULTS: Topical administration of 10 percent sildenafil was accompanied by significant reduction in anal sphincter pressure (18 percent; P < 0.01). Only one patient failed to respond. Average onset of action was less than three minutes, with maximum effect one minute later. MRP1: 119.3 +/- 18.7 cmH(2)O. MRP2: 97.8 +/- 21.3 cmH(2)O. MRP2 < MRP1, P < 0.01. MRP M vs. F, ns. T1: 168 +/- 67 seconds (M = 210 +/- 72, F = 130 +/- 53, P < 0.02). T2: 230 +/- 78 seconds (M = 271 +/- 63, F = 183 +/- 75, P < 0.02). Mild-to-moderate anal discomfort was reported by 26 percent of patients. No headaches or other side effects were reported. CONCLUSIONS: Topical administration of a phosphodiesterase-5 inhibitor (sildenafil, Viagra) significantly reduces anal sphincter pressure in patients with chronic anal fissure. A beneficial effect of nitric oxide on the spastic anal sphincter has been demonstrated previously. This study confirms that this effect need not be derived solely from nitric oxide donors. New therapeutic avenues for treatment of anal fissure through indirect enhancement of nitric oxide activity are suggested.
Authors:
Luis Torrabadella; Gervasio Salgado; Ray W Burns; Irwin R Berman
Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2004-04-13
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  47     ISSN:  0012-3706     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-05-05     Completed Date:  2004-06-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  733-8     Citation Subset:  IM    
Affiliation:
Hospital Europa-USP, Marbella, Spain.
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MeSH Terms
Descriptor/Qualifier:
Administration, Topical
Adult
Aged
Anal Canal / drug effects*,  physiopathology
Chronic Disease
Female
Fissure in Ano / drug therapy*,  physiopathology
Humans
Male
Manometry
Middle Aged
Muscle Hypertonia / drug therapy*,  physiopathology
Phosphodiesterase Inhibitors / administration & dosage*
Piperazines / administration & dosage*
Purines
Rest / physiology
Sulfones
Chemical
Reg. No./Substance:
0/Phosphodiesterase Inhibitors; 0/Piperazines; 0/Purines; 0/Sulfones; 139755-83-2/sildenafil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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