A RANDOMIZED TRIAL OF TOPICAL DIAZEPAM AND TOPICAL DILTIAZEM IN THE TREATMENT OF CHRONIC ANAL FISSURE.

Dr. Sampath Kumar Appuchami.K; Dr. Indira.G; Dr. Kannan.R

Volume : IX, Issue : VIII, August - 2020

A RANDOMIZED TRIAL OF TOPICAL DIAZEPAM AND TOPICAL DILTIAZEM IN THE TREATMENT OF CHRONIC ANAL FISSURE.

Dr. Sampath Kumar Appuchami. K, Dr. Indira. G, Dr. Kannan. R

Abstract :

BACKGROUND Anal fissure is a common surgical problem causing pain and discomfort in the perinealregion .Surgery was the definitive treatment for chronic anal fissure but emerging non pharmacological therapy with diltiazem,nitroglycerine has made non surgical treatment the first choice in treating it.Although there are many advantages with non surgical therapy , surgical sphincterotomy is the ultimate treatment for fissure in ano and each method has its own disadvantages . AIM To determine and compare the outcome of topical diazepam and topical diltiazem in the treatment of chronic anal fissures Objectives: To determine the efficacy of topical diazepam and topical diltiazem on chronic anal fissures by assessing pain relief and per rectal bleeding and to determine the side effects of diazepam and diltiazem on chronic anal fissure like faecal incontinence,perianal itching,dizziness . Materials and methods Around 60 patients presented to department of general surgery out patientdepartment were included in sequential manner based on inclusion criteria .Clinical examination and history was obtained from these patients and 1 group of patients received Diltiazem cream and other group received Diazepam cream ,both given in similar looking containers . These patient were reviewed 6 weeks after the therapy to look for reduction of symptoms and also to look for side effects. RESULTS We have concluded that majority of the chronic anal fissure occur among male gender (61.66 %).This study also concludes that the maximal incidence of chronic anal fissure occurs in the middle aged group and that pain is the most common presenting complaint in chronic anal fissure . Pain relief and bleeding was better with 2% Diltiazem when compared with 2% Diazepam ,and side effects were lesser in patients who used Diltiazem when compared with Diazepam (3 patients complained of dizziness). CONCLUSION Both diltiazem and diazepam has their own merits and demerits .Inspite of many studies showing the superiority of diltiazem over other pharmacological preparations ,in this study where diltiazem was compared with diazepam we conclude that diazepam is not efficacious than diltiazem . Larger study population and multicentric studies need to be done to concrete this evidence .