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Chili pepper

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The chili pepper, chilli pepper, or more simply just "chili", is the fruit of the plants from the genus Capsicum, which are members of the nightshade family, Solanaceae. Even though chilis may be thought of as a vegetable, their culinary usage is generally as a spice, the part of the plant that is usually harvested is the fruit, and botany considers the plant a berry shrub. The name, which is spelled differently in many regions (chili, chile, or chilli), comes from Nahuatl via the Spanish word chile. The term chili in most of the world refers exclusively to the smaller, hot types of capsicum. The mild larger types are called bell pepper in the United States, Canada (and sometimes the United Kingdom), sweet pepper in Britain and Ireland, capsicum in India and Australasia, and paprika in many European countries. Finally, bell peppers are often named simply by their colour (e.g. green or red pepper).

Chili peppers

Chili peppers and their various cultivars originate in the Americas; they are now grown around the world because they are widely used as spices or vegetables in cuisine, and as medicine.

History

Chilli peppers have been a part of the human diet in the Americas since at least 7500 BC and perhaps earlier. There is archaeological evidence at sites located in southwestern Ecuador that chilli peppers were already well domesticated more than 6000 years ago,[1][2] and is one of the first cultivated crops in the Americas.

Chilli peppers are thought to have been domesticated at least five times by prehistoric peoples in different parts of South and North America, from Peru in the south to Mexico in the north and parts of Colorado and New Mexico (Ancient Pueblo Peoples).[3]

Christopher Columbus was one of the first Europeans to encounter them (in the Caribbean), and called them "peppers" because of their similarity in taste (though not in appearance) with the Old World peppers of the Piper genus. Columbus was keen to propose that he had in fact opened a new direct nautical route to Asia, contrary to reality and the expert consensus of the time, and it has been speculated that he was therefore inclined to denote these new substances as "pepper" in order to associate them with the known Asian spice.[citation needed]

Chillis were cultivated around the globe after Columbus' time.[4][5] Diego Álvarez Chanca, a physician on Columbus' second voyage to the West Indies in 1493, brought the first chili peppers to Spain, and first wrote about their medicinal effects in 1494.

From Mexico, at the time the Spanish colony that controlled commerce with Asia, chili peppers spread rapidly into the Philippines and then to India, China, Korea and Japan with the aid of European sailors. The new spice was quickly incorporated into the local cuisines.

An alternate sequence for chili peppers' spread has the Portuguese picking up the pepper from Spain, and thence to India, as described by Lizzie Collingham in her book Curry.[6] The evidence provided is that the chili pepper figures heavily in the cuisine of the Goan region of India, which was the site of a Portuguese colony (e.g. Vindaloo, an Indian interpretation of a Portuguese dish). Collingham also describes the journey of chili peppers from India, through Central Asia and Turkey, to Hungary, where it became the national spice in the form of paprika.

In the publication Svensk Botanisk Tidskrift (1995), Professor Hakon Hjelmqvist published an article on pre-Columbian chili peppers in Europe. In an archaeological dig in the block of St. Botulf in Lund, archaeologists claimed to have found a Capsicum frutescens in a layer dating to the 13th century. Hjelmqvist also claims that Capsicum was described by the Greek Therophrasteus (370-286 BC). He also mentions other antique sources. The Roman poet Martialis (around the 1st century) described "Pipervee crudum" (raw pepper) to be long and containing seeds. The description of the plants does not fit pepper (Piper nigrum), which does not grow well in European climates.[7]

The Black Habanero or as it is sometimes known, the Chocolate Habanero or Habanero Negra, is thought to be the closest to the original peppers that grew in the South American coastal plains. [citation needed] It is known to gourmets but rarely available, due to its long maturity and general rarity. Seeds are more readily available today but care is needed when purchasing as many sub species are sold under the same name [citation needed]. [citation needed]

Species and cultivars

Cayenne chili pepper

The most common species of chili peppers are:

Assorted bell pepper fruits from Mexico

Though there are only a few commonly used species, there are many cultivars and methods of preparing chili peppers that have different common names for culinary use. Bell peppers, for example, are the same cultivar of C. annuum; immature peppers being green and mature peppers being red. In the same species are the jalapeño, the poblano (when dried is referred to as ancho), New Mexico (which is also known as chile colorado), Anaheim, Serrano, and other cultivars.

