GASTROENTEROLOGY ARTICLE OF THE WEEK
August 30, 2007
Dhawan S, Chopra S. Nonsurgical approaches for the treatment of anal fissures. Am J Gastroenterol 2007;102:1312-1321.
1. The underlying pathophysiology of anal fissures is:
a. chronic infection of the anal canal
b. constipation
c. hypertrophic anal papillae with sinus formation
d. spasm of the anal sphinter
2. Medical interventions to heal anal fissures include
a. use of 2% nitropaste applied in the rectal area
b. topical 2% diltiazem
c. topical 0.2% nitroglycerine
d. 2% diltiazem for patients who fail nitroglycerine
e. injection of botulinum toxin
True or False
3. Balding patients with anal fissures can apply minoxidil to their heads and their anuses, improving anal fissures and developing a hairy anus
4. Sitz baths may help relieve the pain, but do not cause lasting reduction in anal sphincter pressures or speed healing of fissures
5. Side effects of topical diltiazem were less than with topical nitroglycerine
6. Lateral internal sphincterotomy should be the first intervention in the treatment of anal fissures