title: Randomized controlled pilot trial of nifedipine as oral therapy vs. topical application in the treatment of fissure-in-ano.
abstract: BACKGROUND
  Fissure-in-ano is a common condition that leads to pain and affects quality of life. Sphincterotomy remains the gold standard, but it may lead to troublesome incontinence in some patients. To overcome this problem, numerous pharmacologic therapies have been tested with varying outcomes. The investigators compared the effect of the addition of oral and topical nifedipine to conservative measures in the treatment of patients with fissure-in-ano.
  
  
  METHODS
  Ninety patients with fissure-in-ano, randomized into 3 groups of 30 each, were included in the study. Group I received conventional treatment, group II received oral nifedipine and conventional treatment, and group III received topical nifedipine along with conventional treatment. Patients were followed for 8 weeks for pain relief (assessed using a visual analogue scale) and healing to evaluate the effect of treatment.
  
  
  RESULTS
  Pain relief was significantly better in the group III at 3 weeks and 2 months compared with group I (P < .05). Groups II and III were comparable in terms of pain relief. Healing rates were significantly better in group II (P = .03) and group III (P = .00) compared with group I, but groups II and III were found to be comparable. Adverse effects were most commonly reported by group II patients, but these were not significantly higher than in other 2 groups.
  
  
  CONCLUSIONS
  We recommend the addition of either oral or topical nifedipine to conservative measures to significantly improve pain relief and healing rates in patients with fissure-in-ano.
authors.affiliation: Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Dilshad Garden, New Delhi 110095, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Agrawal
authors.forename: Gourav
authors.initials: G
authors.lastname: Kaushal
authors.forename: Rachna
authors.initials: R
authors.lastname: Gupta
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D005260:Female; D005401:Fissure in Ano / Q000628:therapy*; D006801:Humans; D008297:Male; D009543:Nifedipine / Q000008:administration & dosage*; D010146:Pain / Q000188:drug therapy; D010865:Pilot Projects; D064232:Visual Analog Scale; D014945:Wound Healing
chemical_list: D002121:Calcium Channel Blockers; D009543:Nifedipine
keywords: Anal fissure; Fissure-in-ano; Nifedipine; Treatment