Abstract

A PROSPECTIVE RANDOMIZED COMPARATIVE EVALUATION OF ORAL DILTIAZEM AND TOPICAL DILTIAZEM (2%) OINTMENT IN THE TREATMENT OF CHRONIC ANAL FISSURE

Kaushik Richa*, Kumar Ashwani, Bansal Priyanka and Singh Vineeta

ABSTRACT

Objectives: To evaluate and prospectively compare the efficacy of oral diltiazem and topical 2% diltiazem ointment in patients with chronic anal fissure in terms of improvement in sign and symptoms, time taken for healing, side effects and recurrence, if any. Study design: A interventional analytical comparative study was conducted in the Department of Surgery, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, from May 2013 to October 2014 in which 50 patients with chronic anal fissure were randomly divided in two groups. In one group oral diltiazem was given and in another topical diltiazem ointment was given for treatment and comparative evaluation was done. Results: Differences in decrease of median pain score between the groups were not statistically significant except at the end of 1st week of treatment. Complete healing was observed in 40% patients in oral diltiazem group whereas 80% patients in topical diltiazem group at the end of 6 weeks and the difference was statistically significant.Oral diltiazem group patients reported headache and nausea and vomiting whereas in topical diltiazem group one patient developed anal excoriation and the difference was not statistically significant when individual side effects were considered but the difference in overall occurrence of side effects was statistically significant. Recurrence rate was 20% in oral diltiazem group and 10% in topical diltiazem group at 3 months of follow up and this difference was not statistically significant. Conclusion: During considering medical management for treating chronic anal fissure topical diltiazem ointment may be the preferred first line treatment.

Keywords: Chronic anal fissure, Diltiazem, Oral, Topical.