Scotch bonnets, and habaneros are common varieties of C. chinense.

The species C. frutescens appears as chiles de árbol, aji, pequin, tabasco, cherry peppers, malagueta and others.

Peppers are commonly broken down into three groupings: bell peppers, sweet peppers, and hot peppers. Most popular pepper varieties are seen as falling into one of these categories or as a cross between them.

Intensity

The substances that gives chili peppers their intensity when ingested or applied topically are capsaicin (8-methyl-N-vanillyl-6-nonenamide) and several related chemicals, collectively called capsaicinoids. Capsaicin is the primary ingredient in pepper spray.

When consumed, capsaicinoids bind with pain receptors in the mouth and throat that are normally responsible for sensing heat. Once activated by the capsaicinoids, these receptors send a message to the brain that the person has consumed something hot. The brain responds to the burning sensation by raising the heart rate, increasing perspiration and releasing the body's natural painkilling chemical, endorphin.

The "heat" of chili peppers is measured in Scoville units (SHU). Bell peppers rank at 0 (SHU), New Mexico green chilis at about 1,500 SHU, jalapeños at 3,000–6,000 SHU, and habaneros at 300,000 SHU. The record for the hottest chili pepper was assigned by the Guinness Book of Records to the Naga Jolokia, measuring over 1,000,000 SHU. Pure capsaicin, which is a hydrophobic, colorless, odorless, crystalline to waxy solid at room temperature, measures 16,000,000 SHU.

Culinary use

Thai pepper. Similar in variety as the African birdseye, it is considerably strong for its size.

The chili has a long association with Mexican cuisine as later adapted into Tex-Mex cuisine. Although unknown in Asia until Europeans introduced it there, chili has also become a part of the Korean, Indian, Indonesian, Szechuan, Thai and other cooking traditions. Its popularity has seen it adopted into many cuisines of the World.

Chili fruit

The fruit is eaten raw or cooked for its fiery hot flavour which is concentrated along the top of the pod. The stem end of the pod has glands which produce the capsaicin, which then flows down through the pod. The white pith, that surrounds the seeds, contains the highest concentrations of capsaicin. Removing the seeds and inner membranes is thus effective at reducing the heat of a pod.

Fresh Indian Green Chilis sold in HAL market, Bangalore

Chili is often sold worldwide as a spice in dried and powdered form. In the United States, it is often made from the Mexican chile ancho variety, but with small amounts of cayenne added for heat. In the Southwest United States, dried ground chili peppers, cumin, garlic and oregano is often known as chili powder. Chipotles are dry, smoked red (ripe) jalapeños.

Chili peppers are also often used around the world to make a wide variety of sauces, known as hot sauce, chili sauce, or pepper sauce. There are countless recipes.

Indian cooking has multiple uses for chilis, from snacks like bajji where the chilis are dipped in batter and fried to the infamously hot vindaloo. Chilis are also dried and roasted and salted for later use as a side dish for rice varieties like vadam (a kind of pappad). In Turkish or Ottoman cuisine, chilis are widely used where it is known as Kırmızı Biber (Red Pepper) or Acı Biber (Hot Pepper). Sambal is dipping sauce made from chili peppers with many other ingredients such as garlic, onion, shallots, salt, vinegar and sugar, which is very popular in Indonesia, Malaysia and Singapore. Chili powder is an important spice in Persian cuisine and is used moderately in a variety of dishes.

