{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T02:48:24Z","timestamp":1787194104945,"version":"build-2736575974"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Calcium channel blockers (CCBs) are first-line pharmacotherapy for chronic anal fissures (CAF), but the optimal administration route (oral vs. topical) remains unclear. This systematic review and meta-analysis compared efficacy and safety of oral vs. topical CCBs for CAF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>PubMed and Embase were systematically searched from inception through February 2025 for relevant randomized controlled trials (RCTs). Two reviewers independently performed study selection, quality assessment, and data extraction. Random-effects models were used to pool effect sizes, with sensitivity analyses to assess robustness. The quality of evidence was assessed using the GRADE approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four RCTs (279 patients) were included. Topical CCBs significantly reduced unhealed fissure risk vs. oral CCBs (OR = 2.65, 95% CI = 1.50\u20134.69, moderate certainty evidence), with comparable recurrence rates (based on limited data from 3 studies). Initial side effect analysis showed no difference, but sensitivity analysis excluding a high-bias trial revealed fewer adverse events with topical CCBs (OR = 13.16, 95% CI = 5.05\u201334.3, moderate certainty evidence).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Based on limited evidence, topical CCBs may offer superior healing rates and safety profiles vs. oral formulations for CAF, with similar recurrence rates, though additional high-quality studies are needed to confirm these findings.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fphar.2025.1642347","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T05:28:31Z","timestamp":1755754111000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy and safety of topical vs. oral calcium channel blockers for chronic anal fissures: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Tianshuo","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengfei","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinli","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lanlan","family":"Xi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuowu","family":"Xi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1016\/j.amjsurg.2013.05.003","article-title":"Randomized controlled pilot trial of nifedipine as oral therapy vs. topical application in the treatment of fissure-in-ano","volume":"206","author":"Agrawal","year":"2013","journal-title":"Am. 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