Efficacy of egg yolk and nitroglycerin ointment as treatments for acute anal fissures
A randomized clinical trial study
Keywords:
Anal fissure, Egg yolk, Nitroglycerin, HeadacheAbstract
Background: Acute anal fissure as a common disease in society has several etiologies and manifestations such as severe anal pain and bleeding. Nitroglycerin ointment 0.2% is the most common topical treatment used. The most common side effect of nitroglycerin is headache, which is annoying for patients and often leads to discontinuation of the drug.
Objective: Comparison of egg yolk as a natural substance with analgesic and anti-inflammatory properties and minimal side effects with nitroglycerin ointment in the treatment of acute anal fissure.
Methods: This randomized clinical trial was carried out during a 10-day period in the Gastroenterology clinic of Ghaem Hospital, Mashhad, Iran (year 2015). 126 patients who filled the inclusion criteria were enrolled. The patients were randomly divided into two groups. Nitroglycerin ointment (0.2%) was applied by patients in the first group, twice daily for 10 days. For the second group, one egg yolk once a day was administered rectally up to 10 days. The pain and bleeding severity were recorded every two days up to 10 days after finishing the treatment course, based on visual scale
Results: The results showed that egg yolk caused a significant reduction in pain and bleeding compared with nitroglycerin (p<0.05). At the beginning of the study, the difference in pain intensity between the two groups was not statistically significant (p-value = 0.25). However, it became significant in the following days. Changes in the frequency of rectorrhagia were also significant in both groups, showing a major decrease in the number of rectorrhagia cases (p<0.001).
Conclusion: Egg yolk is more efficient than nitroglycerin in the treatment of acute anal fissure. In addition, lack of any side effects results in the completion of the treatment course by the patients.
Trial Registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015050718915N3.
Funding: This work was supported by a grant from the Vice Chancellor of Research of Mashhad University of Medical Sciences.
References
Lund JN, Scholefield JH. Aetiology and treatment of anal fissure. Br J Surg. 1996; 83(10): 1335-44. doi:
1002/bjs.1800831006. PMID: 8944447.
Van Outryve M. Physiopathology of the anal fissure. Acta Chir Belg. 2006; 106(5): 517-8. doi:
1080/00015458.2006.11679942. PMID: 17168260.
Blagodarnij LA. Treatment of chronic anal fissure. Rus Med J. 2002; 10: 1327-30.
Kirsch J. Anal fissure. Wien Med Wochenschr. 2004; 154(3-4): 69-72. doi: 10.1007/s10354-004-0038-3.
PMID: 15038578.
Collins EE, Lund JN. A Review of Chronic Anal Fissure Management. Tech Coloproctol. 2007; 11(3):
-23. PMID: 17676270. doi: 10.1007/s10151-007-0355-9.
Schubert MC, Sridhar S, Schade RR, Wexner SD. What every gastroenterologist needs to know about
common anorectal disorders. World J Gastroenterol. 2009; 15(26): 3201-9. doi: 10.3748/wjg.15.3201.
PMID: 19598294, PMCID: PMC2710774.
Zbar AP, Aslam M, Allgar V. Faecal incontinence after internal sphincterotomy for anal fissure. Tech
Coloproctol. 2000; 4(1): 25-8. doi: 10.1007/s101510050050.
Lund JN. Nitric oxide deficiency in the internal anal sphincter of patients with chronic anal fissure. Int J
Colorectal Dis. 2006; 21(7): 673-5. doi: 10.1007/s00384-005-0757-y. PMID: 16052310.
Azarnoff DL, Lee JC, Lee C, Chandler J, Karlin D. Quality of extemporaneously compounded
nitroglycerin ointment. Dis Colon Rectum. 2007; 50(4): 509-16. doi: 10.1007/s10350-006-0818-5. PMID:
Chinese Herbs: Chicken Egg Yolk. Posted on July 30, 2013 by Acupuncture Associates Wilmington.
Mahmoudi M, Ebrahimzadeh MA, Pourmorad F, Rezaie N, Mahmoudi MA. Anti-inflammatory and
analgesic effects of egg yolk: a comparison between organic and machine made. Eur Rev Med Pharmacol
Sci. 2013; 17(4): 472-6. PMID: 23467945.
Shen Q, Riedl KM, Cole RM, Lehman C, Xu L, Alder H, et al. Egg Yolks Inhibit Activation of NF-κB and
Expression of Its Target Genes in Adipocytes after Partial Delipidation. J Agric Food Chem. 2015; 63(7):
-25. doi: 10.1021/jf5056584. PMID: 25620076, PMCID: PMC4362627.
Kennedy ML, Sowter S, Nguyen H, Lubowski DZ. Glyceryl trinitrate ointment for the treatment of chronic
anal fissure: results of a placebo controlled trial and long-term follow-up. Dis Colon Rectum. 1999; 42(8):
-6. doi: 10.1007/BF02236691. PMID: 10458121.
Watson SJ, Kamm MA, Nicholls RJ, Phillips RK. Topical Glyceryl Trinitrate in the Treatment of Chronic
Anal Fissure. Brit J Surg. 1996; 83(6): 771-5. doi: 10.1002/bjs.1800830614. PMID: 8696736.
Simpson J, Lund JN, Thompson RJ, Kapila L, Scholefield JH. The Use of Glyceryl Trinitrate (GTN) in the
Treatment of Chronic Anal Fissure in Children. Med Sci Monitor. 2003; 9(10): 123-6. PMID: 14523338.
Lund JN, Scholefield JH. A Randomised, Prospective, Double-blind, Placebo-controlled trial of Glyceryl
Trinitrate Ointment in Treatment of Anal Fissure. Lancet. 1997; 349(9044): 11-4. doi: 10.1016/S0140- 6736(96)06090-4. PMID: 8988115.
Utzig MJ, Kroesen AJ, Buhr HJ. Concepts in pathogenesis and treatment of chronic anal fissure-a review of
the literature. Am J Gastroenterol. 2003; 98(5): 968-74. doi: 10.1111/j.1572-0241.2003.07423.x. PMID:
Bailey HR, Beck DE, Billingham RP, Binderow SR, Gottesman L, Hull TL, et al. A study to determine the
nitroglycerin ointment dose and dosing interval that best promote the healing of chronic anal fissures. Dis
Colon Rectum. 2002; 45(9): 1192-9. doi: 10.1097/01.DCR.0000027060.14159.6E. PMID: 12352236.
Bulus H, Varol N, Tas A, Coskun A. Comparison of topical isosorbide mononitrate, topical diltiazem, and
their combination in the treatment of chronic anal fissure. Asian J Surg. 2013; 36(4): 165-9. doi:
1016/j.asjsur.2013.01.010. PMID: 24054756.
Yousefi M, Mahdavi MR, Hosseini SM, Bahrami A, Davati A, Kamalinejad M, et al. Clinical Evaluation of
Commiphora Mukul, a Botanical resin, in the Management of Hemorrhoids: A randomized controlled trial.
Pharmacogn Mag. 2013; 9(36): 350-6. doi: 10.4103/0973-1296.117832. PMID: 24124288, PMCID:
PMC3793341.
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
