Evaluation of clinical effectiveness of topical 0.2% glyceryl trinitrate, topical 2% diltiazem and their combination in the treatment of chronic anal fissure

Authors

  • Bikash Bahadur Rayamajhi Assistant Professor, Department of Surgery, Nepalese Army Institute of Health Sciences (NAIHS), Sanobharyang, Kathmandu, Nepal https://orcid.org/0000-0001-8666-4761
  • Anjan Khadka Assistant Professor, Department of Pharmacology, Nepalese Army Institute of Health Sciences (NAIHS), Sanobharyang, Kathmandu, Nepal https://orcid.org/0000-0002-1540-6316
  • Kabir Thakali Assistant Professor, Department of Accident and Emergency, Nepalese Army Institute of Health Sciences (NAIHS), Sanobharyang, Kathmandu, Nepal https://orcid.org/0000-0002-7624-0604
  • Bikash Bikram Thapa Assistant Professor, Department of Surgery, Nepalese Army Institute of Health Sciences (NAIHS), Sanobharyang, Kathmandu, Nepal
  • Narayan Thapa Associate Professor, Department of Surgery, Nepalese Army Institute of Health Sciences (NAIHS), Sanobharyang, Kathmandu, Nepal
  • Bharat Bahadur Bhandari Associate Professor, Department of Surgery, Nepalese Army Institute of Health Sciences (NAIHS), Sanobharyang, Kathmandu, Nepal

DOI:

https://doi.org/10.3126/jkmc.v8i3.29723

Keywords:

Anal Fissure, Chemical Sphincterotomy, Constipation, Pain, Sitz bath

Abstract

Background: The longitudinal tear or defect in the epithelial lining of the anal canal distal to the dentate line is called anal fissure. It is of two types: acute and chronic. The break in the cycle of pain, spasm and ischemia is essential for successful treatment of anal fissure. Among multiple non-surgical treatment approaches, the appropriate approach with good patient compliance might be the use of topical agents as chemical sphincterotomy. However, the effectiveness of these agents has not been evaluated widely.

Objectives: To evaluate clinical effectiveness of topical 0.2% glyceryl trinitrate, topical 2% diltiazem and their combination in the treatment of chronic anal fissure.

Methodology: The study was prospective comparative type including total 158 patients. Initially, they were given first line therapy followed by chemical sphincterotomy agents. The study drugs were given to 84 patients (three groups - 0.2% glyceryl trinitrate, 2% diltiazem and their combination) who were not healed after initial therapy. Patients were assessed for pain using visual analogue scale and other symptoms prior to and after two and six weeks of therapy.

Results: Complete healing rate was higher with combination (92.86%) than individual agents. The reduction of visual analog scale score within each group and between the groups in the period between before and after treatment was found to be statistically significant. Headache and hypotension were the common side effects seen during study.

Conclusion: Anal fissures can be successfully managed by chemical sphincterotomy. The topical nitrates and calcium channel blockers in combination are found to be effective choice rather than individual agents.

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Published

2020-06-27

How to Cite

Rayamajhi, B. B., Khadka, A., Thakali, K., Thapa, B. B., Thapa, N., & Bhandari, B. B. (2020). Evaluation of clinical effectiveness of topical 0.2% glyceryl trinitrate, topical 2% diltiazem and their combination in the treatment of chronic anal fissure. Journal of Kathmandu Medical College, 8(3), 156–161. https://doi.org/10.3126/jkmc.v8i3.29723

Issue

Vol. 8 No. 3 (2019)

Section

Original Research Articles

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