{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T04:24:52Z","timestamp":1775535892742,"version":"3.50.1"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2012,12,20]],"date-time":"2012-12-20T00:00:00Z","timestamp":1355961600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2013,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>Aim\u2002<\/jats:bold> The study analyzed clinical trials investigating the effectiveness of diltiazem (DTZ) and glyceryltrinitrate (GTN) for the nonsurgical management of chronic anal fissure (CAF).<\/jats:p><jats:p><jats:bold>Method\u2002<\/jats:bold> Randomized trials on the effectiveness of DTZ and GTN were analyzed systematically using RevMan<jats:sup>\u00ae<\/jats:sup> where combined outcome was expressed as risk ratio (RR).<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> Seven randomized controlled trials that included 481 patients were analyzed. Two\u2010hundred and thirty\u2010eight patients were treated with DTZ and 243 patients were treated with GTN. There was significant heterogeneity [Tau<jats:sup>2<\/jats:sup>\u2003=\u20030.24, \u03c72\u2003=\u200313.16, d.f.\u2003=\u20036 (<jats:italic>P<\/jats:italic>\u2003&lt;\u20030.05); <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2003=\u200354%] among the included trials. In the random\u2010effects model, DTZ was associated with a lower incidence of side effects (RR\u2003=\u20030.48; 95% CI\u2003=\u20030.27, 0.86; <jats:italic>z<\/jats:italic>\u2003=\u20032.46; <jats:italic>P<\/jats:italic>\u2003&lt;\u20030.01), headache (RR\u2003=\u20030.39; 95% CI\u2003=\u20030.24, 0.66; <jats:italic>z<\/jats:italic>\u2003=\u20033.54; <jats:italic>P<\/jats:italic>\u2003&lt;\u20030.004) and recurrence (RR\u2003=\u20030.68; 95% CI\u2003=\u20030.52, 0.89; <jats:italic>z<\/jats:italic>\u2003=\u20032.77; <jats:italic>P<\/jats:italic>\u2003&lt;\u20030.006) of CAF. Both GTN and DTZ were equally effective (RR\u2003=\u20031.10; 95% CI\u2003=\u20030.90, 1.34; <jats:italic>z<\/jats:italic>\u2003=\u20030.92; <jats:italic>P<\/jats:italic>\u2003=\u20030.36) in the nonsurgical management of CAF.<\/jats:p><jats:p><jats:bold>Conclusion\u2002<\/jats:bold> This systematic review of seven trials validates and strengthens the finding of a previously published meta\u2010analysis of two randomized trials. Both DTZ and GTN are equally effective in the management of CAF. However, DTZ is associated with a lower incidence of headache and recurrent fissure. Therefore DTZ should be the preferred first line of treatment for CAF.<\/jats:p>","DOI":"10.1111\/j.1463-1318.2012.03042.x","type":"journal-article","created":{"date-parts":[[2012,4,8]],"date-time":"2012-04-08T07:32:12Z","timestamp":1333870332000},"page":"19-26","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":60,"title":["Systematic review of the use of topical diltiazem compared with glyceryltrinitrate for the nonoperative management of chronic anal fissure"],"prefix":"10.1111","volume":"15","author":[{"given":"M. S.","family":"Sajid","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. A.","family":"Whitehouse","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Sains","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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