Botox and CCBs were equivalent to GTN in efficacy with fewer adverse events .
No medical therapy came close to the efficacy of surgical sphincterotomy , though none in these RCTs was associated with the risk of incontinence .
Medical therapy for chronic anal fissure , acute fissure and fissure in children may be applied with a chance of cure that is marginally better than placebo , and , for chronic fissure in adults , far less effective than surgery
BACKGROUND Because of the disability associated with surgery for anal fissure and the risk of incontinence , medical alternatives for surgery have been sought .
Most recently , pharmacologic methods that relax the anal smooth muscle , to accomplish reversibly what occurs in surgery , have been used to obtain fissure healing .
OBJECTIVES To assess the efficacy and morbidity of various medical therapies for anal fissure .
Topical Nifedipine vs. Topical Glyceryl Trinitrate for Treatment of Chronic Anal Fissure
Abstract PURPOSE : Nifedipine ( administered orally or applied topically ) has been effective for nonsurgical treatment of anal fissure . We compared the efficacy of nifedipine vs. glyceryl trinitrate for chemical sphincterotomy of anal fissure . METHODS : In a prospect i ve , double-blind trial , 52 patients suffering from chronic anal fissure were r and omly and equally allocated to receive either glyceryl trinitrate or nifedipine , both applied topically to the perianal region . The end point of the study was healing within a predetermined period ( 6 months ) . Variables assessed included demographic data ( age , gender ) , symptoms associated with the fissure , duration of treatment , percentage of healing , untoward effects of treatment , pain scores , duration of follow-up , recurrence , and need for complementary means of treatment . Descriptive data are presented as mean ± st and ard deviation and quantal data as percentage . Inference analysis was performed using the Student ’s t-test for the descriptive data and the chi-squared or Fisher ’s exact test for nominal variables . RESULTS : No significant differences were recorded with regard to age , gender , symptoms associated with the fissure , or duration of treatment . Healing rate was higher ( P < 0.04 ) with nifedipine ( 89 percent ) as compared with glyceryl trinitrate ( 58 percent ) . Treatment side effects ( headache , flushing ) were more frequent ( P < 0.01 ) with glyceryl trinitrate ( 40 percent ) as compared with nifedipine ( 5 percent ) . Pain scores were significantly lower ( P < 0.03 ) on completion of treatment in both groups ( 3.2 in glyceryl trinitrate and 3.4 in nifedipine vs. 6.2 and 6.1 , respectively ) , but did not differ between the two groups . Recurrence occurred in 31 percent of patients treated with glyceryl trinitrate and 42 percent of those treated with nifedipine after a mean period of 18 ± 3 weeks and 12 ± 4 weeks , respectively . CONCLUSION : Topical application of nifedipine for management of chronic anal fissure was more effective and had fewer side effects than topical glyceryl trinitrate . Recurrence was frequent with both drugs
Botox and CCBs were equivalent to GTN in efficacy with fewer adverse events .
No medical therapy came close to the efficacy of surgical sphincterotomy , though none in these RCTs was associated with the risk of incontinence .
Medical therapy for chronic anal fissure , acute fissure and fissure in children may be applied with a chance of cure that is marginally better than placebo , and , for chronic fissure in adults , far less effective than surgery
BACKGROUND Because of the disability associated with surgery for anal fissure and the risk of incontinence , medical alternatives for surgery have been sought .
Most recently , pharmacologic methods that relax the anal smooth muscle , to accomplish reversibly what occurs in surgery , have been used to obtain fissure healing .
OBJECTIVES To assess the efficacy and morbidity of various medical therapies for anal fissure .