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Topical diltiazem versus topical glyceryl trinitrate (gtn) in the treatment of chronic anal fissure: prospective study

Authors:Rithin Suvarna,Hanumanthappa.M.B,Panchami ,Guruprasad Rai,
Int J Biol Med Res. 2012; 3(2): 1747 – 1750  |  PDF File


Introduction: Anal fissure (AF) is a linear tear in the distal anal canal & is associated with spasm of internal anal sphincter muscle. Acute AF usually heals with simple measures. The usual treatment of chronic fissure is surgical spincterotomy. However, it may cause permanent anal incontinence. The present study was undertaken to assess the efficacy & safety of topical Diltiazem & topical Glyceryl trinitrate in the management of chronic anal fissure. Also, they were compared with each other. Materials & methods: In this prospective comparative study, 200 patients with chronic anal fissure were equally &randomly divided in to DTZ group (received 2%diltiazem ointment) & GTN group (received 0.2% Glyceryl trinitrate ointment). The ointment had to be applied to anal verge twice daily for 6 weeks. Assessment was done at 2nd, 4th & 6th weekends for fissure healing, pain relief & side effects. Results:Complete fissure healing was observed in 71.87%of patients in DTZ group & 68.23% in GTN group (P<0.0001). Pain response was good & was fairly similar in both the groups. Headache occurred in 5.20% in DTZ & 67% in GTN group (P<0.0001). Recurrence rate was 9.67% in DTZ & 19.56% in GTN group. Conclusion:Topical Diltiazem is preferred to topical Glyceryl trinitrate in the treatment of chronic fissure, because it is associated with a few side effects.