Botulinum toxin therapy for chronic anal fissures: where are we at currently?

Dat, Anthony; Chin, Martin; Skinner, Stewart; Farmer, Chip; Wale, Roger; Carne, Peter; Bell, Stephen; Warrier, Satish

doi:10.1111/ans.13329

Cited by 23 publications

(14 citation statements)

References 12 publications

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“…Human casualties due to botulinum toxin are reported every year. On the other hand, botulinum toxin is used to treat several diseases including strabismus, urinary incontinence, anal fissure, cervical dystonia, migraine headaches [4][5][6][7][8], and a variety of other diseases [9]. Botulinum toxin is also one of the most commonly used materials in the field of plastic surgery, constituting a billion-dollar industry [10].…”

Section: Introductionmentioning

confidence: 99%

Comparison study of the response with botulinum toxin muscle injection in the ICR mice from three different sources

Seo

Kim²,

Kang

et al. 2019

Lab Anim Res

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Botulinum-toxin A (BoNT/A) is a widely used not only for cosmetics but also for various experimental purposes including muscle-related research. In this study, we applied BoNT/A to mouse muscle of three different sources to compare and evaluate the biological and pathological response. The three different mouse sources consist of Korl: ICR (Korea FDA source), A:ICR (USA source) and B:ICR (Japan source) which were purchased from each different vendors. To compare the responses of ICR mice with BoNT/A muscle injection, we examined the body weight, hematological and serum biochemistry analysis. Also, we evaluated the muscle change by histopathological analysis and gene expression patterns of muscle-related target by qPCR. The body weight gain was decreased in the BoNT/ A-treated group compared with the control group. In clinical pathologic analysis and gene expression patterns, the data showed that the responses in the BoNT/A-treated group were similar compared with the control group. Decreased muscle fiber was observed in BoNT/A-treated group compared with control group, while Korl:ICR showed a little low response with the other mouse sources. In conclusion, our results suggest that three different sources ICR mice (Korl:ICR, A:ICR and B:ICR) have a similar biological and pathological responses in BoNT/A muscle injection.

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Section: Introductionmentioning

confidence: 99%

Comparison study of the response with botulinum toxin muscle injection in the ICR mice from three different sources

Seo

Kim²,

Kang

et al. 2019

Lab Anim Res

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“…In our cases, the most inadequate treatment ndings were detected both in Gp A and Gp B in the rst week after treatment (Table 3).Daf et al stated in their study on 101 patients that the most important symptom of relapse cases was that the pain did not pass and that this occurred during the rst patient control [21].…”

Section: Discussionmentioning

confidence: 53%

A New Botox Therapy Method in Chronic Anal Fissüre

Boz¹,

Acar

2020

Preprint

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BackgroundBotox toxin treatment(BT) is an effective method in chronic anal fissures(CAF).However, there are different suggestions regarding the application place and method of BT in the literature. Our aim in this study is to reveal the most appropriate application site and method in BT for CAFs. MethodsFor this purpose, 2 groups were randomly selected from patients who admitted to our hospital with CAF complaints. In our study, we performed the BT application in different places in different amounts in both groups. After the treatment, we evaluated the recurrence and anal incontinence scores of the patients in certain periods and compared them with each other. The follow-up period for our patients were at least 12 months. ResultsThe recurrence rate was found to be 33.3% in patients in Group A (Gp A) and 19.3% in patients in Group B (Gp B). Patients in Gp A had a statistically significant higher recurrence rate (inadequate treatment) compared to patients in Gp B at the first control, which was performed at first week after treatment(p<00.5). Anal incontinence rate 3.3% in Gp A, 6.4% in Gp B. The difference between anal incontinence rates according to Cleveland Clinic Incontinence Score (CCIS) was not statistically significant between patients with GP A and Gp B (p>0.05).Conclusion3-way BT in internal and external anal sphincters in CAFs, is an effective and low-risk treatment method.

