Topical Diltiazem versus Topical Sucralfate and Lignocaine in the Treatment of Chronic Fissure in Ano: A Prospective Randomized Control Trial
Abstract Background: Chronic anal fissure is the most prevalent anorectal disorder, characterized by linear or oval ulcers in the anal canal's squamous epithelium. Although lateral sphincterotomy stands as the gold standard for treatment, chemical sphincterotomy with calcium channel blockers, n...
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| Published in: | Journal of Surgical Specialties and Rural Practice Vol. 5; no. 3; pp. 70 - 74 |
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| Main Authors: | , , , |
| Format: | Journal Article |
| Language: | English |
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India
Wolters Kluwer - Medknow
01.09.2024
Medknow Publications and Media Pvt. Ltd Wolters Kluwer Medknow Publications |
| Edition: | 2 |
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| ISSN: | 2772-3143, 2772-3151 |
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| Abstract | Abstract
Background:
Chronic anal fissure is the most prevalent anorectal disorder, characterized by linear or oval ulcers in the anal canal's squamous epithelium. Although lateral sphincterotomy stands as the gold standard for treatment, chemical sphincterotomy with calcium channel blockers, nitrates, and botulinum toxins is favored in the initial stages to avoid surgical side effects.
Aim and Objectives:
The goal is to assess the efficacy of topical diltiazem in treating chronic fissure in ano, particularly its impact on pain, bleeding, discharge, recurrence rates, and healing compared to the lignocaine-sucralfate combination.
Materials and Methods:
A prospective, randomized controlled study was conducted at Mahatma Gandhi Medical College and Research Institute, Puducherry, from October 2014 to April 2016, involving 100 cases. Subjects were divided into two groups: Group A received topical 2% diltiazem and Group B was treated with 2% lignocaine and 7% sucralfate. Both groups followed a regimen including a high-fiber diet, sitz baths, and laxatives, with follow-ups at 2, 4, 6 weeks, and 6 months to evaluate treatment outcomes.
Results:
Significant improvements were noted in Group A, with pain reduction from a mean of 6.48 to 0.48 by the 6th week. Both groups saw enhanced healing rates and reductions in symptoms, with Group A exhibiting a lower recurrence rate, indicating the superior efficacy of 2% diltiazem.
Conclusion:
Topical 2% diltiazem is more effective in treating chronic anal fissure than the combination of 2% lidocaine gel and 7% sucralfate, offering better pain management, healing rates, and lower recurrence, making it a preferred treatment option. |
|---|---|
| AbstractList | Background: Chronic anal fissure is the most prevalent anorectal disorder, characterized by linear or oval ulcers in the anal canal’s squamous epithelium. Although lateral sphincterotomy stands as the gold standard for treatment, chemical sphincterotomy with calcium channel blockers, nitrates, and botulinum toxins is favored in the initial stages to avoid surgical side effects. Aim and Objectives: The goal is to assess the efficacy of topical diltiazem in treating chronic fissure in ano, particularly its impact on pain, bleeding, discharge, recurrence rates, and healing compared to the lignocaine–sucralfate combination. Materials and Methods: A prospective, randomized controlled study was conducted at Mahatma Gandhi Medical College and Research Institute, Puducherry, from October 2014 to April 2016, involving 100 cases. Subjects were divided into two groups: Group A received topical 2% diltiazem and Group B was treated with 2% lignocaine and 7% sucralfate. Both groups followed a regimen including a high-fiber diet, sitz baths, and laxatives, with follow-ups at 2, 4, 6 weeks, and 6 months to evaluate treatment outcomes. Results: Significant improvements were noted in Group A, with pain reduction from a mean of 6.48 to 0.48 by the 6th week. Both groups saw enhanced healing rates and reductions in symptoms, with Group A exhibiting a lower recurrence rate, indicating the superior efficacy of 2% diltiazem. Conclusion: Topical 2% diltiazem is more effective in treating chronic anal fissure than the combination of 2% lidocaine gel and 7% sucralfate, offering better pain management, healing rates, and lower recurrence, making it a preferred treatment option. Background: Chronic anal fissure is the most prevalent anorectal disorder, characterized by linear or oval ulcers in the anal canal's squamous epithelium. Although lateral sphincterotomy stands as the gold standard for treatment, chemical sphincterotomy with calcium channel blockers, nitrates, and botulinum toxins is favored in the initial stages to avoid surgical side effects. Aim and Objectives: The goal is to assess the efficacy of topical