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

被引:19
作者
Pascual, Marta
Pera, Miguel
Courtier, Ricard
Gil, Maria Jose
Pares, David
Puig, Sonia
Andreu, Montserrat
Grande, Luis
机构
[1] Hosp Mar, Colorectal Surg Unit, Dept Surg, Barcelona 08003, Spain
[2] Hosp Mar, Dept Gastroenterol, Barcelona 08003, Spain
关键词
Anal fissure; Internal anal sphincter thickness; Manometry; Anal endosonography; Glyceryl trinitrate;
D O I
10.1007/s00384-006-0251-1
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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 methtods 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. Conclusions 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.
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页码:963 / 967
页数:5
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