Randomised Comparison of the Effect of 0.2% Glyceryl Trinitrate and 0.5% Topical Nifedipine in Acute Anal Fissure Treatment

Abstract

Aim: This prospective clinical trial study aimed to compare the effects of 0.2% glyceryl trinitrate (GTN) and 0.5% topical nifedipine (ND) on acute anal fissure treatment and recurrence prevention. Method: The study included 100 patients who were diagnosed with acute anal fissure and randomly divided into two groups: the 0.2% GTN and 0.5% topical ND groups. On the first visit, age, sex, constipation, pain duration after defaecation and visual analogue scale (VAS) score were recorded. After 21 days of treatment, symptomatic relief levels, healing, VAS score and drug side effects were recorded. Results: The female/male ratios for the GTN and ND groups were 50%/50% and 54%/46%, respectively. The mean ages were 29.3 and 30.7 years for the GTN and ND groups, respectively. After treatment, the excellent symptomatic relief level in the ND group (56%) was higher than in the GTN group (22%; p=0.005). Post-treatment mean VAS score was significantly lower in the ND group than in the GTN group (p<0.001). The mean decrease of VAS score in the ND group between pre-treatment and post-treatment was significantly higher than in the GTN group (p=0.001). The healing rate in the ND group (86%) was higher than in the GTN group (64%; p=0.011). The drug side effect rate was significantly lower in the ND group (4%) than in the GTN group (22%; p=0.007). The recurrence rates were 38% in the GTN group and 18% in the ND group (p=0.026). Conclusion: Our study shows that both GTN and topical ND have favourable effects on anal fissure treatment. However, 0.5% topical ND is superior to 0.2% GTN for treating anal fissure in terms of symptomatic relief, pain score, healing, drug side effects and recurrence rate. INSET: 246.