Topical diltiazem versus topical glyceryl trinitrate in the treatment of chronic anal fissure: a prospective comparative study

Abstract

Background: Acute anal fissure (AAF) heals spontaneously with conservative line of treatment. Chronic anal fissure (CAF) needs either traditional surgical lateral sphicterotomy or chemical sphincterotomy with topical agents. The present study aims at the effectiveness of topical diltiazem (DTZ) cream over topical glyceryl trinitrate (GTN) ointment in the treatment of chronic anal fissure.Methods: A total of 100 patients with CAF were included in this comparative prospective study conducted in Rajarajeswari Medical College and Hospital Bengaluru from July 2017 to December 2018. Eligible patients were randomly assigned to one of the two treatment groups of 50 patients each and were advised to apply 2% DTZ cream or 0.2% GTN ointment by fingertip to the anal verge twice daily for 8 weeks. The results were analysed and compared on two weekly intervals to know the effectiveness of treatment. P value of <0.05 is considered to be significant.Results: Complete healing of the fissure occurred in 80% of the patients in DTZ group against 76% in the GTN group by the end of 6 weeks (p>0.05, statistically not significant). Mild headache was experienced by 14% of the patients in the DTZ group, while 46% of the cases in the GTN group reported about the same (p<0.05 statistically significant).Conclusions: Topical 2% DTZ appeared to be well tolerated and effective preferred first-line method of chemical sphincterotomy with less side effects for chronic anal fissure.