title: [Endosonographic and manometric assessment of the internal anal sphincter in patients with chronic anal fissure].
abstract: BACKGROUND
  High anal resting pressures have been implicated in the pathophysiology of chronic anal fissure. It is not known, however, whether altered function is associated with any morphological abnormalities of the internal anal sphincter (IAS). The aims of the present study were to determine IAS thickness in patients with chronic anal fissure and to investigate the correlation between IAS thickness and anal resting pressure.
  
  
  METHODS
  Patients with chronic anal fissure were prospectively included between November 1999 and December 2002. Patients with a history of inflammatory bowel disease, anal surgery, and those previously treated with nitroglycerine ointment or botulinum toxin were excluded. Anal endosonography and manometry were performed. IAS thickness was considered to be increased when it was > 2.5 mm in patients < 50 years and > 3 mm in patients > or = 50 years. Anal resting pressure was considered to be increased when it was higher than 80 mmHg.
  
  
  RESULTS
  Sixty-three patients were analyzed. An abnormally thick IAS was observed in 58 patients (92%). The mean IAS thickness was 3.7 +/- 0.7 mm. IAS hypertonia was found in 47 patients (66%). The mean anal resting pressure was 91 +/- 28 mmHg. No correlation was found between IAS thickness and anal resting pressure (r = 0.05; p < 0.68).
  
  
  CONCLUSIONS
  Most of the patients with chronic anal fissure had an abnormally thick IAS. However, increased thickness of the IAS did not correlate with increased anal resting pressure.
authors.affiliation: Servicio de Cirugía General, Hospital del Mar, IMA, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Pascual
authors.forename: Ricard
authors.initials: R
authors.lastname: Courtier
authors.forename: María José
authors.initials: MJ
authors.lastname: Gil
authors.forename: Sonia
authors.initials: S
authors.lastname: Puig
authors.forename: Alejandro
authors.initials: A
authors.lastname: Serrano
authors.forename: Montserrat
authors.initials: M
authors.lastname: Andreu
authors.forename: Miguel
authors.initials: M
authors.lastname: Pera
authors.forename: Luis
authors.initials: L
authors.lastname: Grande
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D019160:Endosonography; D005260:Female; D005401:Fissure in Ano / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies