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OBJECTIVE	To further resolve the clinical equipoise on the choice of chemical sphincterotomy agent for early symptomatic relief of anal fissure by comparing the effectiveness of 2 % Diltiazem gel with 0.2 % Glyceryl TriNitrate .
METHODS	The randomized clinical trial was conducted at Aga Khan University Hospital , Karachi , from February 1 , to July 30 , 2008 , and comprised 60 adult patients with anal fissure who were equally randomised to either Diltiazem or Glyceryl TriNitrate after taking informed consent .
METHODS	The creams were applied locally ; the former twice daily , and the latter three times a day for a period of two weeks .
METHODS	The rest of the treatment was standard .
METHODS	Patients were followed up in clinic by the principal investigator at two weeks for primary outcome i.e. self-reported symptomatic relief on Visual Analogue Scale , and secondary outcomes i.e. side effects and the overall cost of treatment .
RESULTS	Of the total , 31 ( 52 % ) patients were males and the overall mean age was 37 + / - 11 years .
RESULTS	Patients , who used Diltiazem reported more symptomatic relief than Glyceryl TriNitrate ( p < 0.01 ) .
RESULTS	Side effects were found more in Glyceryl TriNitrate than Diltiazem ( p < 0.01 ) , and most common side effect in the former group was headache in 12 ( 40 % ) patients .
RESULTS	Cost of the treatment was not significantly different between both treatment arms ( p < 0.28 ) .
CONCLUSIONS	Chemical sphincterotomy with topical 2 % Diltiazem gel is an effective first-line treatment for early symptomatic relief of anal fissures , owing to negligible side effects .

