Comparative evaluation of 0.2% glyceryl trinitrate vs. 2% diltiazem ointment in treatment of chronic anal fissure treatment - a randomized trial

Bansal, Anand; Yadav, Pawan Kumar; Godara, Rajesh; Pal, Naresh; Tripura, Rathindra; Jaikaran,

doi:10.1007/s13126-016-0278-x

Cited by 7 publications

(4 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…So 2% Diltiazem ointment may be preferred in the medical management of chronic anal fissure as first line of treatment. 26 May be due to less duration (6 week) of treatment and as parents were also instructed not to apply GTN inside the anus to decrease systemic absorption, no side effect were observed in our study population. The limitation of our study was that both of these creams were not available as readymade in combination with lignocaine, so there were dispensed by the pharmacy on our request.…”

Section: Discussionmentioning

confidence: 84%

Topical Lignocaine with Diltiazem or Glyceryltrinitrate for Paediatric Acute Anal Fissure: A Randomized Clinical Trial

et al. 2020

View full text Add to dashboard Cite

Introduction: Anal fissure is a common problem in children, the exact etiology of which is unknown and it mostly presents with painful defecation and bleeding per rectum. The standard treatment of anal fissure is lateral internal sphincterotomy but due to risk of fecal incontinence chemical sphincterotomy is used as alternative to surgical sphincterotomy. Aims & Objectives: To compare the effectiveness of topical diltiazem and lignocaine with glyceryl trinitrate and lignocaine in relieving of symptoms and healing of acute anal fissure in children. Place and duration of study: This study was conducted in the Department of Paediatric Surgery, Shaikh Zayed Hospital, Lahore & Department of Paediatric Surgery, Fatima Memorial Hospital, Lahore from September 2017 to September 2018. Material & Methods: Total 228 children were enrolled in the study and randomly divided in group A and B, 114 children in each group. Group A received topical 2% diltiazem cream and 2% lignocaine gel, while group B received topical 0.2% glyceryl trinitrate and 2% lignocaine gel, applied locally, twice daily. Results: There were 78(68.4%) male children in group A and 66(57.9%) in group B. All patients completed 6 week treatment course. The symptoms and condition of the anal fissure were evaluated before start of treatment and at subsequent follow up periods. In group A 55 (48.2%) cases completely healed by second week, while in group B, 33 (28.9%) cases healed. The number of completely healed cases at 4 weeks follow up in group A and group B were 91 (79.8%) and 69(60.5%) respectively, while at week 6 follow up this rate was 95 (83.3%) and 73 (64.0%) respectively. Symptomatic relief in painful defecation observed in group A and group B was 74(64.9%) and 55(48.2%) at week 2, 95(83.3%) and 74(64.9%) at week 4 while 95(83.3%) and 77(67.5%) at week 6 in two groups respectively. Conclusion: Use of combination of topical diltiazem and lignocaine for the treatment of acute anal fissure in paediatric population is preferred over combination of glyceryl trinitrate and lignocaine.

show abstract

Section: Discussionmentioning

confidence: 84%

Topical Lignocaine with Diltiazem or Glyceryltrinitrate for Paediatric Acute Anal Fissure: A Randomized Clinical Trial

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Shrivastava et al reported recurrence rates as 33% in the glyceryl trinitrate group and 13.3% in the diltiazem group 22 . Bansal et al found a recurrence rate of 11.1% in the glyceryl trinitrate group and 15% in the diltiazem group 23 . In our study, recurrence rates were 6.5% (n:2) in the surgical treatment, 20% (n:7) (in the glyceryl trinitrate group and 12.5% (n.4) in the diltiazem group after 6 months of follow-up without any statistically significant intergroup difference.…”

Section: Discussionmentioning

confidence: 97%

Can topical applicatıons be an alternative to surgery in the treatment of chronic anal fissures?

