A PROSPECTIVE STUDY COMPARING THE RESULTS OF TREATMENT OF ACUTE & CHRONIC ANAL FISSURE BY 2% DILTIAZEM CREAM LOCALLY
Introduction: Pain during & after defecation is one of commonest symptom in surgical OPD. These patients are diagnosed with either acute or chronic anal fissure. Traditionally anal fissure is treated surgically. The physiological functioning of internal sphincter is well understood and hence medical treatment using 2% Diltiazem cream for local application should be tried. In this study, we analyze symptomatic relief, pain relief, healing of fissure with use of 2% Diltiazem twice a day locally.
Material & Methods: This trial includes 72 patients divided into two groups of 36 patients each of acute & chronic anal fissure. Both groups were started with 2% Diltiazem cream locally twice a day for 6 weeks. Both the groups were fortnightly examined for symptomatic relief.
Results: Anal fissure gets completely healed in 85% patients with acute anal fissure whereas chronic anal fissure healing rate was 65%. The non healed fissure patients were further treated for 2 weeks & successful healing rate increases to 90% in acute anal fissure & 80% in chronic fissure. Rest of the patients were taken for excision of fissure & lateral sphincterotomy.
Conclusion: Local application of 2% Diltiazem per anal can be opted as initial therapy for acute & chronic anal fissure & those chronic fissure not responding can be taken up for surgery.
Aggarwal V, Vansal V, and Shivani. (2015). “Evaluation of role of topical Diltiazem ointment in healing of anal fissure”, IAIM, Vol.2(2), pp.8-15.
Bielecki K, and Kolodziejczak M. (2003). “A prospective randomized trial of diltiazem and glyceryl trinitrate ointment in the treatment of chronic anal fissure”, Colorectal Dis, Vol.5, pp.256-257.
Carapeti EA, Kamm MA, Evans BK, and Phillips RK. (1999). “Topical diltiazem and bethanechol decrease anal sphincter pressure without side effects”, Gut, Vol.45, pp.719-722.
Dasgupta R, Franklin I, Pitt J, and Dawson PM. (2002). “Successful treatment of chronic anal fissure with Diltiazem gel”, Colorectal Disease, Vol.4(1), pp.20-22.
Haq Z, Rahman M, Chowdhury RA, Baten MA, and Khatun M. (2005). “Chemical sphincterotomy – first line of treatment for chronic anal fissure”, Mymensingh Medical Journal, Vol.14(1), pp.88-90.
Jawaid M, Masood Z, and Salim M. (2009). “Topical diltiazem hydrochloride and glyceryl trinitrate in the reament of chronic anal fissure”, J Coll Physicians Surg Pak, Vol.19, pp.614-617.
Jonas M, Speake W, and Scholefield JH. (2002). “Diltiazem heals glyceryl trinitrate-resistant chronic anal fissures: a prospective study”, Dis Colon Rectum, Vol.45, pp.1091-1095.
Knight JS, Birks M, and Farouk R. (2001). “Topical Diltiazem ointment in the treatment of chronic anal fissure”, British Journal of Surgery, Vol.88(4), pp.553-556.
Kocher HM, Steward M, and Leather AJ, et al. (2002). “Randomized clinical trial assessing the side-effects of glyceryl trinitrate and diltiazem hydrochloride in the treatment of chronic anal fissure”, Br J Surg, Vol.89, pp.413-417.
Latif A, Ansar A, and Qasim Butt M. (2013). “Morbidity associated with treatment of chronic anal fissure”, Pak J Med Sci, Vol.29, pp.1230-1234.
Medhi B, Prakash A, and Upadhyay S, et al. (2011). “Comparison of observational and controlled clinical trials of diltiazem in the treatment of chronic anal fissure”, Indian J Surg, Vol.73, pp.427-431.
Nash GF, Kapoor K, Saeb-Parsy K, Kunanadam T, and Dawson PM. (2006). “The long term results of Diltiazem treatment for anal fissure”, International Journal of Clinical Practice, Vol.60(11), pp.1411-1413.
Popat A, Pandey CP, Agarwal K, Shrivastava VP, Sharma SM, and Dixit A. (2016). “A comparative study of role of topical Diltiazem 2% organo gel and lateral sphinceterotomy for the management of chronic fissure in ano”, International journal of contemporary Medical Research, Vol.3(5), pp.1362-1365.
Sajid MS, Rimple J, and Cheek E, et al. (2008). “The efficacy of diltiazem and glyceryltrinitrate for the medical management of chronic anal fissure: A meta-analysis”, Int J Colorectal Dis, Vol.23, pp.1-6.
Shrivastara UK, Jain BK, Kumar P, and Saifee Y. (2007). “A comparison of the effects of diltiazem and glyceril trinitrate ointment in the treatment of chronic anal fissure: A randomised clinical trial”, Surg Today, Vol.37, pp.482-485.
Suvarna R, Panchami, Rai GD. (2012). "Chemical sphincterotomy versus surgical sphincterotomy in the management of chronic fissure in ano: a prospective randomized trial", Journal of Clinical and Diagnostic Research, Vol.6, pp.1018-1021.
Swarnkar M, Bagasrawala S, Shinde RK, and Jain SC. (2015). “Sphincter preserving Therapy with topical 2% Diltiazem for chronic anal fissure : our experience”, JKIMSU, oct-dec, Vol.4(4), pp.8-15.
- There are currently no refbacks.
Send mail to firstname.lastname@example.org with questions or comments about this web site.
International Journal of Surgery and Surgical Sciences, All rights reserved.