Increasing efficacy and reducing side effects in treatment of chronic anal fissures: A study of topical diazepam therapy

• Published in: Medicine (Baltimore) 2017-05, Vol.96 (20), p.e6853-e6853
• Main Authors: Hang, Minh Tuan H., Smith, Betsy E., Keck, Carson, Keshavarzian, Ali, Sedghi, Shahriar
• Format: Article
• Language: English
• Subjects: Administration, Topical; Analgesics - administration & dosage; Analgesics - adverse effects; Chronic Disease; Diazepam - administration & dosage; Diazepam - adverse effects; Dose-Response Relationship, Drug; Drug Resistance; Female; Fissure in Ano - drug therapy; Fissure in Ano - physiopathology; Follow-Up Studies; Hemorrhage - drug therapy; Hemorrhage - physiopathology; Humans; Male; Middle Aged; Outpatients; Pain - drug therapy; Pain - physiopathology; Pain Measurement; Quality Improvement; Quality Improvement Study; Retrospective Studies
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000006853

This is a single institution nonexperimental study intended to analyze the therapeutic efficacy of topical diazepam in treating symptoms of chronic anal fissures.Anal fissures are a common cause of anal pain. Conventional treatments include nonsteroidal anti-inflammatory drugs, topical creams, such as nitroglycerin and nifedipine, and surgery. However, these treatments are usually suboptimally efficacious or have deterring side effects.Patients at an outpatient community center with a diagnosis of a chronic anal fissure were prescribed either topical 2% (n = 19) or 4% (n = 18) diazepam cream between January 2013 and February 2015. We retrospectively analyzed their responses to treatment.All 19 patients using 2% diazepam cream experienced a positive response in pain, whereas 47.4% experienced a complete response, with a numerical rating scale (NRS) score of 0 (0-10). Eighty-eight percent of patients using 4% dose had a positive response in pain, whereas 23.5% experienced a complete response. Ninety-four percent of patients using 2% dose had a positive response in anal bleeding, whereas 68.8% experienced a complete response with an anal bleeding score (ABS) of 2 (2-9). Ninety-four percent of patients using 4% dose had a positive response in anal bleeding, whereas 64.7% experienced a complete response. Only 1 patient reported a side effect from diazepam cream-perianal pruritus.Both 2% and 4% topical diazepam provided significant pain and bleeding relief from chronic anal fissures that were refractory to conventional therapies. There were insignificant differences when assessing independent comparisons for pain and bleeding between the doses.