Systematic review of the use of topical diltiazem compared with glyceryltrinitrate for the non-operative management of chronic anal fissure

Abstract

Aim:  The study analyzed the clinical trials on the effectiveness of diltiazem (DTZ) and glyceryltrinitrate (GTN) for the non-surgical management of chronic anal fissure (CAF).

Method:  Randomized trials on the effectiveness of DTZ and GTN were analysed systematically using RevMan® where combined outcome was expressed as risk ratio (RR).

Results:  Seven randomized controlled trials including 481 patients were analysed. There were 238 patients having DTZ group and 243 patients having GTN. There was significant heterogeneity [Tau² = 0.24, chi² = 13.16, df = 6, (p < 0.05); I² = 54%] among the included trials. In the random effects model, DTZ was associated with a lower incidence (RR, 0.48; 95% CI, 0.27, 0.86; z = 2.46; p < 0.01) of side effects, 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 non-surgical 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. diltiazem should therefore be the preferred first line treatment for CAF.

© 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland