Sadaf Aba Umer, Manzar S.
Effectiveness of topical Diltiazem versus Glyceryl Trinitrate in the treatment of chronic anal fissures
Pak J Surg Oct - Dec 2003;19(2):62-7.
Dow Medical College & Civil Hospital, Karachi

Anal fissure is a very distressing condition, associated with internal anal sphincter hypertonia. Surgical treatment of this condition is successful but accompanied with significant morbidity. A variety of agents have been found to cause pharmacological manipulation of the internal anal sphincter to reduce its tone, a reversible chemical sphincterotomy. This prospective, randomized, therapeutic trial was conducted on 100 patients in the Surgical Outpatient of Civil Hospital, Karachi to compare the efficacy, side effects and recurrence rates of topical 2% diltiazem (DTZ) versus 0.2% glyceryl trinitrate (GTN) in the treatment of chronic anal fissures. The results reveal that at the end of the 8th week of treatment, out of 50 patients in each group, 82% had fissure healing in the DTZ group as compared to 76% in the GTN group. There was no significant difference observed in pain relief, bleeding on defaecation and sphincter tone between the two groups. However, side effects were seen more in the GTN group (60%) than in the DTZ group (18%), as was recurrence i.e. 18% as compared to 6%. It is therefore concluded that topical diltiazem is preferable over GTN in the treatment of anal fissures.

Category: Surgery
Keywords: Anal Fissure. Sphincterotomy. Diltiaz. Glyceryl Trinitrate. Anus.

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