Acute Hemorrhoids Research Articles

Use of mesoglycan in the acute phase of hemorrhoidal disease (the CHORMES study): study protocol for a double-blind, randomized controlled trial

BackgroundHemorrhoidal disease (HD) is associated with substantial economic burden and negative effects on health-related quality of life (HRQoL). The aCute HaemORrhoids treatment with MESoglycan (CHORMES) study aims to evaluate the effects of orally administered mesoglycan, a natural preparation of glycosaminoglycans with antithrombotic and profibrinolytic properties, as an acute treatment in patients with HD.MethodsCHORMES is a phase 2, double-blind, randomized controlled trial being conducted at two centers in Italy. Adults aged 18–75 years with Grade I–III HD according to Goligher classification or external thrombosed hemorrhoids, and a Hemorrhoidal Disease Symptom Score (HDSS) of ≥ 5, will be randomly allocated in a 1:1 ratio to mesoglycan or placebo and will be treated for 40 days (two capsules for the first 5 days and one capsule for the subsequent 35 days twice daily [after breakfast and dinner], equivalent to 200 mg in the first 5 days and 100 mg subsequently). Concomitant use of analgesics is permitted in both treatment groups. The trial aims to enroll 50 patients, with 25 patients in each treatment group. The primary objective of the trial is to evaluate the efficacy of mesoglycan in reducing symptoms of HD, assessed via change in HDSS from baseline (day 0) to day 40 in the intention-to-treat population. Secondary objectives include changes in HRQoL from baseline to day 40 using the Short Health Scale for Hemorrhoidal Disease, safety (adverse effects, physical assessments, vital signs and laboratory parameters in the safety population), fecal continence assessed using the Vaizey score, bleeding assessed using the Bleeding score, the amount and type of analgesic taken, and pain. Patient enrolment began on 11 December 2023, and trial completion is expected by December 2024.DiscussionThe CHORMES trial will evaluate the efficacy and safety of mesoglycan, in addition to its impact on HRQoL, analgesic use and pain, in patients with HD. The results of the trial will assist clinicians in determining the most effective treatment for patients with HD.Trial registrationClinicalTrials.gov NCT06101992. Prospectively registered on 26 October 2023 at https://clinicaltrials.gov/ct2/show/NCT06101992.

The efficacy of Aescin combined with MPFF for early control of bleeding from acute hemorrhoids, A randomized controlled trial

BackgroundHemorrhoidal disease, affecting over 20 % of the population, presents management challenges due to its multifaceted nature. While treatments like Micronized Purified Flavonoid Fraction (MPFF) show promise, Aescin's efficacy remains uncertain. This study assesses the combined effectiveness of Aescin with MPFF against MPFF alone in treating Grades 1 and 2 hemorrhoids, focusing on halting bleeding and reducing mass effect. MethodThis study recruited patients from the Division of Colorectal Surgery, Chiang Mai University. Patients were randomly assigned to receive MPFF alone or MPFF with Aescin. Outcomes included the duration until bleeding cessation and resolution of mass effect. ResultsOf 120 patients randomized to each group, the combination therapy demonstrated superiority in halting bleeding (two days VS four days) and resolving mass effect (four days VS five days) compared to MPFF alone with statistically significant differences. Treatment failure rates were lower in the combination therapy group, with high patient satisfaction. ConclusionCombining Aescin with MPFF shows promise as a therapeutic approach for Grades 1 and 2 internal hemorrhoids, offering expedited relief from bleeding and mass effect. These findings suggest the need for further research to validate results in larger cohorts and optimize treatment strategies for hemorrhoidal disease.

Features of treatment of haemorrhoids in overweight patients

Hemorrhoidal disease is one of the most common proctological diseases in the population, covering, according to a number of authors, from 4 to 86% of the population over the age of 40 years. In addition, the problem of metabolic syndrome and accompanying obesity have become a real disease of the century in developed countries. This condition predisposes to a large number of diseases, including hemorrhoidal disease. From these positions, it is advisable to highlight the possibilities of treating not only hemorrhoids themselves, but also combating metabolic syndrome in this category of patients. The article describes modern data on the therapeutic effect of bioflavonoids, in particular hesperidin, and the mechanisms of their therapeutic action in acute and chronic hemorrhoids. The possibilities of using topical therapy for hemorrhoids are also highlighted, attention is paid to suppositories based on sodium alginate, thanks to which the drug has a hemostatic, anti-inflammatory and reparative effect, alleviating local symptoms of hemorrhoids and anal fissure. Data are provided on the therapeutic effect of the combination of hesperidin + diosmin in relation to the symptoms of hemorrhoids in patients with excess body weight and to metabolic syndrome are presented, as well as the experience of clinical observation in the hospital of the Faculty of Surgery No. 2 L/F of the N.I. Russian National Research Medical University is presented. Pirogov in the treatment of 1 300 comorbid patients with acute hemorrhoids and exacerbation of chronic hemorrhoids, followed by surgical treatment. The potential benefits of drugs with a standardized content of hesperidin (Venarus®) in relation to the treatment of hemorrhoids in patients with excess body weight and metabolic syndrome, comparison with other drugs from the group of bioflavonoids, are described.

