Comparative Study to Assess the Effectiveness of Topical Nifedipine and Diltiazem in the Treatment of Chronic Anal Fissure.

BACKGROUND: Chronic anal fissure is a common condition which is classically treated by surgery which may lead to incontinence. Recently medical treatment in form of calcium channel blockers (CCB) has gained interest.

AIMS: The aim of this study is to compare the effectiveness of local Nifedipine and Diltiazem with lignocaine as control. We also aimed to observe the clinical pattern of chronic anal fissure.

MATERIAL AND METHOD: Patients of chronic anal fissure were divided into three groups. First group received topical Nifedipine, second received topical Diltiazem, and the control group received only local lignocaine for 1 month. Their clinical data was recorded. The intensity of pain and bleeding was assessed from a visual analogue score (VAS). On the 4th week patients were examined for healing.

STATISTICAL ANALYSIS: Statistical analysis was done by Medcalc statistical software v14. Student's t -test and Chi-square test was used accordingly.

RESULTS: Mean age was 35.89 with a male female ratio of 1.7:1. Most common clinical feature was pain (100%), followed by constipation, bleeding, and pruritus. Most common location was posterior. VAS scores for pain of the Nifedipine group and Diltiazem group was significantly better than control group ( P < 0.0001). VAS scores for bleeding in the Nifedipine group ( P = 0.0091) and Diltiazem group ( P = 0.0045) was significantly better than control group. The healing rate for NFD group was 93.33% ( P < 0.0001), that of DTZ group was 86.67% ( P = 0.0002), which was statistically better than control group (36.67%). There was no significant difference between the two CCBs.

CONCLUSION: Adding topical Nifedipine or Diltiazem in the treatment of anal fissure is far superior to treatment with only topical Lignocaine.