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L-Arginine Application Speeds Healing of Anal Fissure: Presented at ASCRS
By W. A. Thomasson
Special to DG News
CHICAGO, IL -- June 10, 2002 -- Topical application of a gel containing L-arginine 400 mg/mL promotes healing of chronic anal fissures, according to results of a small phase II study, presented Friday at the annual meeting of the American Society of Colon and Rectal Surgeons (ASCRS).
The study was carried out and reported by M. Darby, MD, of University Hospital Dijkzigt in Rotterdam, Netherlands, and colleagues there and at Norgine Gmbh in Marburg, Germany.
L-arginine is the natural precursor of nitric oxide (NO), the effects of which include relaxation of the anal sphincter. Topical application of artificial NO precursors, such as isosorbide dinitrate (ISDN), has been shown to promote fissure healing but is accompanied by frequent and sometimes severe headaches. The researchers hypothesized that because it is naturally present in the body, L-arginine might be free of headache risk.
Fifteen patients (median age 36) were enrolled in the study. One patient dropped out of the study after a day, and one was excluded for protocol violation. The 13 evaluable patients had chronic anal fissures, and eight had previously been treated unsuccessfully with ISDN; five of the eight had experienced severe headache during ISDN treatment.
Patients were treated with L-arginine gel for at least 12 weeks. Anal resting pressure decreased significantly after 12 weeks, from 89±17 to 74±14 mm Hg (p<0.005). There was likewise a significant increase in anodermal blood flow, from 0.36±0.25 to 0.64±0.33. Eight of the 13 fissures were healed and no patient had experienced headache after 12 weeks.
These results indicate that topical application of L-arginine gel effectively promotes healing, even in patients who have not responded to other NO precursors. Furthermore, it does so without significant risk of headache. Precise details of efficacy and safety await larger studies, but these preliminary results are highly encouraging.
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