Chemical sphincterotomy has proved effective in treating chronic anal fissures. Glyceryl trinitrate is the most widely used agent, and topical 0.2% glyceryl trinitrate ointment heals up to two-thirds of chronic anal fissures.
Unfortunately, however, many patients experience troublesome headaches as a side-effect of this treatment.
In an attempt to find new therapies to reduce the number of patients that experience these side-effects, a study has assessed the effectiveness of oral and topical diltiazem in healing chronic fissures.
|Topical diltiazem was associated with no side-effects.|
|Diseases of the Colon and Rectum|
50 consecutive patients with chronic anal fissures were randomly assigned to receive oral (60 mg, n = 24) or topical (2% gel, n = 26) diltiazem twice daily for up to 8 weeks.
Anal manometry was performed before and after the first dose, and blood pressure was recorded at 15-minute intervals.
A review of patients was conducted fortnightly, assessing pain and recording blood pressure. The degree of fissure healing was also measured and any side-effects of the treatments were noted.
In the orally treated group the mean maximum resting anal pressure fell by 15%, from 95 to 81 cm H2O.
With the use of topical diltiazem, a greater reduction of 23% was seen, with anal pressure falling from 102 to 79 cm H2O.
In both groups no significant reduction in blood pressure was observed, either during the study or in follow-up assessments.
After 8 weeks, fissure healing was complete in 9 patients (38%) receiving oral diltiazem and 15 (6%) on topical treatment.
Oral diltiazem caused side-effects in 8 patients. These included rash (n = 2), headaches (n = 2), nausea or vomiting (n = 3), and reduced smell and taste (n = 1). Patients receiving topical therapy experienced no side-effects.
The research team carrying out the study, which came from the University of Nottingham, England, concluded that both oral and topical diltiazem heal chronic anal fissures.
Topical diltiazem is more effective, achieving healing rates comparable to those reported with topical nitrates, with significantly fewer side-effects. It may therefore represent a new therapy for the treatment of chronic anal fissures.