Abnormalities in collagen composition may contribute to the pathogenesis of hemorrhoids: morphometric analysis.

Y. Y. Nasseri,M. C. Osborne,S. D. Wexner,K. M. Van Groningen,M. Berho,S. Wollman,E. G. Weiss,E. Krott

doi:10.1007/s10151-014-1238-5

Y. Y. Nasseri, M. C. Osborne + Show 6 more

Open Access

https://doi.org/10.1007/s10151-014-1238-5

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Abstract

PurposeWhile hemorrhoidal disease is common, its etiology remains unclear. It has been postulated that disturbances in collagen lead to reduced connective tissue stability, and in turn to the development of hemorrhoidal disease. We aimed to compare the quality and quantity of collagen in patients with hemorrhoidal disease versus normal controls.MethodsSpecimens from 57 patients with grade III or IV internal hemorrhoids undergoing hemorrhoidectomy between 2006 and 2011 were evaluated. Samples from 20 human cadavers without hemorrhoidal disease served as controls. Quality of collagen was analyzed by collagen I/III ratio, and quantity of collagen was determined by collagen/protein ratio. The study group was subdivided into gender and age subgroups.ResultsThe male:female ratios in the study and control groups were 30:27 and 10:10, respectively. Median age was significantly less in the study group [46.9 years (range 20–69)] compared to the control group [76 years (range 46–90)] with P < 0.05. Tissues from patients in the study group had significantly lower collagen I/III ratio as compared to the control group (4.4 ± 1.1 vs. 5.5 ± 0.6; P < 0.0001). Nevertheless, despite a trend toward lower collagen/protein ratio in the study group, it did not reach statistical significance (57 ± 42.4 vs. 73 ± 32.5 g/mg; P = 0.167). There was no difference in collagen I/III or collagen/protein ratios among different age groups and genders.ConclusionsHemorrhoidal tissues from patients with hemorrhoidal disease appear to have reduced mechanical stability as compared to normal controls.

Highlights

Hemorrhoids have been described as far back as the preChristian era [1]
The main theory regarding the pathophysiology of hemorrhoidal disease suggest that they are the result of abnormal dilation of veins of the internal hemorrhoidal venous plexus, abnormal distention of the arteriovenous anastomosis, and prolapse of the cushions and the surrounding connective tissue
The mean age of the study group was 46.9 (20–69), which was significantly lower than the mean age of the control group 76 (46–90) years with P \ 0.05

Summary

Introduction

In 1830, de Montegre [2] assembled an early literature review of 78 articles on hemorrhoids published between 1582 and 1817. His manuscript remarked how little was known about the overall prevalence and risk factors of hemorrhoidal disease; not much changed during the past 200 years. Most colorectal surgeons recognize that hemorrhoids are common, they are unaware of their true prevalence. Hemorrhoidal disease is defined as the symptomatic enlargement and distal displacement of the normal anal cushions [5]. Numerous factors have been linked with hemorrhoidal disease including inadequate fiber intake, prolonged lavatory sitting, constipation, diarrhea, and pregnancy.

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