Gazi Şahin,

Sayan,

Alçı

2024

Dicle Tıp Dergisi

View full text Add to dashboard Cite

Introduction: Anal fissure, characterized by a painful ulcer in the anal canal, presents a significant medical challenge. While surgical approaches like lateral internal sphincterotomy (LIS) have been the gold standard for chronic anal fissures, they come with potential complications such as incontinence and abscess formation. In contrast, medical treatments, including topical glyceryl trinitrate and diltiazem, have emerged as alternatives, offering non-invasive options with potentially fewer complications. Method: In this retrospective study, we evaluated 136 patients treated for chronic anal fissures between June 2019 and December 2022 at Balikesir University Hospital, comparing surgical and medical interventions. The study encompassed demographic analysis, treatment modalities, complete recovery, recurrence rates, and side effects/complications. Statistical analyses, including logistic regression, were performed to assess the efficacy and risks associated with different treatments. Results: Our findings indicated a higher rate of complete recovery with surgical treatment (86.1%) compared to medical treatments (glyceryl trinitrate: 64.8%, diltiazem: 69.6%). However, no significant difference was observed in recurrence rates between treatment groups. Surgical intervention exhibited a higher incidence of complications such as incontinence and abscess formation, while medical treatments were associated with side effects like headache and gastrointestinal disturbances. Notably, diltiazem therapy showed outcomes comparable to other modalities, indicating its potential as an effective and safer alternative. Conclusion: Despite the favorable outcomes of surgical treatment, considerations of potential complications underscore the importance of tailored approaches. Prospective, randomized controlled trials with larger cohorts are warranted to further elucidate the efficacy and safety profiles of medical treatments in chronic anal fissures, facilitating informed decision-making in clinical practice.

show abstract

“…It is also suggested that the addition of topical ointments accelerates the healing process and prevents the progression to chronic anal fissure [ 19 ]. Topical ointments are increasingly being used to treat chronic anal fissure due to the cost-effectiveness and to avoid postsurgical complications [ 20 ]. These topical anesthetics include nitrates and calcium channel blockers (CCBs) that heal the fissure through relaxation of the anal sphincter [ 7 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

MEBO versus topical Diltiazem versus a combination of both ointments in the treatment of acute anal fissure: a randomized clinical trial protocol

Charif

Doughan

Kredly³

et al. 2021

BMC Complement Med Ther

View full text Add to dashboard Cite

Background Anal fissure is a common complication of the anorectal region and one of the most reported causes of anal pain. Acute anal fissure can be cured by surgery or medical treatment. There is an increase in the use of topical therapy for the treatment of anal fissures. A common topical drug used is Diltiazem (DTZ), a calcium-channel blocker, which relaxes the anal sphincter and thus promotes healing of the anal fissure. Moist exposed burn ointment (MEBO) is an ointment that is effective for the treatment of burns and wound healing and is becoming popular in the treatment of anal fissures. Methods This is a 1:1:1 randomized, controlled, parallel design, with endpoint measures of change in pain score, wound healing, defecation strain score and patient’s global impression of improvement. The study will be conducted at AUBMC over a 10-week period. Patients will be randomized to three treatment arms: MEBO, Diltiazem, and a combination of MEBO and Diltiazem ointments. Discussion The results of this study will allow physicians to assess the efficacy and safety of MEBO in the treatment of acute anal fissure, and also in comparison to Diltiazem. This trial will generate evidence-based conclusions regarding the use of a herbal/natural-based product (MEBO ointment) for the treatment of anal fissures. Trial registration ClinicalTrials.gov Identifier NCT04153032. Clinical Trial Registration Date: 06-NOVEMBER-2019.

show abstract

Comparative evaluation of 0.2% glyceryl trinitrate vs. 2% diltiazem ointment in treatment of chronic anal fissure treatment - a randomized trial

Cited by 7 publications

References 10 publications

Topical Lignocaine with Diltiazem or Glyceryltrinitrate for Paediatric Acute Anal Fissure: A Randomized Clinical Trial

Topical Lignocaine with Diltiazem or Glyceryltrinitrate for Paediatric Acute Anal Fissure: A Randomized Clinical Trial

Can topical applicatıons be an alternative to surgery in the treatment of chronic anal fissures?

MEBO versus topical Diltiazem versus a combination of both ointments in the treatment of acute anal fissure: a randomized clinical trial protocol

Contact Info

Product

Resources

About