diltiazem in treating chronic fissure in ano, particularly its impact on pain, bleeding, discharge, recurrence rates, and healing compared to the lignocaine-sucralfate combination. Materials and Methods: A prospective, randomized controlled study was conducted at Mahatma Gandhi Medical College and Research Institute, Puducherry, from October 2014 to April 2016, involving 100 cases. Subjects were divided into two groups: Group A received topical 2 diltiazem and Group B was treated with 2 lignocaine and 7 sucralfate. Both groups followed a regimen including a high-fiber diet, sitz baths, and laxatives, with follow-ups at 2, 4, 6 weeks, and 6 months to evaluate treatment outcomes. Results: Significant improvements were noted in Group A, with pain reduction from a mean of 6.48 to 0.48 by the 6[sup.th] week. Both groups saw enhanced healing rates and reductions in symptoms, with Group A exhibiting a lower recurrence rate, indicating the superior efficacy of 2 diltiazem. Conclusion: Topical 2 diltiazem is more effective in treating chronic anal fissure than the combination of 2 lidocaine gel and 7 sucralfate, offering better pain management, healing rates, and lower recurrence, making it a preferred treatment option. Keywords: Chronic fissure in ano, lidocaine gel, topical diltiazem, topical sucralfate Abstract Background: Chronic anal fissure is the most prevalent anorectal disorder, characterized by linear or oval ulcers in the anal canal's squamous epithelium. Although lateral sphincterotomy stands as the gold standard for treatment, chemical sphincterotomy with calcium channel blockers, nitrates, and botulinum toxins is favored in the initial stages to avoid surgical side effects. Aim and Objectives: The goal is to assess the efficacy of topical diltiazem in treating chronic fissure in ano, particularly its impact on pain, bleeding, discharge, recurrence rates, and healing compared to the lignocaine-sucralfate combination. Materials and Methods: A prospective, randomized controlled study was conducted at Mahatma Gandhi Medical College and Research Institute, Puducherry, from October 2014 to April 2016, involving 100 cases. Subjects were divided into two groups: Group A received topical 2% diltiazem and Group B was treated with 2% lignocaine and 7% sucralfate. Both groups followed a regimen including a high-fiber diet, sitz baths, and laxatives, with follow-ups at 2, 4, 6 weeks, and 6 months to evaluate treatment outcomes. Results: Significant improvements were noted in Group A, with pain reduction from a mean of 6.48 to 0.48 by the 6th week. Both groups saw enhanced healing rates and reductions in symptoms, with Group A exhibiting a lower recurrence rate, indicating the superior efficacy of 2% diltiazem. Conclusion: Topical 2% diltiazem is more effective in treating chronic anal fissure than the combination of 2% lidocaine gel and 7% sucralfate, offering better pain management, healing rates, and lower recurrence, making it a preferred treatment option. Chronic anal fissure is the most prevalent anorectal disorder, characterized by linear or oval ulcers in the anal canal's squamous epithelium. Although lateral sphincterotomy stands as the gold standard for treatment, chemical sphincterotomy with calcium channel blockers, nitrates, and botulinum toxins is favored in the initial stages to avoid surgical side effects. The goal is to assess the efficacy of topical diltiazem in treating chronic fissure in ano, particularly its impact on pain, bleeding, discharge, recurrence rates, and healing compared to the lignocaine-sucralfate combination. A prospective, randomized controlled study was conducted at Mahatma Gandhi Medical College and Research Institute, Puducherry, from October 2014 to April 2016, involving 100 cases. Subjects were divided into two groups: Group A received topical 2 diltiazem and Group B was treated with 2 lignocaine and 7 sucralfate. Both groups followed a regimen including a high-fiber diet, sitz baths, and laxatives, with follow-ups at 2, 4, 6 weeks, and 6 months to evaluate treatment outcomes. Significant improvements were noted in Group A, with pain reduction from a mean of 6.48 to 0.48 by the 6[sup.th] week. Both groups saw enhanced healing rates and reductions in symptoms, with Group A exhibiting a lower recurrence rate, indicating the superior efficacy of 2 diltiazem. Topical 2 diltiazem is more effective in treating chronic anal fissure than the combination of 2 lidocaine gel and 7 sucralfate, offering better pain management, healing rates, and lower recurrence, making it a preferred treatment option. |
| Audience | Academic |
| Author | Sadayappan, Vinothkumar Sundaresan, Vinoth Rajendiran, R Kannan Aroul, T Tirou |
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| Cites_doi | 10.1046/j.1463-1318.2003.00440.x 10.1136/gut.39.3.465 10.1007/BF02553100 10.1308/003588407X202137 10.1007/BF02234624 10.1002/bjs.1800791248 10.1046/j.1463-1318.2002.00294.x 10.1007/BF02050683 10.1016/0002-9610(77)90445-7 10.1007/BF02054225 10.1002/bjs.1800760504 |
