{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T19:08:07Z","timestamp":1777316887138,"version":"3.51.4"},"reference-count":21,"publisher":"BMJ","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"accepted":{"date-parts":[[1998,11,4]]},"published-print":{"date-parts":[[1999,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Topical application of glyceryl trinitrate (GTN) ointment heals chronic anal fissures, providing an alternative to the traditional first line treatment of surgical sphincterotomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>AIMS<\/jats:title>\n                    <jats:p>To determine the most effective dose of topical GTN for treatment of chronic anal fissures and to assess long term results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Seventy consecutive patients with chronic anal fissure, were randomly allocated to eight weeks treatment with placebo, 0.2% GTN three times daily, or GTN starting at 0.2% with weekly 0.1% increments to a maximum of 0.6%, in a double blind study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>After eight weeks fissure had healed in 67% of patients treated with GTN compared with 32% with placebo (p=0.008). No significant difference was seen between the two active treatments. Headaches were reported by 72% of patients on GTN compared with 27% on placebo (p&lt;0.001). Maximum anal sphincter pressure reduced significantly from baseline by GTN treatment (p=0.02), but not placebo (p=0.8). Mean pain scores were lower after treatment with GTN compared with placebo (NS). Of fissures healed with placebo 43% recurred, compared with 33% of those healed with 0.2% GTN and 25% healed with escalating dose GTN (p=0.7).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>GTN is a good first line treatment for two thirds of patients with anal fissure. An escalating dose of GTN does not result in earlier healing. Significant recurrence of symptomatic fissures and a high incidence of headaches are limitations of the treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/gut.44.5.727","type":"journal-article","created":{"date-parts":[[2010,6,30]],"date-time":"2010-06-30T12:46:12Z","timestamp":1277901972000},"page":"727-730","source":"Crossref","is-referenced-by-count":149,"title":["Randomised controlled trial shows that glyceryl trinitrate heals anal fissures, higher doses are not more effective, and there is a high recurrence rate"],"prefix":"10.1136","volume":"44","author":[{"given":"E A","family":"Carapeti","sequence":"first","affiliation":[{"name":"aSt Mark\u2019s Hospital, Northwick Park, Watford Road, Harrow, Middlesex HA1 3UJ, UK, \n\nbNorth Middlesex Hospital, Sterling Way, London N8 1QX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M A","family":"Kamm","sequence":"additional","affiliation":[{"name":"aSt Mark\u2019s Hospital, Northwick Park, Watford Road, Harrow, Middlesex HA1 3UJ, UK, \n\nbNorth Middlesex Hospital, Sterling Way, London N8 1QX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P J","family":"McDonald","sequence":"additional","affiliation":[{"name":"aSt Mark\u2019s Hospital, Northwick Park, Watford Road, Harrow, Middlesex HA1 3UJ, UK, \n\nbNorth Middlesex Hospital, Sterling Way, London N8 1QX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S J D","family":"Chadwick","sequence":"additional","affiliation":[{"name":"aSt Mark\u2019s Hospital, Northwick Park, Watford Road, Harrow, Middlesex HA1 3UJ, UK, \n\nbNorth Middlesex Hospital, Sterling Way, London N8 1QX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Melville","sequence":"additional","affiliation":[{"name":"aSt Mark\u2019s Hospital, Northwick Park, Watford Road, Harrow, Middlesex HA1 3UJ, UK, \n\nbNorth Middlesex Hospital, Sterling Way, London N8 1QX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R K S","family":"Phillips","sequence":"additional","affiliation":[{"name":"aSt Mark\u2019s Hospital, Northwick Park, Watford Road, Harrow, Middlesex HA1 3UJ, UK, \n\nbNorth Middlesex Hospital, Sterling Way, London N8 1QX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1999,5,1]]},"reference":[{"key":"2025121220380194000_44.5.727.1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(77)90445-7"},{"key":"2025121220380194000_44.5.727.2","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1002\/bjs.1800730609","article-title":"Anal hypertonia in fissures: cause or effect?","volume":"73","author":"Gibbons","year":"1986","journal-title":"Br J 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