A Comparative Study of Topical Diltiazem (2%) with Topical Glyceryl Trinitrate (0.2%) as a Conservative Treatment for Anal Fissure

Abstract

Introduction: An anal fissure is defined as a split in the mucosa extending from the anal verge towards the dentate line and most common proctologic symptom. The management of anal fissures is diverse and range from non-operative techniques like dietary changes, topical ointments (2% diltiazem, 0.2% glyceryl trinitrate), botulinum toxin injections and sitz baths to surgical intervention. Aim: To evaluate and compare the efficiency of Topical Glycerine Nitrate (0.2%) with Topical Diltiazem (2%) in patients with anal fissures. Materials and Methods: Out of 100 patients of anal fissure, 50 were selected for treatment with topical application of 2% Diltiazem and were classified as Group I while rest 50 selected for topical application of 0.2% Glyceryl trinitrate and were classified as Group II. Patients were followed for a period of six weeks (weekly follow-up) to evaluate the healing effect of above two topical ointments. Results: On follow-up at week six, patients relieved of all the complaints were assessed as fully cured and patients still having any of the complaints were assessed as partially cured. Full cure was observed in significantly higher proportion of cases of Group I as compared to Group II (88.0% vs. 68.0%), rest of the patients of both the groups had partial cure. Majority of the patients of both the groups did not observe any side effects (Group I-94.0% and Group II-84.0%), remaining patients of Group I reported side effects of Itching (6.0%) while remaining patients of Group II reported headache as side effect (16.0%). Difference in side effects of patients of above two groups was found statistically significant. Conclusion: Findings of the present study indicated that topical diltiazem (2%) was more effective as compared to glyceryl trinitrate (0.2%) for conservative treatment of anal fissure. Diltiazem was capable to provide full relief of complaints within six weeks to majority of the cases (88.0%).