title: Early and late results of topical diltiazem and bethanechol for chronic anal fissure: a comparative study.
abstract: OBJECTIVE
  Late efficacy of medical treatment of chronic anal fissure remains controversial due to high recurrence. This study aimed at analyzing safety and efficacy of topical diltiazem and bethanechol regarding healing and symptoms relief, safety, recurrence, and need for surgery.
  
  
  METHODS
  This was a single-center nonrandomized trial. Outcomes of 30 patients with chronic anal fissure treated with 2% diltiazem were compared to 30 patients treated with 0.1% bethanechol, both for eight weeks. Patients were assessed after seven days and eight weeks.
  
  
  RESULTS
  In diltiazem group, after seven days, 31% were symptomatic; after bethanechol, 71% (p = 0.06). After seven days, fissure healing occurred in 19% after diltiazem and in 11% after bethanechol. After eight weeks, in both groups, 64% were asymptomatic; after diltiazem, 53% healed; after bethanechol, 50% (p = 0.80). Success was the same for both groups: 63.3%. Groups were similar regarding complications. After diltiazem, 9 (30%) patients were operated on; and 11 (36.7%) after bethanechol (p = 0.60). Recurrence occurred in 4 (13.3%) patients in both groups. Median time to recurrence after diltiazem was 15 (10-24) months and 7.5 (2-15) after bethanechol - p = 0.15.
  
  
  CONCLUSIONS
  Both treatments are safe and effective. Diltiazem may be associated to earlier relief and more sustained response.
authors.affiliation: Discipline of Coloproctology, Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil. sergioed@terra.com.br
authors.forename: Sergio Eduardo Alonso
authors.initials: SE
authors.lastname: Araujo
authors.forename: Manoela Moreira
authors.initials: MM
authors.lastname: Sousa
authors.forename: Pedro Paulo de Paris
authors.initials: PP
authors.lastname: Caravatto
authors.forename: Angelita
authors.initials: A
authors.lastname: Habr-Gamai
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D018723:Bethanechol / Q000627:therapeutic use*; D002908:Chronic Disease; D015331:Cohort Studies; D004110:Diltiazem / Q000627:therapeutic use*; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D018721:Muscarinic Agonists / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*; D014945:Wound Healing; D055815:Young Adult
chemical_list: D018721:Muscarinic Agonists; D014665:Vasodilator Agents; D018723:Bethanechol; D004110:Diltiazem