Chili leaves

The leaves of the chili pepper plant, which are mildly bitter, are cooked as greens in Filipino cuisine, where they are called dahon ng sili (literally "chili leaves"). They are often used in the chicken soup dish known as tinola.[1] In Korean cuisine, the leaves are also used to produce kimchi (풋고추잎 깍두기).[8]

Decoration

Chili peppers can also be used decoratively

There are entire breeds of chili pepper which are not intended for consumption at all, but are grown only for their decorative qualities, generally referred to as "ornamental peppers". Some of them are too hot for most common cooking techniques, or simply don't taste good. Some are grown for both decoration and food. Either way, they tend to have peppers of unusual shapes or colors. Examples of these include Thai Ornamental, Black Pearl, Marble, Numex Twilight, and the Medusa pepper. Numex Twilight is a green plant which produces fruit starting purple, then ripening to yellow, orange, and red. Black Pearl has black leaves and round black fruit that ripen to a bright red. In India, the chili, along with lime is used to ward off evil spirits and is often seen in vehicles and in homes for that purpose. It is also used to check the evil eye and remove its effects in Hinduism as people will also be asked to spit into a handful of chilis kept in that plate, which are then thrown into fire. If the chilis make a noise - as they should - then there is no case of "drishti" (evil eye); if on the other hand they don't make any sound, then the spell of the evil eye is removed in the fire.

The Black Pearl cultivar has round black fruit that ripen to a bright red

Popularity

Scotch bonnet chili peppers in a Caribbean market

Chili peppers are popular in food. They are rich in vitamin C and are believed to have many beneficial effects on health. Psychologist Paul Rozin suggests that eating chilis is an example of a "constrained risk" like riding a roller coaster, in which extreme sensations like pain and fear can be enjoyed because individuals know that these sensations are not actually harmful.[9]

Chili peppers drying in Kathmandu, Nepal

Evolutionary advantages

Birds do not have the same sensitivity to capsaicin as mammals, as capsaicin acts on a specific nerve receptor in mammals, and avian nervous systems are rather different. Chili peppers are in fact a favorite food of many birds living in the chili peppers' natural range. The flesh of the peppers provides the birds with a nutritious meal rich in vitamin C. In return, the seeds of the peppers are distributed by the birds, as they drop the seeds while eating the pods or the seeds pass through the digestive tract unharmed. This relationship is theorized to have promoted the evolution of the protective capsaicin. Products based on this substance have been sold to treat the seeds in bird feeders, in order to deter squirrels and other mammalian vermin without also deterring birds.

Spelling and usage

The three primary spellings are chili, chile and chilli, all of which are recognized by dictionaries.

  • Chili is widely used, although in much of South America the plant and its fruit are better known as ají, locoto, chile, or rocoto. However, this spelling is discouraged by some in the United States of America, since it also commonly refers to a popular Southwestern-American dish (also known as chili con carne (literally chili with meat); the official state dish of Texas[10]), as well as to the mixture of cumin and other spices (chili powder) used to flavor it. Chili powder and chile powder, on the other hand, can both refer to dried, ground chili peppers.
  • Chile is an alternate usage, the most common Spanish spelling in Mexico[11], as well as some parts of the United States of America and Canada, which refers specifically to this plant and its fruit. In the American southwest (particularly northern New Mexico), chile also denotes a thick, spicy, un-vinegared sauce, which is available in red and green varieties and which is often served over most New Mexican cuisine.

Despite the country's mapped shape resembling a chili pepper, the name of this plant bears no relation to Chile, the country, which is named after the Quechua chin ("cold"), tchili ("snow"), or chilli ("where the land ends"). Chile is one of the Spanish-speaking countries where chilis are known as ají, a word of Taíno origin.

There is also some disagreement about whether it is proper to use the word "pepper" when discussing chili peppers because "pepper" originally referred to the genus Piper, not Capsicum. Despite this dispute, a sense of pepper referring to Capsicum is supported by English dictionaries, including the Oxford English Dictionary (sense 2b of pepper) and Merriam-Webster.[13] Furthermore, the word "pepper" is commonly used in the botanical and culinary fields in the names of different types of chili peppers.

Nutritional value

Red chilis contain high amounts of vitamin D and provitamin A. Because of the high amount of vitamin D some South American athletes consume chili peppers before strenuous exercises. Yellow and especially green chilis (which are essentially unripe fruit) contain a considerably lower amount of both substances. In addition, peppers are a good source of most B vitamins, and vitamin B6 in particular. They are very high in potassium and high in magnesium and iron. Their high vitamin D content can also substantially increase the uptake of non-heme iron from other ingredients in a meal, such as beans and grains.

