A Prospective Randomized Comparative Evaluation of Oral Diltiazem and Topical Diltiazem (2%) Ointment in the Treatment of Chronic Anal Fissure

Objectives To evaluate and prospectively compare the efficacy of oral diltiazem and topical 2 % diltiazem ointment in patients with chronic anal fissure in terms of improvement in sign and symptoms, time taken for healing, side effects and recurrence, if any. Study design 50 patients with chronic anal fissure were randomly divided in two groups. In one group oral diltiazem was given and in another topical diltiazem ointment was given for treatment and comparative evaluation was done. Results Complete healing was observed in 40 % patients in oral diltiazem group and 80 % patients in topical diltiazem group at the end of 6 weeks. Oral diltiazem group patients reported headache and nausea and vomiting whereas in topical diltiazem group one patient developed anal excoriation. Recurrence rate was more in oral diltiazem group than topical diltiazem group at 3 months of follow up. Conclusion While considering medical management for treating chronic anal fissure topical diltiazem ointment may be the preferred first line treatment.