Long-term follow-up of chronic anal fissure (CAF) on diltiazem 2% using a telephone questionnaire. Do results change?

Introduction: Calcium channel blockers have an excellent effectiveness in the conservative management of chronic anal fissure (CAF).

Objectives: To assess the long-term results of management with diltiazem 2% ointment using a telephone questionnaire.

Methods: A descriptive, retrospective study from March 2004 to March 2011 in patients with CAF on diltiazem 2%, 3 applications daily for 4-6 weeks. Starting at 12 months a questionnaire was administered over the phone by medical staff outside the surgery department to record socio-demographic data, predominant manifestations, and response to diltiazem on a 5-point scale measuring symptom relief (1 = poorest, 5 = best). Patients with therapy failure were referred to surgery.

Results: The study was completed for 166 patients with a mean age of 54.1 years. CAF was posterior in 82.3% of subjects. Diltiazem tolerability was excellent with only 4 adverse event cases (3 skin irritation, 1 hypotension). We obtained symptom relief in 62.1% of patients and CAF healing in 51.2%, and referred 33.7% to surgery. The questionnaire showed that 74.1% of patients had used only 2 applications daily, and that results were better with an increased number of applications, albeit without statistical significance.

Conclusions: The telephone questionnaire showed symptom relief for 62% and healing for 51.2% of patients with CAF on diltiazem 2%, which should be considered first-choice for the conservative management of this condition.