title: Diltiazem (2%) versus glyceryl trinitrate cream (0.2%) in the management of chronic anal fissure.
abstract: 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.
  
  
  METHODS
  Comparative, descriptive study.
  
  
  METHODS
  Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad from September 2004 to August 2005.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad. fazilahasmi@yahoo.com
authors.forename: Fazila
authors.initials: F
authors.lastname: Hashmi
authors.forename: Faisal Ghani
authors.initials: FG
authors.lastname: Siddiqui
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D002908:Chronic Disease; D004110:Diltiazem / Q000008:administration & dosage*; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D014665:Vasodilator Agents / Q000008:administration & dosage*; D014945:Wound Healing; D055815:Young Adult
chemical_list: D002121:Calcium Channel Blockers; D014665:Vasodilator Agents; D004110:Diltiazem; D005996:Nitroglycerin