The Management of Anal Fissure: ACPGBI Position Statement

Cross, K. L. R.; Massey, Edwin; Fowler, A. L.; Monson, J. R. T.

doi:10.1111/j.1463-1318.2008.01681.x

Cited by 81 publications

(67 citation statements)

References 45 publications

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“…A n estimated 400,000 patients in the United States annually require medical treatment for anal fissures or rectal tears (1,2). Wounds in microbially contaminated environments (such as the colon and rectum) can be difficult to heal due to the presence of biofilms.…”

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confidence: 99%

Caprylic Acid and Glyceryl Trinitrate Combination for Eradication of Biofilm

Rosenblatt

Reitzel

Raad

2015

Antimicrob Agents Chemother

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There is a growing need for biocompatible, broad-spectrum, nonantibiotic, antimicrobial treatments because of the frequent ineffectiveness of antibiotics against biofilms and the increasing incidence of antibiotic resistance. In this study, we demonstrate rapid and complete biofilm eradication in an in vitro model with synergistic combinations of glyceryl trinitrate and caprylic acid against resistant Gram-positive, Gram-negative, and fungal biofilms.A n estimated 400,000 patients in the United States annually require medical treatment for anal fissures or rectal tears (1, 2). Wounds in microbially contaminated environments (such as the colon and rectum) can be difficult to heal due to the presence of biofilms. Furthermore, surgical site infections associated with implanted devices pose significant medical problems, frequently complicated by microbial biofilm formation on device surfaces (3). This, coupled with the increasing emergence of antibioticresistant biofilms (4), adversely impacts the outcomes of antibiotic wound therapies.Previously, we reported on the synergy of ethanol, citrate, and glyceryl trinitrate (GTN) as a novel nonantibiotic catheter lock solution (5). In other applications involving direct contact with tissues, the use of ethanol above trace concentrations can be undesirable due to potential irritation and cytotoxic responses from certain cell types. Additionally, in applications where bleeding occurs, chelator use can be undesirable, as it can interfere with blood coagulation, an essential step in initiating the healing response. Caprylic acid (CAP) is a medium-chain fatty acid naturally present in human breast milk. CAP has been used intravenously in some total parenteral nutrition formulations (6, 7). It is also readily absorbed following oral administration and yields significant blood concentrations (8). Protonated CAP has been reported to have antimicrobial properties (9, 10). Here, we studied biofilm eradication by the use of medical GTN plus CAP for potential use in medical applications where antimicrobial concentrations of ethanol might cause irritation and where the anticoagulant effects of citrate might be undesirable.The in vitro antimicrobial efficacy of GTN plus CAP was assessed in a well-established biofilm colonization model testing the eradication of biofilm following 2 h of antimicrobial agent exposure. This exposure duration was selected because previous studies showed solutions exhibiting biofilm eradication within 2 h that were also clinically effective (11). Biofilm eradication was assessed for clinical isolates of methicillinresistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus epidermidis (MRSE), multidrug-resistant Pseudomonas aeruginosa, and Candida albicans, representative of key Gram-positive, Gram-negative, and infectious fungal pathogens (12). Briefly, 1-cm silicone discs were placed in 1 ml of human plasma and incubated overnight at 37°C. The plasma was replaced with 1 ml of 5.5 ϫ 10 5 CFU/ml of challenge organism inoculum and incubated f...

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confidence: 99%

Caprylic Acid and Glyceryl Trinitrate Combination for Eradication of Biofilm

Rosenblatt

Reitzel

Raad

2015

Antimicrob Agents Chemother

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“…46 Botulinum toxin, which is very popular in the USA before sphincterotomy, is more expensive than glycerine trinitrate and is associated with a similar rate of healing. In addition, there is no consensus on the dosage, the precise site of administration, or the number of injections that are required.…”

Section: Discussionmentioning

confidence: 99%

Glyceryl Trinitrate Ointment (0.25%) and Anal Cryothermal Dilators in the Treatment of Chronic Anal Fissures

Visconte

Munegato

2009

Journal of Gastrointestinal Surgery

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“…I would propose that our A. P. Zbar (&) The Universities of New England and Newcastle, Tamworth, NSW, Australia e-mail: apzbar@yahoo.com societies unite to establish an international regulatory body designed to specifically oversee and sanction trialling in order to ascertain the value of these innovations in an effort to combat substandard data informing practice; a result compounded rather than clandestinely generated by our industry associations. A case in point would be the ability finally to define subgroups of patients undergoing surgery for chronic anal fissure where there is a wealth of nonsphincterotomy alternatives [9], a profusion of data on a well-defined condition, but still little to guide us regarding operative management practice [10]. That which is not sanctioned and supported will no longer have pride of place in our meetings which are rightly renowned for their honesty and professionalism.…”

Section: Sirmentioning

confidence: 99%

Innovations in coloproctology

Zbar

2009

Tech Coloproctol

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The Management of Anal Fissure: ACPGBI Position Statement

Cited by 81 publications

References 45 publications

Caprylic Acid and Glyceryl Trinitrate Combination for Eradication of Biofilm

Caprylic Acid and Glyceryl Trinitrate Combination for Eradication of Biofilm

Glyceryl Trinitrate Ointment (0.25%) and Anal Cryothermal Dilators in the Treatment of Chronic Anal Fissures

Innovations in coloproctology

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