Is botulinum toxin injection a better treatment than nitroglycerin ointment for patients with chronic anal fissure?  

Oleh:

Collison, Rowan J. ; Mortensen, Neil JMcC

Jenis: Article from Bulletin/Magazine - ilmiah internasional
Dalam koleksi: Medical Progress vol. 34 no. 12 (Dec. 2007), page 577.

Ketersediaan

Perpustakaan FK Nomor Panggil: M36.K.2007.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Background : To evaluate the efficacy of botulinum toxin injection compared with topical application of nitroglycerin oinment in patients with chronic anal fissure. Design : This prospective, randomizes study included patients with chronic anal fissure who were scheduled for surgery. Patients were randomly assigned to treatment with botulinum toxin injection or topical application of nitroglycerin ointment. Botulinum toxin (30 units of Botox or 90 units of Dysport) was administered by injection to both sides of the anterior midline of the internal anal sphincter, and 0.3% nitroglycerin ointment was applied to the anus and anal canal three times daily for 8 weeks. Treatment success was defined as complete healing ofanal fissure at 8 weeks. Symptomatic relief was defined as the persistence anal fissure in the absence of symptoms.Two examiners, blinded to treatment data, followed up patients at 4 and 8 weeks and evaluated outcome by clinical evaluation and anorectal manometry. Patients with persisten anal fissure at 8 weeks were offered the choice of receiving the alternative therapy to the one they were initially assigned to. Result : In total, 100 patients were included in the study. at 4 and 8 weeks follow-up, significantly more patients who recieved botulinum toxin injection had complete healing of anal fissure compared with patients who recieved nitroglycerin treatment with nitroglycerin ointment (41 and 46 patients vs 29 and 35 patient, p=0,009 for both comparisons). Adverse effects were significantly more frequent in patient who received nitroglycerin treatment compared with those who received botulinum toxin injection (17 patients vs 3 patients, p<0.001). In the nitroglycerin ointment group, adverse effects consisted of moderate-to severe headaches and moderate anal burning whereas in botulinum toxin group, adverse effects consisted of mild incontinence to flatus. At 8 weeks, resting anal canal pressure was reduced by 22.2% and 18.6% compared with baseline in patients who received botulinum toxic injection and nitroglycerin oinment treatment, respectively. Mean follow-up was 21.3 months and 20.7 months for patients in the botulinum toxin and nitroglycerin ointment group, respectively. Conclusion: Botulinum toxin injection has an efficacy superior to that of nitroglycerin ointment for the treatment of patients with chronic anal fissure, and is associated with fewer adverse effects. However, both treatments are effective in these patients.

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