Comparative Efficacy and Safety of Botulinum Toxin and Nitroglycerin in the Treatment of Chronic Anal Fissures: A Systematic Review and Meta-Analysis of Clinical Trials.

Hamid Reihani, Ali Daneshmandi, Amir Hossein Hassani, Maryam Hashemi

Abstract readSystematic ReviewMeta-AnalysisComparative Study

In one paragraph

Synthesis in BioMed research international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it

0cells of the map it votes in

0citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Hamid ReihaniStudent Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, sums.ac.ir.ORCID https://orcid.org/0000-0002-8161-1385

Ali DaneshmandiStudent Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, sums.ac.ir.

Amir Hossein HassaniStudent Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, sums.ac.ir.ORCID https://orcid.org/0000-0002-8341-2523

Maryam HashemiStudent Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, sums.ac.ir.ORCID https://orcid.org/0009-0009-0318-0901

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundChronic anal fissures (CAF) are a common anorectal condition that significantly impacts patients' quality of life. Treatment options include pharmacological therapies, such as botulinum toxin (BT) and topical nitroglycerin (TNG). Despite their widespread use, the relative efficacy and safety of BT and TNG remain controversial. This systematic review and meta-analysis is aimed at comparing the effectiveness, recurrence rates, and adverse effects of BT and TNG in the treatment of CAF.

methodsA comprehensive search was conducted across multiple databases, including PubMed, Scopus, and Cochrane. Studies were included if they compared BT with TNG in the treatment of CAF. Ten clinical trials, comprising 698 patients, were included. Data were extracted and analyzed using STATA, and risk ratios were calculated for healing rates, recurrence rates, and side effects.

resultsThe analysis showed that BT resulted in significantly higher healing rates compared with TNG (risk ratio: 1.18, 95% CI: 1.02-1.36, p = 0.029). However, there was no significant difference in recurrence rates between the two treatments (p = 0.146). BT was associated with a significantly lower incidence of side effects, including headaches, compared with TNG (p < 0.001).

conclusionBT is more effective than TNG in the healing of CAF, with a superior safety profile. These findings suggest that BT may be the preferable treatment option for CAF.

Indexed as

Botulinum ToxinsFissure in AnoNitroglycerinChronic DiseaseClinical Trials as TopicHumansTreatment OutcomeBotulinum ToxinsNitroglycerinbotulinum toxinschronic anal fissuresnitroglycerinType A

Identifiers

PMID42663187

DOI10.1155/bmri/6831460

PMCPMC13523157

What OpenQuestion holds

Textmetadata

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.