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“…In the literature, there are a few studies investigating factors related with recurrence after BT application. 19,20 These studies revealed that persisting pain after 30 days and the lack of high anal tone were associated with recurrence. In a randomized controlled trial of 99 patients in Iran in 2015, the results of LIS and topical diltiazem + BT were compared.…”

Section: Discussionmentioning

confidence: 99%

Duration of the Sypmtoms Influence the Outcome after Botulinum Toxin Injection in Anal Fissure

Arslan¹,

Özdenkaya²

2019

tjcd

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Amaç: Anal fissürde semptom süresinin botulinum toksini uygulaması sonrası tedaviye yanıtsızlık ve nüks üzerindeki etkisini araştırmaktır. Yöntem: Mart 2016'dan itibaren anal fissür nedeniyle botulinum toksini uygulanan hastaların verileri incelendi. Takip süresi en az 18 ay olan hastalar çalışmaya dahil edildi. Hastalara internal sfinktere 4 kadrandan 100 IU botulinum toksin-A uygulandı. İşlem sonrası 7, 15, 30. günlerde poliklinik kontrolü ile; 3, 6, 12 ve 18. aylarda telefonla aranarak değerlendirme yapıldı. Botulinum toksini uygulamasına yanıtsızlık ya da nüks başarısızlık olarak kaydedildi. Semptom süresi ve başarısızlık arasındaki ilişki alıcı işletim karakteristiği analizi ile araştırıldı ve bulunan kesme değerine göre iki gruba ayrılan botulinum toksini uygulanan hastalar aynı dönemde lateral internal sfinkterotomi ile tedavi edilmiş hastalarla karşılaştırıldı. Bulgular: Botulinum toksini uygulanan 56 hastada ortalama yaş 33,1±9,4 idi. Hastaların 39'u (%69,6) kadındı. Ortalama semptom süresi 8,5±7,4 aydı. Ortanca 21 (18-28) aylık izlem süresinde 47 (%83,9) hastada iyileşme oldu. Semptom süresinin 8,5 aydan uzun olması tedavi başarısızlığını öngörmekteydi (Eğri altındaki alan: 0,721, güven aralığı: 0,500-0,942, p=0,037). Hastalar semptom süresine göre 2 gruba ayrılarak aynı dönemde lateral internal sfinkterotomi yapılan 32 hasta ile sonuçları karşılaştırıldı. İyileşme oranları semptom süresi uzun olan botulinum toksini grubunda %61,1, semptom süresi kısa olan botulinum toksini grubunda %94,7 ve lateral internal sfinkterotomi grubunda %96,2 idi (p=0,003). Botulinum toksini uygulaması sonrası 1 hastada lokal hematom, lateral internal sfinkterotomi uygulaması sonrası 1 (%3,1) hastada minör inkontinens görüldü. Sonuç: Anal fissür tedavisinde botulinum toksini uygulaması semptom süresi kısa olan hastalarda lateral internal sfinkterotomi ile benzer etkinliktedir. Botulinum toksini uygulamasında hasta seçimi tedavi başarısını etkileyebilir. Anahtar Kelimeler: Botulinum toksini, anal fissür, lateral internal sfinkterotomi Aim: To assess the effect of duration of the symptoms on outcome after botulinum toxin injection in anal fissure treatment. Method: Data of the patients who underwent botulinum toxin injection for chronic anal fissur were reviewed. Patients with a minimum follow-up of 18 months were included. One-hundred IU botulinum toxine was injected in the internal anal sphincter through 4 quadrants. Follow-up was carried out by clinic visits on post-procedure days 7, 15 and 30 and by telephone survey in 3, 6, 12 and 18 th months. Refractory symptoms or recurrence were recorded as failure. The relationship between duration of the symptoms and failure was investigated and a cutoff value was determined. Patients were divided into two groups according to duration of the symtoms and outcome was compared with the patients who underwent lateral internal sphincterotomy within the same period. Results: There were 56 patients fulfilling inclusion criteria. Mean age was 33.1±9.4 and 39 (69.6%) patients were female. Pre...

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Botulinum toxin therapy for chronic anal fissures: where are we at currently?

Abstract: Botox is an effective strategy for CAF. Low doses can be given with good efficacy as highlighted by our audit and has the potential for great cost saving. The best predictor of recurrence is the presence of pain at the first post-procedure visit.

Cited by 23 publications

References 12 publications

Comparison study of the response with botulinum toxin muscle injection in the ICR mice from three different sources

Comparison study of the response with botulinum toxin muscle injection in the ICR mice from three different sources

A New Botox Therapy Method in Chronic Anal Fissüre

Duration of the Sypmtoms Influence the Outcome after Botulinum Toxin Injection in Anal Fissure

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