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| References_xml | – volume: 5 start-page: 256 year: 2003 ident: R17-20241130 article-title: A prospective randomized trial of diltiazem and glyceryltrinitrate ointment in the treatment of chronic anal fissure publication-title: Colorectal Dis doi: 10.1046/j.1463-1318.2003.00440.x – volume: 39 start-page: 465 year: 1996 ident: R11-20241130 article-title: Pathophysiological aspects and clinical outcome of intra-anal application of isosorbide dinitrate in patients with chronic anal fissure publication-title: Gut doi: 10.1136/gut.39.3.465 – volume: 25 start-page: 198 year: 1982 ident: R8-20241130 article-title: Anal sphincteric pressure in fissure-in-ano before and after lateral internal sphincterotomy publication-title: Dis Colon Rectum doi: 10.1007/BF02553100 – volume: 3 start-page: 2710 year: 2015 ident: R3-20241130 article-title: Study of 100 cases of chronic fissure in Ano for comparing between anal canal dilatation and lateral anal sphincterotomy publication-title: Scholars J Appl Med Sci – volume: 6 start-page: 1014 year: 2012 ident: R13-20241130 article-title: Topical diltiazem is superior to topical lignocaine in the treatment of chronic anal fissure:Results of A prospective comparative study publication-title: J Clin Diagn Res – volume: 89 start-page: 472 year: 2007 ident: R14-20241130 article-title: Modern perspectives in the treatment of chronic anal fissures publication-title: Ann R Coll Surg Engl doi: 10.1308/003588407X202137 – volume: 44 start-page: 1074 year: 2001 ident: R18-20241130 article-title: A randomized trial of oral versus topical diltiazem for chronic anal fissures publication-title: Dis Colon Rectum doi: 10.1007/BF02234624 – volume: 79 start-page: 1381 year: 1992 ident: R7-20241130 article-title: Manual dilatation of the anus publication-title: Br J Surg doi: 10.1002/bjs.1800791248 – volume: 4 start-page: 20 year: 2002 ident: R15-20241130 article-title: Successful treatment of chronic anal fissure with diltiazem gel publication-title: Colorectal Dis doi: 10.1046/j.1463-1318.2002.00294.x – volume: 20 start-page: 93 year: 2002 ident: R16-20241130 article-title: Long term follow up of the trial patients who were treated with diltiazem for anal fissure publication-title: Colorectal Dis – volume: 35 start-page: 206 year: 1992 ident: R6-20241130 article-title: Practice parameters for the management of anal fissure. The standards task force American Society of Colon and Rectal Surgeons publication-title: Dis Colon Rectum doi: 10.1007/BF02050683 – volume: 134 start-page: 608 year: 1977 ident: R5-20241130 article-title: Anal pressures in hemorrhoids and anal fissure publication-title: Am J Surg doi: 10.1016/0002-9610(77)90445-7 – volume: 19 start-page: 614 year: 2009 ident: R10-20241130 article-title: Topical diltiazem hydrochloride and glyceryl trinitrate in the treatment of chronic anal fissure publication-title: J Coll Physicians Surg Pak – volume: 38 start-page: 378 year: 1995 ident: R12-20241130 article-title: Anal fissure. 20-year experience publication-title: Dis Colon Rectum doi: 10.1007/BF02054225 – volume: 66 start-page: 190 year: 2023 ident: R2-20241130 article-title: The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures publication-title: Dis Colon Rectum – volume: 76 start-page: 431 year: 1989 ident: R9-20241130 article-title: Sequelae of internal sphincterotomy for chronic fissure in ano publication-title: Br J Surg doi: 10.1002/bjs.1800760504 |
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Background:
Chronic anal fissure is the most prevalent anorectal disorder, characterized by linear or oval ulcers in the anal canal's squamous... Background: Chronic anal fissure is the most prevalent anorectal disorder, characterized by linear or oval ulcers in the anal canal's squamous epithelium.... Chronic anal fissure is the most prevalent anorectal disorder, characterized by linear or oval ulcers in the anal canal's squamous epithelium. Although lateral... Background: Chronic anal fissure is the most prevalent anorectal disorder, characterized by linear or oval ulcers in the anal canal’s squamous epithelium.... |
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| SubjectTerms | Anal fissure Calcium channels Care and treatment chronic fissure in ano Clinical trials Diltiazem Gastrointestinal diseases Lidocaine lidocaine gel Medical colleges Nitrates Original Article Pain Sucralfate topical diltiazem topical sucralfate |
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| Title | Topical Diltiazem versus Topical Sucralfate and Lignocaine in the Treatment of Chronic Fissure in Ano: A Prospective Randomized Control Trial |
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