Comparison of Observational and Controlled Clinical Trials of Diltiazem in the Treatment of Chronic Anal Fissure

Medhi, Bikash; Prakash, Ajay; Upadhyay, Sujata; Xess, Deonis; Yadav, Thakur Deen; Kaman, Lileshwar

doi:10.1007/s12262-011-0340-4

Cited by 10 publications

(15 citation statements)

References 23 publications

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“…Diltiazem is given 60 mg BD in oral form or applied as 2% cream BD for 4 to 6 weeks. 10 The commonest age group affected in this study was 31-40 years (40%) age group, which concurs with the data by Goligher, et al 13 in whom, the commonest age group affected was 31-40 years. Though the incidence of chronic fissure is equal in both sexes, 13 in our study we found a higher incidence in males compared to females (2.33:1).…”

Section: Discussionsupporting

confidence: 93%

A Comparative Study of Lateral Sphincterotomy and Local Application of 2% Diltiazem Gel in Treatment of Chronic Anal Fissure

Jade¹,

Raghunath²,

Naveen³

2015

jebmh

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BACKGROUND AND OBJECTIVES Anal fissures are commonly encountered in routine colorectal practice. Chronic fissures have traditionally been treated surgically. Developments in the pharmacological understanding of the internal anal sphincter have resulted in more conservative approaches towards treatment. In this study, we compare topical 2% Diltiazem gel and lateral internal sphincterotomy with respect to symptomatic relief, healing and side effects in the treatment of chronic fissure in ano. METHODS 60 patients with chronic fissure in ano were randomly divided into Diltiazem gel and internal sphincterotomy groups. Patients were followed up at weekly intervals for minimum of eight weeks. Data was recorded accordingly. RESULTS Fissure completely healed in 28(93.33%) out of 30 patients treated with 2% Diltiazem gel between 4-8 weeks. Healing was 100% with internal sphincterotomy. The mean duration required for healing of fissure was 4.86 weeks in Diltiazem gel group and 3.66 weeks in internal sphincterotomy group. 61.5% patients were free from pain after treatment with Diltiazem gel whereas in internal sphicterotomy group 66.66% patients had pain relief at the end of 4 weeks. INTERPRETATION AND CONCLUSION Comparison between Diltiazem gel application and internal sphincterotomy did not show any significant difference in fissure healing and pain relief. No side effects were seen in Diltiazem gel therapy. Topical Diltiazem should be the initial treatment in chronic fissure in ano. It is better to reserve internal sphincterotomy for patients with relapse or therapeutic failure to prior pharmacological treatment.

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Section: Discussionsupporting

confidence: 93%

A Comparative Study of Lateral Sphincterotomy and Local Application of 2% Diltiazem Gel in Treatment of Chronic Anal Fissure

Jade¹,

Raghunath²,

Naveen³

2015

jebmh

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“…17,18 A study by Medhi et al described Diltiazem to be efficacious in the treatment of chronic fissure in ano. 10 Study showed that oral intake and topical applications of Diltiazem reduced the anal pressure significantly with better healing rates. Another review by Bharadwaj et al showed that Diltiazem was a valid alternative to glyceryl trinitrate with improved healing rates and lower rates of recurrence.…”

Section: Discussionmentioning

confidence: 96%

“…Side effects are minimal with Diltiazem and include perianal dermatitis. 10 Also, use of topical 2% Diltiazem is not associated with headache and therefore increased compliance of the patients unlike the use of nitric oxide donors such as Glyceryl trinitrate and Isosorbide dinitrate as a form of chemical sphincterotomy as it is associated with headache and therefore decreased compliance of the patient resulting in poor results. 11 The aim of the study was thus to compare the efficacy of outcome of lateral internal sphincterotomy and subcutaneous fissurectomy with topical 2% Diltiazem gel in the treatment of chronic fissure in ano.…”

mentioning

confidence: 99%

Prospective comparative study between lateral sphincterotomy and subcutaneous fissurectomy with topical 2% diltiazem gel in the treatment of chronic fissure in ano

Dey

Pai

2019

Int Surg J

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Background: Anal fissure is defined as an ulcer in the anoderm usually in the posterior midline, less frequently in the anterior midline and rarely in the lateral position of the anal canal. Different treatment modalities include non-invasive pharmacological therapies, lateral internal sphincterotomy (LIS) which is the gold standard for treatment and new therapies that include perineal support devices, Gonyautoxin injection, fissurectomy, fissurotomy, sphincterolysis, and flap procedures. Thus, aim of the study was to compare the efficacy of outcome of lateral internal sphincterotomy and subcutaneous fissurectomy with topical 2% Diltiazem gel in the treatment of chronic fissure in ano.Methods: 50 patients with chronic fissure in ano attending OPD of Department of General Surgery, KVGMCH, Sullia were randomly selected and divided into Group A (n=25): Lateral internal sphincterotomy (control group) and Group B (n=25): Subcutaneous fissurectomy + topical 2% Diltiazem Gel (test group).Results: Patients of Group B showed much less mean duration of absenteeism (2.88 weeks) compared to Group A. Comparison between Group B and Group A showed statistically significant differences in pain relief (P<0.0001), complications (p=0.03), mean duration of sitz baths (p<0.0001), absenteeism (p<0.0001) respectively.Conclusion: Hence Subcutaneous fissurectomy with topical 2% Diltiazem gel is a better surgical option for chronic fissure in ano than conventional Lateral internal sphincterotomy.

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“…Nitroglycerin ointments have been reported to be effective in treatment by providing a significant increase in blood flow and decreasing anal pressure (15). A calcium channel blocker, diltiazem, has been suggested for patients who are refractory to glyceryl trinitrate (16). Balloon dilatation may be an option for surgically high-risk patients (17).…”

Section: Discussionmentioning

confidence: 99%

The effect of lateral internal sphincterotomy on resting anal sphincter pressures*

Peker¹,

Yılmaz²,

Demiryılmaz³

et al. 2014

Turk J Med Sci

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Comparison of Observational and Controlled Clinical Trials of Diltiazem in the Treatment of Chronic Anal Fissure

Cited by 10 publications

References 23 publications

A Comparative Study of Lateral Sphincterotomy and Local Application of 2% Diltiazem Gel in Treatment of Chronic Anal Fissure

A Comparative Study of Lateral Sphincterotomy and Local Application of 2% Diltiazem Gel in Treatment of Chronic Anal Fissure

Prospective comparative study between lateral sphincterotomy and subcutaneous fissurectomy with topical 2% diltiazem gel in the treatment of chronic fissure in ano

The effect of lateral internal sphincterotomy on resting anal sphincter pressures*

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