Diltiazem (2%) versus glyceryl trinitrate cream (0.2%) in the management of chronic anal fissure.

OBJECTIVE: To assess and compare the effectiveness of topical 0.2% glycerl trinitrate (GTN) and topical 2% diltiazem (DTZ), in the management of chronic anal fissure. STUDY DESIGN: Comparative, descriptive study. PLACE AND DURATION OF STUDY: Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad from September 2004 to August 2005. METHODOLOGY: Patients with chronic anal fissure were treated with topical 0.2% GTN (50 patients) and 2% DTZ (47 patients) application for 8 weeks, three times a day at peri anal area. Symtoms, recurrence, wound healing and side effects were compared. Data was analyzed using SPSS version 10 employing X2 test. A p-value below 0.05 were considered statistically significant. RESULTS: There were 53 females and 44 males with a mean age of 30 years. Patients who received topical diltiazem (DTZ) showed statistically significant difference than those who were prescribed topical glycerl trinitrate terms of wound healing and side effects mainly the headaches (p=0.02 and 0.003 respectively). Improvement in symptoms (p=0.345) and recurrence rates (p=0.612) turned to be statistically insignificant although recurrence rate was lower with DTZ. CONCLUSION: Chemical sphincterotomy is an effective first line management for chronic anal fissure. Both GTN and DTZ are equally effective in managing the chronic anal fissure. DTZ has fewer side effects, a better healing response and low recurrence rates.