Dr Heiko Fruehauf and colleagues from Switzerland evaluated the efficacy and safety of botulinum toxin A injection in chronic anal fissure.
The researchers compared this with topical nitroglycerin ointment for the treatment of chronic anal fissure.
The research team randomized 50 outpatients to receive either a single botulinum toxin injection or topical nitroglycerin ointment 0.2% b.i.d. for 2 weeks.
If the initial therapy failed, patients were assigned to the other treatment group for a further 2 weeks.
If chronic anal fissure still showed no healing at week 4, patients received combination therapy of botulinum toxin and nitroglycerin for 4 additional weeks.
Persisting chronic anal fissure at week 8 was treated according to the researchers' decision.
|Nitroglycerin showed a higher healing rate, occurring in 52%|
|The American Journal of Gastroenterology|
The researchers recorded healing rates, symptoms, and side effects of the therapy at week 2, 4, 8, 12, and 24 after randomization.
The group initially treated with nitroglycerin showed a higher healing rate of chronic anal fissure, occurring in 52%.
The team noted that with the botulinum toxin group, 24% showed healing of chronic anal fissure after the first 2 week of therapy.
At the end of week 4, the team observed the fissure healed in 3 additional patients, all receiving nitroglycerin after initial botulinum toxin injection.
Mild side effects occurred in 26% of patients.
The researchers noted that all except 1 were on nitroglycerin.
Dr Fruehauf's team concludes, “Nitroglycerin ointment was superior to the more expensive and invasive botulinum toxin injection for initial healing of chronic anal fissure, but was associated with more but mild side effects.”