From the Guidelines
Topical Calcium Channel Blockers (CCBs) are effective in treating anal fissures.
Key Points
- The primary goal of anal fissure (AF) therapy is to achieve internal anal sphincter (IAS) relaxation, reducing pain and facilitating the healing process 1.
- Topical CCBs, such as diltiazem or nifedipine, are effective in treating AF, with healing rates ranging from 65 to 95% 1.
- CCBs work by blocking slow L-type calcium channels of vascular smooth muscle cells, reducing IAS tone and promoting an increase in local blood flow 1.
- A systematic review and meta-analysis found that CCBs are more effective than glyceryl trinitrate and have fewer side effects, such as headache and hypotension 1.
- The optimal duration of therapy is not established, but administration for at least 6 weeks is suggested, with pain relief usually occurring after 14 days 1.
- Topical CCBs are a viable alternative to other treatments, such as surgery or botulinum toxin injection, and have a remarkable cost-effectiveness compared to other non-operative treatments 1.
- The American Gastroenterological Association recommends considering topical therapy, including CCBs, as a treatment option for anal fissures, especially for patients who do not respond to conservative care or have significant pain 1.
From the Research
Effectiveness of Topical Calcium Channel Blockers (CCBs) in Treating Anal Fissures
- Topical CCBs, such as nifedipine and diltiazem, have been shown to be effective in treating anal fissures, with healing rates ranging from 49% to 93.33% 2, 3, 4, 5.
- A systematic review and meta-analysis found that glyceryl trinitrate (GTN) was significantly more likely to heal anal fissure than placebo, and diltiazem was marginally significantly more effective than GTN 6.
- Topical nifedipine has been shown to be effective in healing anal fissures, with a healing rate of 70% in one study, and 93.33% in another study 3, 5.
- Diltiazem has also been shown to be effective, with a healing rate of 49% in one study, and 86.67% in another study 4, 5.
- The use of topical CCBs has been associated with fewer side effects compared to other treatments, such as GTN, with mild headache being the most common side effect 3, 4.
Comparison of Topical CCBs with Other Treatments
- Topical CCBs have been compared to other treatments, such as GTN and lignocaine, and have been found to be more effective in healing anal fissures 6, 5.
- A study found that topical nifedipine and diltiazem were significantly more effective than lignocaine in reducing pain and bleeding, and in healing anal fissures 5.
- Another study found that diltiazem was effective in healing glyceryl trinitrate-resistant chronic anal fissures, with a healing rate of 49% 4.
Clinical Implications
- The use of topical CCBs, such as nifedipine and diltiazem, may be a viable alternative to surgical treatment for anal fissures, with fewer side effects and a lower risk of incontinence 2, 3, 4, 5.
- Topical CCBs may be particularly useful for patients who are resistant to other treatments, or who have failed to respond to other medical therapies 4.
- Further studies are needed to fully establish the effectiveness of topical CCBs in treating anal fissures, and to compare their efficacy with other treatments 6.