{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T08:36:26Z","timestamp":1774341386140,"version":"3.50.1"},"reference-count":28,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2014,9,16]],"date-time":"2014-09-16T00:00:00Z","timestamp":1410825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"The present study was supported by Ipsen Farmaceutica B.V. (The Netherlands): in patient randomized for a Dysport\u00ef\u00bf\u00bd injection, they supplied Dysport\u00ef\u00bf\u00bd for free. Ipsen Farmaceutica B.V. had no role in the protocol design, study conduct, data analysis, or publication decisions."}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2014,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Nitric oxide donors, such as isosorbide dinitrate ointment (<jats:styled-content style=\"fixed-case\">ISDN<\/jats:styled-content>), are considered as first\u2010choice agents in the treatment of chronic anal fissure. Injection with botulinum toxin <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content> in the internal anal sphincter is often used as a second\u2010line therapy, although it may give better results and fewer side effects than nitric oxide donors. The aim of this randomized clinical trial was to investigate whether botulinum toxin <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>ysport<jats:sup>\u00ae<\/jats:sup>) is more effective than <jats:styled-content style=\"fixed-case\">ISDN<\/jats:styled-content> in the primary treatment of chronic anal fissure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>From <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>pril 2005 until <jats:styled-content style=\"fixed-case\">O<\/jats:styled-content>ctober 2009, 60 patients (32 men) with a median age of 42 (25\u201382) years were randomized to receive either <jats:styled-content style=\"fixed-case\">ISDN<\/jats:styled-content> 10\u00a0mg\/ml (1%) (<jats:italic>n<\/jats:italic>\u00a0=\u00a033) or injection with 60 units of <jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>ysport<jats:sup>\u00ae<\/jats:sup> (<jats:italic>n<\/jats:italic>\u00a0=\u00a027). The primary end\u2010point was the percentage of complete fissure healing after 8\u00a0weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After a median of 9\u00a0weeks complete fissure healing was noted in 18 of 27 patients in the <jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>ysport<jats:sup>\u00ae<\/jats:sup> group and in 11 of 33 patients in the <jats:styled-content style=\"fixed-case\">ISDN<\/jats:styled-content> group (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.010). Absolute improvement of pain scores after 9\u00a0weeks was similar in both groups (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.733). Patients treated with <jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>ysport<jats:sup>\u00ae<\/jats:sup> had fewer side effects than patients treated with <jats:styled-content style=\"fixed-case\">ISDN<\/jats:styled-content> (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.028). Of the patients with a healed fissure, 28% of the <jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>ysport<jats:sup>\u00ae<\/jats:sup> group and 50% of the <jats:styled-content style=\"fixed-case\">ISDN<\/jats:styled-content> group had a recurrence within 1\u00a0year (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.286; hazard ratio 2.08; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a00.54\u20137.97).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Dysport<jats:sup>\u00ae<\/jats:sup> is more effective than <jats:styled-content style=\"fixed-case\">ISDN<\/jats:styled-content> ointment and has fewer side effects in the primary treatment of chronic anal fissure. The recurrence rate within 1\u00a0year in both treatment groups is high.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.12615","type":"journal-article","created":{"date-parts":[[2014,3,15]],"date-time":"2014-03-15T11:43:53Z","timestamp":1394883833000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Isosorbide dinitrate ointment <i>vs<\/i> botulinum toxin <scp>A<\/scp> (<scp>D<\/scp>ysport<sup>\u00ae<\/sup>) as the primary treatment for chronic anal fissure: a randomized multicentre study"],"prefix":"10.1111","volume":"16","author":[{"given":"A. E. M.","family":"Berkel","sequence":"first","affiliation":[{"name":"Department of Surgery Medisch Spectrum Twente Enschede The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Rosman","sequence":"additional","affiliation":[{"name":"Department of Surgery Canisius Wilhelmina Ziekenhuis Nijmegen The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Koop","sequence":"additional","affiliation":[{"name":"Department of Surgery Medisch Spectrum Twente Enschede The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"van Duijvendijk","sequence":"additional","affiliation":[{"name":"Department of Surgery Gelre Ziekenhuizen Location Lukas Apeldoorn The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"van der Palen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Medisch Spectrum Twente Enschede The Netherlands"},{"name":"Department of Research Methodology, Measurement and Data Analysis University of Twente Enschede The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. 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