Systematic review of the use of topical diltiazem compared with glyceryltrinitrate for the nonoperative management of chronic anal fissure
Article first published online: 20 DEC 2012
© 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland
Volume 15, Issue 1, pages 19–26, January 2013
How to Cite
Sajid, M. S., Whitehouse, P. A., Sains, P. and Baig, M. K. (2013), Systematic review of the use of topical diltiazem compared with glyceryltrinitrate for the nonoperative management of chronic anal fissure. Colorectal Disease, 15: 19–26. doi: 10.1111/j.1463-1318.2012.03042.x
- Issue published online: 20 DEC 2012
- Article first published online: 20 DEC 2012
- Accepted manuscript online: 7 APR 2012 11:13AM EST
- Received 6 June 2011; accepted 20 January 2012; Accepted Article online 7 April 2012
- Chronic anal fissure;
- peri-anal irritation
Aim The study analyzed clinical trials investigating the effectiveness of diltiazem (DTZ) and glyceryltrinitrate (GTN) for the nonsurgical management of chronic anal fissure (CAF).
Method Randomized trials on the effectiveness of DTZ and GTN were analyzed systematically using RevMan® where combined outcome was expressed as risk ratio (RR).
Results Seven randomized controlled trials that included 481 patients were analyzed. Two-hundred and thirty-eight patients were treated with DTZ and 243 patients were treated with GTN. There was significant heterogeneity [Tau2 = 0.24, χ2 = 13.16, d.f. = 6 (P < 0.05); I2 = 54%] among the included trials. In the random-effects model, DTZ was associated with a lower incidence of side effects (RR = 0.48; 95% CI = 0.27, 0.86; z = 2.46; P < 0.01), headache (RR = 0.39; 95% CI = 0.24, 0.66; z = 3.54; P < 0.004) and recurrence (RR = 0.68; 95% CI = 0.52, 0.89; z = 2.77; P < 0.006) of CAF. Both GTN and DTZ were equally effective (RR = 1.10; 95% CI = 0.90, 1.34; z = 0.92; P = 0.36) in the nonsurgical management of CAF.
Conclusion This systematic review of seven trials validates and strengthens the finding of a previously published meta-analysis of two randomized trials. Both DTZ and GTN are equally effective in the management of CAF. However, DTZ is associated with a lower incidence of headache and recurrent fissure. Therefore DTZ should be the preferred first line of treatment for CAF.