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Diltiazem:
Topical diltiazem and bethanechol decrease anal sphincter pressure without side effects. Carapeti, EA - Gut - 01-Nov- 1999; 45(5): 719-22. Differences in contractile properties of anorectal smooth muscle and the effects of calcium channel blockade. Cook TA - Br J Surg - 01-Jan-1999; 86(1): 70-5.

Topical diltiazem and bethanechol decrease anal sphincter pressure and heal anal fissures without side effects. Carapeti EA - Dis Colon Rectum - 01-Oct-2000; 43(10): 1359-62.

Topical diltiazem ointment in the treatment of chronic anal fissure. Knight JS - Br J Surg - 01-Apr-2001; 88(4): 553-6. A randomized trial of oral vs. topical diltiazem for chronic anal fissures. Jonas M - Dis Colon Rectum - 01-Aug-2001; 44(8): 1074-8.

Randomized clinical trial assessing the side-effects of glyceryl trinitrate and diltiazem hydrochloride in the treatment of chronic anal fissure. Kocher HM - Br J Surg - 01-Apr-2002; 89(4): 413-7. Comment In: Br J Surg. 2002 Oct;89(10):1325 Br J Surg. 2002 Sep;89(9):1193; discussion 1193-4.

Diltiazem heals glyceryl trinitrate-resistant chronic anal fissures: a prospective study. Jonas M - Dis Colon Rectum - 01-Aug-2002; 45(8): 1091-5.

Nifedipine:   Back to top
Effect of nifedipine on rectoanal motility. Chrysos E - Dis Colon Rectum - 01-Feb-1996; 39(2): 212-6. Effects of nifedipine on anorectal smooth muscle in vitro. Cook TA - Dis Colon Rectum - 01-Jun-1999; 42(6): 782-7.

Nifedipine for local use in conservative treatment of anal fissures: preliminary results of a multicenter study. Antropoli C - Dis Colon Rectum - 01-Aug-1999; 42(8): 1011-5. Comment In: Dis Colon Rectum. 2000 Mar;43(3):430-1.

Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine. Perrotti P - Dis Colon Rectum - 01-Mar-2001; 44(3): 405-9.

Topical nifedipine with lidocaine ointment vs. active control for treatment of chronic anal fissure: results of a prospective, randomized, double-blind study. Perrotti P - Dis Colon Rectum - 01-Nov-2002; 45(11): 1468-75.

Is topical nifedipine effective for chronic anal fissures? Merenstein D - J Fam Pract - 01-Mar-2003; 52(3): 190-2.

Phosphodiesterase Inhibitors:   Back to top
Phosphodiesterase inhibitors cause relaxation of the internal anal sphincter in vitro. Jones OM - Dis Colon Rectum - 01-Apr-2002; 45(4): 530-6

Nitric Oxide:   Back to top
Distribution of nitric oxide synthase containing neurons in the rectal myenteric plexus and anal canal. Morphologic evidence that nitric oxide mediates the rectoanal inhibitory reflex. O'Kelly TJ - Dis Colon Rectum - 01-Apr-1994; 37(4): 350-7.

Nitrergic innervation and relaxant response of rectal circular smooth muscle. Stebbing JF - Dis Colon Rectum - 01-Mar-1996; 39(3): 294-9.

Role of nitric oxide in relaxation of the longitudinal layer of rectal smooth muscle. Stebbing JF - Dis Colon Rectum - 01-Jun-1997; 40(6): 706-10.

Nitric oxide synthase neurones and neuromuscular behaviour of the anorectum. Stebbing JF - Ann R Coll Surg Engl - 01-Mar-1998; 80(2): 137-45.

The role of nitric oxide (NO) in the human internal anal sphincter. Tomita R - J Gastroenterol - 01-Jan-2001; 36(6): 386-91.

