Value Assessment of Local Treatment (Diltiazem Hydrochloride gel/vs Glycerile Trinitrite ointment) in acute Anal Fissure

Abstract

Background: Anal fissure is a linear tear in the distal anal canal, associated with spasm of internal anal sphincter. Acute anal pain with bleeding on defecation are the main symptoms. Different types of chemical treatment to relax the sphincteric muscles have tried. Objective: Assess the efficacy, side effects and recurrence rate of 0.2% glycerile trinitrate ointment (GTN) and 2% diltiazim hydrochloride gel (DTZ) in treatment of acute anal fissure. Methods: A prospective randomized trial of 112 patient with acute anal fissure over 1.5 years period at Al-Kindy Teaching Hospital. The diagnosis was entirely clinical. Setting of inclusion and exclusion criteria, ethical consideration respected. Two groups of patients submitted randomly to either 0.2% GTN ointment or 2% DTZ gel twice daily for 8 weeks. Correct pain score by the patient every day, follow up to the end of week 1, 2, 8 and at 6 months. Scientific signs of healing assessed blinded to the mode of treatment. The collected data was analyzed and compared. Results: Complete fissure healing was observed in (83.3%) of the DTZ group and (76%) of the GTN group. Pain response was better in DTZ than GTN patients were. Side effects had reported. The recurrence rate was (15%) in DTZ group and (30%) in GTN after 6 months follow up. Conclusion: Topical Diltiazem is greater than Glyceryl trinitrate in managing acute anal fissure with low side effects and reappearance rate.