Sphincter-Preserving Therapy with Topical 2% Diltiazem for Chronic Anal Fissure: Our Experience

Background: Chronic anal fissure is a common problem across the world treated largely by surgical methods. Studies have demonstrated the efficacy of topical agents like Glyceryl Trinitrate (GTN) in anal fissure but it has been shown to have side effects like headache and dizziness. There is a need for a pharmacological therapy for fissure which has fewer side effects. Hence, this study was taken up to assess the efficacy and adverse effects of topical 2% Diltiazem (DTZ) gel. Aim & Objectives: To assess the efficacy and side effect of topical treatment with 2% DTZ gel in patient with chronic anal fissure. Material and Methods: Consecutive fifty adult patients with symptomatic chronic anal fissure attending the surgery clinic were enrolled in the study form February 2014July 2014 and they were treated with regular topical application of 2% DTZ cream. Patients were followed up at regular intervals for symptomatic relief and healing of fissure. Results: In our study post-defecatory pain, bleeding and irritation were significantly reduced after 2week of therapy and a primary healing rate of 86% (43 out of 50) at 6th week of therapy. The primary side-effects of 2% DTZ gel appeared to be perianal dermatitis and pruritis ani in 14% cases. Conclusion: Topical 2% DTZ gel is an effective agent in the treatment of chronic anal fissure. The need for hospital stay is abolished; psychological and financial burden on the patient is reduced. With a healing rate close to 90%, topical DTZ can be easily advised as the first line of treatment of chronic anal fissure.