Comparison of topical glyceryl trinitrate with diltiazem ointment for treatment of chronic anal fissure. A randomized clinical trial.
BACKGROUND
The aim of this study was to compare the effect of topical glycerol trinitrate ointment (GTN) with topical diltiazem hydrochloride ointment (DTZ) in the treatment of chronic anal fissure.


METHODS
Prospectively, 102 patients were treated randomly with either GTN ointment (0.2%) or DTZ ointment (2%) couple of times daily for 12 weeks.


RESULTS
Forty-five patients (88.2%) in group DTZ and 36 patients (70.6%) in group GTZ had reduction of symptoms. The decrease in the symptoms for group DTZ were significantly more than that for group GTN (P = 0.02). Mean time of symptom reduction was 2.44 +/- 0.30 in group DTZ and 2.50 +/- 0.28 weeks in group GTN without significant differences between two groups (P > 0.05). Complete relieving of symptoms was observed in 72.5%, 54.9% patients in groups DTZ and GTN, respectively. The frequency of complete relieving of symptoms between two groups was not significant (P > 0.05). Complete remission of anal fissure was occurred in 66.7% patients in group DTZ and 54.9% patients in group GTN, which was no different, significantly. Mean time taken for fissure healing in GTN group was dramatically less than DTZ group (P = 0.001). Finally, 33.3% of patients in DTZ group and 45.1% of patients in GTN group was operated. The need for operation was not significant between two groups (P > 0.05).


CONCLUSIONS
Both DTZ and GTN are equally effective and can be the preferred first-line treatment of chronic anal fissure a. However, GTN is associated with a higher rate of headache, and it should be replaced by DTZ.
Sanei
Behnam
B
Department of General Surgery, Alzahra Hospital, Isfahan, Iran.
Mahmoodieh
Mohsen
M
Masoudpour
Hassan
H
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D004110:Diltiazem / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D009824:Ointments; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000008:administration & dosage*; D055815:Young Adult
D009824:Ointments; D014665:Vasodilator Agents; D004110:Diltiazem; D005996:Nitroglycerin