Competence of Althaeaofficinalis Seed Extract in control of Haemorrhoids in comparison with Daflon

Background: The use of medicinal plants in herbalism has been documented for thousands of years, with evidence dating back to ancient civilizations such as the, Chinese, Greeks and Egyptians1. Extensive clinical studies have demonstrated that Althaeaofficinalis has properties that promote healing of ulcers2. Aim: To evaluate effectiveness of Althaeaofficinalis seed extract compared to Daflon (diosmin plus hesperidin) in treating hemorrhoids. Methods: A double-blind, randomized clinical trial was carried out in Lahore's urban community. Patients with acute hemorrhoids were randomly divided into two parallel groups, each with 60 participants, for a one-week period. The selection of family physicians for the study was done randomly.6,7,8 Interventions: In the beginning, the participants were given either two capsules of 500mg Althaea seed extract or two tablets of Daflonin morning and evening for four days, followed by two capsules/tablets daily for the next three days. The primary measure of effectiveness was the alleviation of symptoms and signs.9,10 Results: Both groups demonstrated similar improvement from first day tolast day. The intensity of symptoms such as itching, tenesmus, and bleeding ,swelling, painetc reduced markedly in both groups, but the reduction was fast in the Althaeaofficinalis seed extract group observed initial days of the trial. Practical Implications: Estimated prevalence of haemorrhoids ranges from 2.9% to 27.9% worldwide.11,12.13 However, due to cultural practices, it is often ignored and left untreated, It is therefore essential to design preventive measures and control strategies for hemorrhoids. Conclusion: Both Althaea and Daflon were found relieving haemorrhoidal signs and symptoms of hemorrhoids. However, the use of Althaea seed extract resulted in quicker relief and it may be used as good alternative to Daflon. Keywords: Haemorrhoids ,Altthaea seed extract, Althaeaofficinalis, double blind, tenesmus, bleeding,

The importance of hemorrhoidal disease in the modern world

Aim. To study the incidence of hemorrhoidal disease in the Udmurt Republic on the basis of statistical data of the coloproctology department at the Budgetary Healthcare Institution “The First Republican Clinical Hospital of the Ministry of Health of the Udmurt Republic”, Izhevsk, for 2018-2020 and a clinical case of a patient with acute hemorrhoids. Materials and methods. The data of 6506 medical records of outpatients and inpatients with diagnoses K64.0-K64.5 were analyzed. The evaluation of the results was carried out according to the following criteria: gender, age composition, region, diagnosis of patients, progression of the disease, type of surgery. A clinical case of a patient with acute hemorrhoids is presented. Results. Among the hospitalized patients, the male population prevailed (57.1%); among the outpatient patients, the female population prevailed (57.5%). Most of the patients were young and middle-aged patients (77% of hospitalized patients, 70.6% of outpatient patients). The urban population comprised 65.1% of hospitalized patients and 59.1% of outpatient patients. A chronic form of the disease was registered in 94.6% of the hospitalized patients and in 92.3% of the outpatient patients. Among all surgical interventions hemorrhoidectomy was conducted in 73.0% of cases. The analysis of the diagnosis and treatment of hemorrhoidal disease on the basis of a clinical case with positive results was carried out. Conclusions. According to the data obtained by the department, it can be said that among all patients diagnosed with hemorrhoids, the able-bodied and young, mainly urban population prevails, which indicates the influence of urabanization on the development of hemorrhoidal disease. The disease is equally prevalent in men and women. The chronic form prevails in the structure of the incidence of hemorrhoidal disease. The most commonly used surgical treatment of hemorrhoidal disease is hemorrhoidectomy.

