The treatment of anal fissures has evolved over the last 5 years, with the development of topical treatments aimed at reducing sphincter hypertonia.
These treatments are thought to improve anal mucosal blood flow and promote healing of the fissure.
In this study, researchers from England used topical diltiazem in patients with chronic anal fissures, who had failed previous treatment with topical 0.2% glyceryl trinitrate (GTN).
The team assessed 47 patients recruited prospectively from a single center.
Patients were instructed to apply approximately 0.7 g of 2% diltiazem cream to the anal verge twice daily for 8 weeks.
Researchers recorded symptoms of pain, bleeding and itching on a linear analogue score prior to starting the cream, and then repeated at 2 weekly intervals.
Patients reported any side-effects throughout the study period.
|Diltiazem may reduce the need for sphincterotomy in up to 70% of cases.|
The team assessed the healing of the fissures after 8 weeks of treatment.
The research team found that of the 46 patients who completed treatment; 48% had healed fissures.
In addition, 42% of the 24 patients with persistent fissures were symptomatically improved and wished no further treatment.
However, 14 patients remained symptomatic.
Of these, 1 received a repeat course of 0.2% GTN with subsequent healing of the fissure, and 3 were referred for surgery.
The remaining10 patients were recruited into an ongoing study involving injections of botulinum toxin into the internal anal sphincter.
Dr Griffin's team concluded, "This study shows that topical 2% diltiazem is an effective and safe treatment for chronic anal fissure in patients who have failed topical 0.2% GTN".
"The need for sphincterotomy can be avoided in up to 70% of cases".