Sameeah Hanif, Soweba Hanif, Muhammad Nawaz.
Randomized clinical trial comparing topical Diltiazem 2% with GTN 0.2% ointment in the treatment of chronic anal fissure.
Pak J Surg Jan ;37(4):251-4.

Objective: Surgical treatment of anal fissure can cause permanent incontinence in some patients. Topical medications have less adverse effects. The aim of this study was to compare the effectiveness of Diltiazem 2% topical with GTN 0.2% ointment in the treatment of chronic anal fissure with a view to establish which drug should be used as first line in conservative management. Material and Methods: This randomized clinical trial was carried out in Department of Surgery, Distric Headquaters Hospital (DHQ), Abbottabad from April 2020 to February 2021. Patients with chronic anal fissure above 18 years of age were treated with Diltiazem 2% (34 patients) and GTN 0.2% (34 patients) in the anal canal three times a day for 6 weeks duration. Age, symptoms, gender, location of ulcer, healing rate and adverse effect like headache were compared. SPSS 17 was used for calculation. X2 test used for comparing healing rate and incidence of headache. P value below 0.05 considered significant. Results: 68 patients were included in study. They were randomly allocated to two groups. Group-A (Diltiazem DTZ) comprised of 34 patients while group-B (GTN) contained 34 patients. Difference between healing rates was not significant between two groups. GTN group had more headache than DTZ group. Conclusion: Medical treatment is the initial treatment for chronic anal fissure. Both DTZ and GTN have comparable rate in healing chronic anal fissure although DTZ is superior to GTN in relation to headache.

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