Botulinum toxin vs isosorbide dinitrate ointment for anal fissure treatment

A study in December's issue of the British Journal of Surgery compares botulinum toxin versus isosorbide dinitrate ointment for treatment of anal fissure.

Nitric oxide donors such as isosorbide dinitrate are considered the first choice of treatment for anal fissure.

After reports of the successful treatment of such fissures with botulinum toxin, Dr Festen and colleagues performed a randomized blinded trial comparing botulinum toxin with isosorbide dinitrate in the treatment of chronic anal fissure.

Pain scores were lower with isosorbide dinitrate

British Journal of Surgery

The team randomized patients to receive an injection of botulinum in the internal anal sphincter and a placebo ointment, or a placebo injection and isosorbide dinitrate ointment.

The primary endpoint was macroscopic fissure healing after 4 months.

The researchers found that after 4 months macroscopic healing of the fissures was noted in 14 of 37 patients in the botulinum group, and 21 of 36 in the isosorbide dinitrate group.

Pain scores were lower among patients who received isosorbide dinitrate, although the difference was not significant.

Side-effects were similar in the 2 groups.

Dr Festen's team concluded, “In contrast with previous reports on botulinum toxin as a therapeutic agent for anal fissure, this study found no advantage over treatment with a nitric oxide donor as regards fissure healing and fissure-related pain.”