مقایسه تأثیر دیلتیازم ونیتر و گلیسیرین موضعی بر درمان فیشر آنال مزمن

Introduction: Chronic anal fissure is associated with anal hypertonia and considerable pain. Internal sphincter pressure decreases with surgical procedures or medical agents. Numerous clinical studies have evaluated the effectiveness of multiple drugs. Objective: This study compared the efficacy of diltiazem 2% compared to glycerol trinitrate 0.2% for chemical sphincterotomy. Materials & Methods: In a prospective, double-blind trial, 104 patients suffering from chronic anal fissure were randomly and equally distributed to two groups which received either glycerol trinitrate or diltiazem, both drugs were applied topically to the perianal region for 8 weeks. Variables including the percentage of healing and control of pain, complications, recurrence, and the need for complementary means of treatment were assessed. In both groups, constipation was controlled with dietary fiber or psyllium. All the patients were assessed after 2, 4, 6 and 8 weeks and later on after one year. Results: Healing of the fissure occurred in 46 patients (88%) of diltiazem group and 30 patients (57%) of nitroglycerin group after 8 weeks (p<0.04). Headache was experienced by 20 patients (38%) of nitroglycerin group and 3 patients (5.7%) of diltiazem group (p<0.04). Flushing was observed in 2 patients (3.8%) of nitroglycerin group and none of the patients of the diltiazem group (p<0.1). The recurrence of the fissure was similar in two groups. Conclusion: Diltiazem ointment used as an agent for chemical sphincterotomy for chronic anal fissure offers significant healing rates. Nevertheless, it did not have a significant side-effect profile. Thus, it is preferable to the similar ointment i.e. nitroglycerin.