Tratamiento de la fisura anal crónica con diltiazem gel 2%seis años de experiencia

Abstract

Introduction. In recent years, the medical treatment of chronic anal fissure has consolidated as the choice as a result of the morbidity associated to surgical sphincterotomy. Patients and Method. We studied patients diagnosed of chronic anal fissure in our hospital during the period January 2008 to December 2013 (6 years). Inclusion criteria: age greater 18 and less than 65 years, manometry with hypertensive internal anal sphincter and signed informed consent. Exclusion criteria: previous anorrectal surgery, inflammatory bowel disease, intolerance or allergy to calcium antagonists, cognitive impairment, immune suppression, hypotension, and atrioventricular block. We used a formulation of diltiazem gel 2% in 3 daily applications for 8 weeks. There was a clinical and an extent of pain evaluation by visual analog scale (VAS) at the end of the fourth, sixth and eighth weeks. We compared the groups with and without response to diltiazem by the ?2 and the Student test. Results. 46 patients were excluded, because they could ?nt be contacted the follow-up (lost patients). We analyzed 265 patients (137 woman) with a mean age of 46, 7 (18 to 65) years. Localization of the fissure: Posterior 96%, anterior 3% and side 1%. All had pain, 231 bleeding and 198 itching. At the end of 8 weeks of treatment 65.7% (174 patients) were cured, with a morbidity of 11, 7%, of which the 2,6% discontinued the treatment due to adverse effects. Of the 174 patients who improved with treatment, 142 (81,6%) improved after four weeks of treatment, 27 (15,5%) after 6 weeks and only 5 (2, 9%) patients, after the eighth week, with a statistically significant difference (p <0.005) among responders at four weeks, compared to sixth and eighth week of initiation of treatment. There were no significant differences (p< 0,05) between groups with and without response to diltiazem related to age, sex, location, bleeding or itching. After a mean follow up of 31 (7 to72) months, 43 recurrences were detected (16,2%). The median time to recurrence after successful completion of treatment was 5.7 (2.5 to 32) months Conclusions. Diltiazem 2% gel is an effective drug in the treatment of chronic anal fissure, in selected cases. No major side effects were observed with an acceptable compliance, avoiding the morbidity associated to surgical sphincterotomy. Although recurrences are relatively common, they often respond to repeated treatment with diltiazem. Objective. To evaluate the efficacy, safety and recurrence of topical diltiazem in the treatment of chronic anal fissure.