Possible health benefits

All chili peppers contain phytochemicals known collectively as capsaicinoids.

  • Capsaicin was shown, in laboratory settings, to cause cancer cell apoptosis in rats.[14]
  • Recent research in mice shows that chili (capsaicin in particular) may offer some hope of weight loss for people suffering from obesity.[15][16]
  • Canadian researchers used capsaicin from chillies to kill nerve cells in the pancreases of mice with Type 1 diabetes, thus allowing the insulin producing cells to start producing insulin again.[17][18]
  • Research in humans found that "after adding chili to the diet, the LDL, or bad cholesterol, actually resisted oxidation for a longer period of time, (delaying) the development of a major risk for cardiovascular disease".[19][20]
  • Australian researchers at the University of Tasmania found that the amount of insulin required to lower blood sugar after a meal is reduced if the meal contains chili pepper.[21]
  • Chilli peppers are being probed as a treatment for alleviating chronic pain.[22][23]
  • Spices, including chilli, are theorized to control the microbial contamination levels of food in countries with minimal or no refrigeration.[24]
  • Hot peppers can provide symptomatic relief from rhinitis and possibly bronchitis by thinning and clearing mucus from stuffed noses or congested lungs.[citation needed]
  • Several studies found that capsaicin could have an anti-ulcer protective effect on stomachs infected with H. pylori by affecting the chemicals the stomach secretes in response to infection.[25][26][27]
  • By combining an anesthetic with capsaicin, researchers can block pain in rat paws without causing temporary paralysis. This anesthetic may one day allow patients to be conscious during surgery and may also lead to the development of more effective chronic pain treatments.[28][29]

Possible health risks

  • A high consumption of chili is associated with stomach cancer.[30][31][32][33]
  • Chili powders may sometimes be adulterated with Sudan I, II, III, IV, para-Red, and other illegal carcinogenic dyes.[34]
  • Aflatoxins and N-nitroso compounds, which are carcinogenic, are frequently found in chili powder.[35][36][37][38][39]
  • Chronic ingestion of chili products may induce gastroesophageal reflux (GER).[40]
  • Chili may increase the number of daily bowel movements and lower pain thresholds for people with irritable bowel syndrome.[41]
  • Chilis should never be swallowed whole; there are cases where unchewed chilis have caused bowel obstruction and perforation.[42]
  • Consumption of red chilis after anal fissure surgery should be forbidden to avoid postoperative symptoms.[43]
  • Ingestion of even small amounts of hot chilis may temporarily aggravate the symptoms affecting hemorrhoid patients, such as pain, itching, and bleeding.
  • Consumption of chilis or other hot spices may aggravate inflammation of existing joint pain maladies, such as bursitis and gout.

