title: Topical diltiazem cream versus botulinum toxin a for the treatment of chronic anal fissure: a double-blind randomized clinical trial.
abstract: OBJECTIVE
  A double-blind randomized clinical trial to compare topical diltiazem with botulinum toxin A (BTA) in the treatment of chronic anal fissure.
  
  
  BACKGROUND
  Chronic anal fissures remain a challenging condition. Topical diltiazem and BTA are promising agents in the treatment of anal fissure. As to date diltiazem and BTA were never compared in a solid randomized trial, which is the purpose of this study.
  
  
  METHODS
  One hundred thirty-four patients were randomized to receive either diltiazem cream and placebo injection or BTA injection and placebo cream. The primary end point was fissure healing after 3 months.
  
  
  RESULTS
  After 3 months healing of the fissure was noted in 32 of 74 (43%) patients in the diltiazem group and 26 of 60 (43%) patients in the BTA group. Reduction >50% in mean pain score was noted in 58 of 74 (78%) patients in the diltiazem group and 49 of 60 (82%) patients in the BTA group. Perianal itching was the only side effect reported and was noted in 15% of patients in the diltiazem group, and this difference was statistically significant (P = 0.012).
  
  
  CONCLUSIONS
  BTA yields higher healing rates in the short term, though after 3 months diltiazem and BTA resulted in equal healing rates. Also no significant difference in pain reduction was observed for both treatments. This study shows no significant advantage of one treatment compared to the other. This randomized clinical trial is registered by the Dutch Trial Register as NTR1012.
authors.affiliation: Department of Surgery, Diakonessenhuis Hospital, The Netherlands.
authors.forename: Morsal
authors.initials: M
authors.lastname: Samim
authors.forename: Bas
authors.initials: B
authors.lastname: Twigt
authors.forename: Lennart
authors.initials: L
authors.lastname: Stoker
authors.forename: Apollo
authors.initials: A
authors.lastname: Pronk
mesh_terms: D000287:Administration, Topical; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D002908:Chronic Disease; D004110:Diltiazem / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D005401:Fissure in Ano / Q000188:drug therapy*; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D010147:Pain Measurement; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D014945:Wound Healing / Q000187:drug effects
chemical_list: D009465:Neuromuscular Agents; D014665:Vasodilator Agents; D019274:Botulinum Toxins, Type A; D004110:Diltiazem