Systematic review of the use of topical diltiazem compared with glyceryltrinitrate for the nonoperative management of chronic anal fissure

Abstract

This systematic review of seven trials validates and strengthens the finding of a previously published meta-analysis of two randomized trials. Both DTZ and GTN are equally effective in the management of CAF. However, DTZ is associated with a lower incidence of headache and recurrent fissure. Therefore DTZ should be the preferred first line of treatment for CAF.

Anal Fissure; Comparison of Effectiveness of 2% Diltiazem Ointment to 0.2% Glyceryl Trinitrate Ointment in Treatment

“…14,15,16 In our study 85% patients of group A and 75% patients of group B has complete relieved of their symptoms. There was marked relieved of pain after using DTZ & GTN ointment by Behnam Sanei.…”

“…16,17,18 Nevertheless, the number of headaches reported in this study were significantly fewer than with the GTN group.…”

Diltiazem for the Management of Malignancy-Associated Perineal Pain and Tenesmus

“…Similarly, topical diltiazem has been recommended as first-line therapy for conservative management of chronic anal fissure. 17 Topical diltiazem and nifedipine have been shown to improve pain related to thrombosed external hemorrhoids and post-hemorrhoidectomy pain. 18,19 Oral diltiazem has been recommended as secondline therapy for the management of proctalgia fugax related anorectal pain.…”

Non-surgical treatments for anal fissure in adults

“…The Cochrane meta-analysis suggests that calcium channel blockers have similar efficacy to glyceryl trinitrate (365 patients; four trials using diltiazem, one using nifedipine topically and two using nifedipine orally) 5. A more recent systematic review of comparisons of topical diltiazem with glyceryl trinitrate for chronic anal fissure included 7 randomised trials (involving 481 patients) 13. The treatments were equally effective in healing anal fissure, but diltiazem was associated with a lower risk of recurrent fissure (relative risk [RR] 0.68; 95% CI 0.52 to 0.89).…”

“…The treatments were equally effective in healing anal fissure, but diltiazem was associated with a lower risk of recurrent fissure (relative risk [RR] 0.68; 95% CI 0.52 to 0.89). Diltiazem was also associated with fewer unwanted effects than glyceryl trinitrate, including a lower likelihood of headache (RR 0.39; 95% CI 0.24 to 0.66) 13. Diltiazem ointment has been reported to cause migraine and pruritus ani 1…”