Randomized clinical trial assessing the side-effects of glyceryl trinitrate and diltiazem hydrochloride in the treatment of chronic anal fissure

Kocher, Hemant M.; Steward, M.; Leather, Andrew J M; Cullen, P. T.

doi:10.1046/j.0007-1323.2001.02042.x

Cited by 132 publications

(83 citation statements)

References 16 publications

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“…Oral diltiazem caused side effects such as rash, headache, nausea, vomiting, decreased smell and taste, whereas topically treated groups showed no side effects. Kocher et al [17] showed adverse effects of GTN and diltiazem in the treatment of chronic anal fissure. Diltiazem therapy was shown to cause less headache than GTN therapy [P=0.01].…”

Section: Resultsmentioning

confidence: 99%

Comparison of Observational and Controlled Clinical Trials of Diltiazem in the Treatment of Chronic Anal Fissure

et al. 2011

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Section: Resultsmentioning

confidence: 99%

Comparison of Observational and Controlled Clinical Trials of Diltiazem in the Treatment of Chronic Anal Fissure

et al. 2011

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“…37 The topical formulation of diltiazem has been subjected to rigorous scrutiny and is a valid alternative to GTN with similar reductions in MRP, improved healing rates and lower rates of recurrence. [38][39][40][41] There are also data to suggest that topical diltiazem heals GTN-resistant fissures. 42 …”

Section: Calcium Antagonistsmentioning

confidence: 99%

Modern Perspectives in the Treatment of Chronic Anal Fissures

Bhardwaj

Parker

2007

annals

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INTRODUCTION Anal fissures are commonly encountered in routine colorectal practice. Developments in the pharmacological understanding of the internal anal sphincter have resulted in more conservative approaches towards treatment. Simple measures are often effective for early fissures. Glyceryl trinitrate is well established as a first-line pharmacological therapy. The roles of diltiazem and botulinum, particularly as rescue therapy, are not well understood. Surgery has a defined role and should not be discounted completely.METHODS Data were obtained from Medline publications citing 'anal fissure'. Manual cross-referencing of salient articles was conducted. We have sought to highlight various controversies in the management of anal fissures.FINDINGS Acute fissures may heal spontaneously, although simple conservative measures are sufficient. Idiopathic chronic anal fissures need careful evaluation to decide what therapy is suitable. Pharmacological agents such as glyceryl trinitrate (GTN), diltiazem and botulinum toxin have been subjected to most scrutiny. Though practices in the UK vary, GTN or diltiazem would be suitable as first-line therapy with botulinum toxin used as rescue treatment. Sphincterotomy is indicated for unhealed fissures; fissurectomy has been revisited and advancement flaps have a role in patients in whom sphincter division is not suitable.

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“…The incidence of anal fissure was slightly higher in males than in females which is comparable to Kocher et al study where incidence of anal fissure is slightly higher in males. 5 After six weeks, complete pain relief was seen in 38 patients out of 50 patients in Lignocaine group and 46 patients out of 50 patients in Combination group. Results of the present were similar to study conducted Lund et al where 18 out of 21 patients were asymptomatic after second week of treatment and Mann et al where 15 out of 16 patients were asymptomatic after four weeks.…”

Section: Discussionmentioning

confidence: 96%

Comparative evaluation of 5% lignocaine ointment and a combination of 0.2% glyceryl trinitrate and 5% lignocaine in management of acute fissure in ano.

et al. 2017

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Background: Anal fissure is one of the most common anorectal problem and presents as a tear in the anoderm distal to the dentate line. It is a common proctologic problem and accounts for 10-15% of proctological consultations and seen frequently in young and middle-aged patients. Presently wide range of medical and surgical treatment options were available. Present study was aimed to evaluate the therapeutic efficacy of 5% lignocaine ointment and a combination of 0.2% glyceryl trinitrate and 5% lignocaine in management of acute fissure in ano.Methods: In the present study, a total of 100 patients diagnosed with acute fissure in ano were randomly allocated into two groups (I, II) of 50 patients each and were managed by local application of 5% Lignocaine (LIG) ointment and a combination of both 0.2% Glyceryl trinitrate (NTG) and 5% Lignocaine (LIG) ointment respectively.Results: In the present study, the incidence of anal fissure was higher in males than in females with mean age of occurrence of 35.12 years. Pain was the most common symptom to present with. After six weeks, complete pain relief was seen in most of the patients and was comparable in both the groups but healing was superior in group II when compared to group I. Headache and dizziness were the side effects only noticed in group II.Conclusions: To conclude the study, we can say that the treatment of anal fissure is becoming increasingly medical as it can be carried out on outpatient basis and is cost effective and there is no loss of man hours. Lignocaine may be preferred as the first line treatment as there are no side effects and if there is failure to heal then we can prescribe the combination of both drugs owing to their risk benefit ratio.

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Randomized clinical trial assessing the side-effects of glyceryl trinitrate and diltiazem hydrochloride in the treatment of chronic anal fissure

Abstract: DTZ cream caused substantially fewer headaches than GTN ointment. There was no significant difference in the healing or improvement of chronic anal fissure between the treatments. DTZ may be the preferred first-line treatment for chronic anal fissure.

Cited by 132 publications

References 16 publications

Comparison of Observational and Controlled Clinical Trials of Diltiazem in the Treatment of Chronic Anal Fissure

Comparison of Observational and Controlled Clinical Trials of Diltiazem in the Treatment of Chronic Anal Fissure

Modern Perspectives in the Treatment of Chronic Anal Fissures

Comparative evaluation of 5% lignocaine ointment and a combination of 0.2% glyceryl trinitrate and 5% lignocaine in management of acute fissure in ano.

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