See also

Footnotes

  1. ^ Perry, L. et al. 2007. Starch fossils and the domestication and dispersal of chilli peppers (Capsicum spp. L.) in the Americas. Science 315: 986-988.
  2. ^ BBC News Online. 2007. Chillies heated ancient cuisine. Friday, 16 February. Available from: http://news.bbc.co.uk/2/hi/americas/6367299.stm. Accessed 16 February 2007.
  3. ^ Bosland, P.W. 1996. Capsicums: Innovative uses of an ancient crop. p. 479-487. In: J. Janick (ed.), Progress in new crops. ASHS Press, Arlington, VA.
  4. ^ Heiser Jr., C.B. 1976. Pp. 265-268 in N.W. Simmonds (ed.). Evolution of Crop Plants. London: Longman.
  5. ^ Eshbaugh, W.H. 1993. Pp. 132-139 in J. Janick and J.E. Simon (eds.). New Crops. New York: Wiley.
  6. ^ Collingham, Elizabeth (2006). Curry. Oxford University Press. ISBN 0-09-943786-4. {{cite book}}: Unknown parameter |month= ignored (help)
  7. ^ Hjelmqvist, Hakon. "Cayennepeppar från Lunds medeltid". Svensk Botanisk Tidskrift, vol 89. pp. 193-. {{cite news}}: Cite has empty unknown parameter: |1= (help); More than one of |author= and |last= specified (help)
  8. ^ http://sfood.info/cuisine/kimchi/k35.htm
  9. ^ Paul Rozin1 and Deborah Schiller. "The nature and acquisition of a preference for chili pepper by humans". Motivation and Emotion. 4 (1): 77–101. {{cite journal}}: |access-date= requires |url= (help); Cite has empty unknown parameters: |month= and |coauthors= (help)CS1 maint: numeric names: authors list (link)Journal Publisher ISSN 0146-7239 (Print) 1573-6644 (Online) Issue Volume 4, Number 1 / March, 1980 DOI 10.1007/BF00995932 Pages Subject Collection Behavioral Science SpringerLink Date Wednesday, January 19, 2005
  10. ^ State Symbols - Texas State Library
  11. ^ Heiser, Charles (1990). Seed To Civlization: The Story of Food. Cambridge: Harvard University Press. ISBN 0-67-479681-0. {{cite book}}: Unknown parameter |month= ignored (help)
  12. ^ A Brief History of Chilies : Kakawa Chocolate House, Mesoamerican Mayan Aztec Drinking Chocolate, Historic European and Colonial American Drinking Chocolate, Truffles and More
  13. ^ va=pepper - Definition from the Merriam-Webster Online Dictionary
  14. ^ Athanasiou A, Smith PA, Vakilpour S; et al. (2007). "Vanilloid receptor agonists and antagonists are mitochondrial inhibitors: how vanilloids cause non-vanilloid receptor mediated cell death". Biochem. Biophys. Res. Commun. 354 (1): 50–5. doi:10.1016/j.bbrc.2006.12.179. PMID 17214968. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  15. ^ Hsu CL, Yen GC (2007). "Effects of capsaicin on induction of apoptosis and inhibition of adipogenesis in 3T3-L1 cells". J. Agric. Food Chem. 55 (5): 1730–6. doi:10.1021/jf062912b. PMID 17295509.
  16. ^ extract may stop fat cell growth By Stephen Daniells 3/1/2007
  17. ^ Razavi R, Chan Y, Afifiyan FN; et al. (2006). "TRPV1+ sensory neurons control beta cell stress and islet inflammation in autoimmune diabetes". Cell. 127 (6): 1123–35. doi:10.1016/j.cell.2006.10.038. PMID 17174891. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  18. ^ Chili extract makes diabetes go awayDecember 15, 2006 The Vancouver Sun
  19. ^ Chili peppers can improve your health 9/9/2007 Daily Herald
  20. ^ Ahuja KD, Ball MJ (2006). "Effects of daily ingestion of chilli on serum lipoprotein oxidation in adult men and women". Br. J. Nutr. 96 (2): 239–42. PMID 16923216.
  21. ^ "Blood sugar and spice Science News - Find Articles". Retrieved 2007-09-19.
  22. ^ "BBC NEWS". Retrieved 2007-09-19. {{cite web}}: Text "Could chilli peppers relieve pain?" ignored (help); Text "Health" ignored (help)
  23. ^ "Great Moments in Science - Chilli - Nuclear Food 3". Retrieved 2007-09-19.
  24. ^ Billing J, Sherman PW (1998). "Antimicrobial functions of spices: why some like it hot". The Quarterly review of biology. 73 (1): 3–49. PMID 9586227.
  25. ^ Lee IO, Lee KH, Pyo JH, Kim JH, Choi YJ, Lee YC (2007). "Anti-inflammatory effect of capsaicin in Helicobacter pylori-infected gastric epithelial cells". Helicobacter. 12 (5): 510–7. doi:10.1111/j.1523-5378.2007.00521.x. PMID 17760719.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  26. ^ Satyanarayana MN (2006). "Capsaicin and gastric ulcers". Critical reviews in food science and nutrition. 46 (4): 275–328. doi:10.1080/1040-830491379236. PMID 16621751. {{cite journal}}: |access-date= requires |url= (help)
