Comparison of topical isosorbide mononitrate, topical diltiazem, and their combination in the treatment of chronic anal fissure.
OBJECTIVE
Chronic anal fissure is a painful condition that is associated with an increase in internal anal sphincter pressure. The main aim of this study is to evaluate the efficacy and adverse effects of topical isosorbide 5 mononitrate and topical diltiazem, when administered either as single agents or in combination, in the treatment of anal fissure.


METHODS
Patients with chronic anal fissure were enrolled in the study. They were randomized into three groups: Group A (0.2% isosorbide 5 mononitrate users), Group B (2% diltiazem users), and Group C (2%diltiazem + 0.2% isosorbide 5 mononitrate users). Pain was evaluated using a visual analog scale (VAS). Level of strain during defecation was graded on a 4-point scale.


RESULTS
A total of 55 patients were enrolled in the study. The average ages of patients in Groups A, B, and C were 37.94 ± 16.19, 42.83 ± 13.21, 40 ± 13.58 years, respectively. After treatment, pain completely abated in 55.6% of patients in Group A, 27.8% (n = 5) in Group B, and 42.1% (n = 8) in Group C. The decreases in average VAS values prior to and after treatment in Groups A, B, and C were statistically significant (p values 0.0001, 0.001, and 0.0001, respectively). Average strain scores prior to and after treatment were 2.11/0.72 for Group A, 2.17/0.94 for Group B, and 1.95/0.47 for Group C. Strain during defecation prior to and after treatment in Groups A, B, and C was statistically significant (p values 0.001, 0.001, and 0.003, respectively).


CONCLUSIONS
Topical diltiazem and a combination of nitrate and diltiazem can be used in the treatment of anal fissure. However, the agents are not significantly superior each other.
Department of General Surgery, Kecioren Training and Research Hospital, Ankara, Turkey.
Hakan
H
Bulus
Numan
N
Varol
Adnan
A
Tas
Ali
A
Coskun
D000287:Administration, Topical; D000328:Adult; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D002908:Chronic Disease; D004110:Diltiazem / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy*; D006801:Humans; D007548:Isosorbide Dinitrate / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D020030:Nitric Oxide Donors / Q000008:administration & dosage*; D010147:Pain Measurement; D016896:Treatment Outcome
D002121:Calcium Channel Blockers; D020030:Nitric Oxide Donors; D004110:Diltiazem; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate
anal fissure; diltiazem; isosorbide mononitrate