L-Arginine:    Back to top
Darby et al report a phase 2 study to determine the effects of topical L Arginine for treatment of chronic anal fissure. Abstract from ASCRS 2002

Topical L-arginine gel lowers resting anal pressure: possible treatment for anal fissure. Griffin N - Dis Colon Rectum - 01-Oct-2002; 45(10): 1332-6.

Glyceryl Trinitrate:   Back to top
Audit of topical glyceryl trinitrate for treatment of fissure-in-ano. Hasegawa H - Ann R Coll Surg Engl - 01-Jan-2000; 82(1): 27-30.Comment: Ann R Coll Surg Engl. 2001 May; 83(3): 220-1.

Double-blind manometric assessment of two topical glyceryl trinitrate formulations in patients with chronic anal fissures. Bassotti G - Dig Liver Dis - 01-Nov-2000; 32(8): 699-702.

Treatment of chronic anal fissure with topical glyceryl trinitrate: a double-blind, placebo-controlled trial. Chaudhuri S - Indian J Gastroenterol - 2001 May-Jun; 20(3): 101-2. Comment In: Indian J Gastroenterol. 2001 Sep-Oct; 20(5): 206-8.

Systemic levels of glyceryl trinitrate following topical application to the anoderm do not correlate with the measured reduction in anal pressure. Jonas M - Br J Surg - 01-Dec-2001; 88(12): 1613-6.

Topical mononitrate treatment in patients with anal fissure. Tankova L - Aliment Pharmacol Ther - 01-Jan-2002; 16(1): 101-3.

Treatment of chronic anal fissure with topically applied nitroglycerin ointment. A systematic review of evidence-based results. Svendsen CB - Ugeskr Laeger - 12-Aug-2002; 164(33): 3845-9.

Randomized, placebo-controlled treatment of anal fissure by lidocaine, EMLA, and GTN in children. Sönmez K - J Pediatr Surg - 01-Sep-2002; 37(9): 1313-6. A study to determine the nitroglycerin ointment dose and dosing interval that best promote the healing of chronic anal fissures. Bailey HR - Dis Colon Rectum - 01-Sep-2002; 45(9): 1192-9.

AGA technical review on the diagnosis and care of patients with anal fissure. Madoff, RD and Fleshman, JW. Gastroenterology 2003; Vol 124(1); 235-245.

Anal fissure. Jonas, M and Scholefield, JH. Gastroenterology Clinics March 2001; Vol 30 (1).

Anal Fissure. Metcalf, AM. Surgical Clinics of North America; December 2002; Volume 82(6).

Isosorbide Dinitrate:   Back to top
Pathophysiological aspects and clinical outcome of intra-anal application of isosorbide dinitrate in patients with chronic anal fissure Gut, Vol 39, 465-469, WR Schouten, JW Briel, MO Boerma, JJ Auwerda, EB Wilms and BH Graatsma.

Treatment of chronic anal fissure with isosorbide dinitrate: long-term results and dose determination. Lysy J - Dis Colon Rectum - 01-Nov-1998; 41(11): 1406-10.

Topical nitrates potentiate the effect of botulinum toxin in the treatment of patients with refractory anal fissure. Lysy J - Gut - 01-Feb-2001; 48(2): 221-4.

Fissurectomy and isosorbide dinitrate for chronic fissure in ano not responding to conservative treatment. Engel AF - Br J Surg - 01-Jan-2002; 89(1): 79-83.

Phenylephrine:   Back to top
Topical phenylephrine is an effective long-term therapy for anal seepage. Mutach, M., Sasse, R., Barrett, J et al. ASCRS 2002 presentation P17.

Preliminary study of topical phenylephrine as a treatment for fecal incontinence. Sasse, K.C., Yip, B. et al. ASCRS 2000 presentation RF1.

Randomized controlled trial of topical phenylephrine in the treatment of faecal incontinence. Carapeti EA, Kamm MA, Phillips RK. Br J Surg 2000;87(1):38-42.

Fecal incontinence. Parker, SC. 2002 Surgical Clinics of North America; Vol 82(6).