  27. ^ O'Mahony R, Al-Khtheeri H, Weerasekera D; et al. (2005). "Bactericidal and anti-adhesive properties of culinary and medicinal plants against Helicobacter pylori". World J. Gastroenterol. 11 (47): 7499–507. PMID 16437723. {{cite journal}}: |access-date= requires |url= (help); Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  28. ^ Binshtok AM, Bean BP, Woolf CJ (2007). "Inhibition of nociceptors by TRPV1-mediated entry of impermeant sodium channel blockers". Nature. 449 (7162): 607–10. doi:10.1038/nature06191. PMID 17914397.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  29. ^ "Using Hot Chili Peppers To Relieve Pain". CBS News. 2007. Retrieved 2007-10-20.
  30. ^ Mathew A, Gangadharan P, Varghese C, Nair MK (2000). "Diet and stomach cancer: a case-control study in South India". Eur. J. Cancer Prev. 9 (2): 89–97. PMID 10830575.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  31. ^ López-Carrillo L, López-Cervantes M, Robles-Díaz G; et al. (2003). "Capsaicin consumption, Helicobacter pylori positivity and gastric cancer in Mexico". Int. J. Cancer. 106 (2): 277–82. doi:10.1002/ijc.11195. PMID 12800206. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  32. ^ Archer VE, Jones DW (2002). "Capsaicin pepper, cancer and ethnicity". Med. Hypotheses. 59 (4): 450–7. PMID 12208187.
  33. ^ López-Carrillo L, Hernández Avila M, Dubrow R (1994). "Chili pepper consumption and gastric cancer in Mexico: a case-control study". Am. J. Epidemiol. 139 (3): 263–71. PMID 8116601.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  34. ^ Gajda J, Switka A, Kuźma K, Jarecka J (2006). "[Sudan and other illegal dyes--food adulteration]". Roczniki Państwowego Zakładu Higieny (in Polish). 57 (4): 317–23. PMID 17713194.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  35. ^ "Final report on the safety assessment of capsicum annuum extract, capsicum annuum fruit extract, capsicum annuum resin, capsicum annuum fruit powder, capsicum frutescens fruit, capsicum frutescens fruit extract, capsicum frutescens resin, and capsaicin". Int. J. Toxicol. 26 Suppl 1: 3–106. 2007. doi:10.1080/10915810601163939. PMID 17365137.
  36. ^ Fazekas B, Tar A, Kovács M (2005). "Aflatoxin and ochratoxin A content of spices in Hungary". Food additives and contaminants. 22 (9): 856–63. doi:10.1080/02652030500198027. PMID 16192072.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  37. ^ Vrabcheva TM (2000). "[Mycotoxins in spices]". Voprosy pitaniia (in Russian). 69 (6): 40–3. PMID 11452374.
  38. ^ Reddy SV, Mayi DK, Reddy MU, Thirumala-Devi K, Reddy DV (2001). "Aflatoxins B1 in different grades of chillies (Capsicum annum L.) in India as determined by indirect competitive-ELISA". Food additives and contaminants. 18 (6): 553–8. PMID 11407753.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  39. ^ Tricker AR, Siddiqi M, Preussmann R (1988). "Occurrence of volatile N-nitrosamines in dried chillies". Cancer Lett. 38 (3): 271–3. PMID 3349447.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  40. ^ Milke P, Diaz A, Valdovinos MA, Moran S (2006). "Gastroesophageal reflux in healthy subjects induced by two different species of chili (Capsicum annum)". Digestive diseases (Basel, Switzerland). 24 (1–2): 184–8. doi:10.1159/000090323. PMID 16699276.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  41. ^ Agarwal MK, Bhatia SJ, Desai SA, Bhure U, Melgiri S (2002). "Effect of red chillies on small bowel and colonic transit and rectal sensitivity in men with irritable bowel syndrome". Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology. 21 (5): 179–82. PMID 12416746.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  42. ^ Rajaratnam SS, Boyle N, Owen WJ (2001). "'Always chew your chillies': a report of small bowel obstruction with perforation". Int. J. Clin. Pract. 55 (2): 146. PMID 11321857.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  43. ^ Gupta PJ (2007). "Red Hot Chili Consumption Is Harmful in Patients Operated for Anal Fissure - A Randomized, Double-Blind, Controlled Study". 24 (5): 354–357. doi:10.1159/000107716. PMID 17785979. {{cite journal}}: Cite journal requires |journal= (help)