Experience of homeopathic ointment during the non-surgical treatment for acute hemorrhoids in the outpatient settings

Introduction. The use of traditional anti-inflammatory and local anesthetic preparations during the non-surgical treatment of acute hemorrhoids is liable to cause the progression of serious side effects in patients.Purpose of the study. To evaluate the clinical efficacy of homeopathic ointment as the topical preparation in the complex treatment of patients with acute hemorrhoids on the outpatient settings.Materials and methods. The comparative analysis of the results of the non-surgical treatment was conducted and applied to 48 patients with acute hemorrhoids of 1–3 degrees, who were divided into two groups. In 23 patients (control group), traditional non-surgical treatment was conducted without the use of topical preparations. In 25 patients (the main group), traditional preparation therapy was supplemented with local treatment using homeopathic ointment.Results. In the patients of the main group, a faster regression of pain syndrome and other manifestations of the disease (itching, burning and discomfort in the anal canal, perianal edema) was noted in the dynamics of treatment, and higher values of quality of life parameters were recorded than in patients of the control group. In the main group, good and satisfactory treatment results were obtained in 23 (92.0%) patients, unsatisfactory – in 2 (8.0%) patients. In the control group, good and satisfactory treatment results were observed in 18 (78.3%) patients, unsatisfactory results – in 5 (21.7%) patients.Discussion. The maximum therapeutic effect with topical application of ointment was observed in patients with acute hemorrhoids of 2–3 degrees, the disease in which proceeded with a pronounced inflammatory-allergic component.Conclusion. Our results allow us to consider homeopathic ointment as an alternative topical preparation in the non-surgical treatment of acute hemorrhoids in outpatient settings in patients with serious contraindications to the use of traditional topical preparations.

Modern trends in combined treatment of hemorrhoids: topical form Tribenoside + Lidocaine and phlebotonic Ginkgo biloba + Troxerutin + Heptaminol

Acute hemorrhoids are the most common reason for referring to coloproctologist in people of working age. In the modern world, food culture and lifestyle are the most prominent factors leading to the risk of hemorrhoids. In the 21st century, it is hard to overestimate an importance of potential employability and active social role regarding socio-economic well-being. This thesis applies to patients suffering from proctological diseases, and those with hemorrhoids prevail among these ones. Minimally invasive treatment and pharmacotherapy defined primary needs of patients, i.e. treatment should be quick, safe and effective. Favorable treatment outcomes are possible only in pathogenetic therapy. In this review, we will define the priorities in effective combined treatment of hemorrhoids.

The effectiveness of combined topical product with fluocortolone pivalate and lidocaine for hemorrhoids: results of a multicenter observational study

AIM: to assess the changes in hemorrhoids symptoms and satisfaction with treatment against the background of treatment with a combined topical product Relief® Pro.PATIENTS AND METHODS:multicenter prospective non-interventional cohort study was done in 13 clinical centers in Russia. The study included patients aged 18 to 65 years with acute hemorrhoids of stages 1–2 treated with the combined product Relief® Pro (rectal suppositories, cream or a combination thereof). The follow-up period was up to 14 days (in the case of 2 visits to the clinical center after receiving the initial data). The analysis was performed on the basis of data obtained at Visit 2 (5–7 days of therapy) and Visit 3 (10–14 days of therapy) vs the initial data (Visit 1). Following criteria were used: the severity of hemorrhoid symptoms on the Sodergren scale, the severity of hemorrhoid symptoms (pain, bleeding, itching, edema, the presence of discharge, a feeling of discomfort), the size of the largest hemorrhoid node, the satisfaction of the doctor and the patient with treatment, assessment of the patient’s adherence to recommendations for lifestyle changes and treatment, evaluation of the use of the drug Relief® were evaluated as endpoints About the treatment process and patient preferences regarding the dosage form of the prescribed drug. In addition, adverse events were evaluated.RESULTS: the study included 1000 patients aged 18 to 65 years (men — 54.5%, women — 45.5%) Patients had grade 1 acute hemorrhoids (330 patients), grade 2 acute hemorrhoids (345 patients) and exacerbation of chronic hemorrhoids (325 patients). The drug Relief® Pro rectal cream was used by 333 patients; suppositories — 383 patients; joint therapy with both dosage forms — 284 patients. During follow-up (visits 2 and 3), positive dynamics was observed in patients — a decrease in the severity of hemorrhoid symptoms both during objective examination and according to patient questionnaires. So, according to the patients’ estimates, the use of Relief® Pro, regardless of the form, led to a decrease in the severity or disappearance of the main symptoms of hemorrhoids — bleeding, itching, edema, the presence of discharge, discomfort already by Visit 2 and in almost all patients by the end of observation. A similar change of the symptoms due the digital examination: by day 5–7, the severity of edema and bleeding in the perianal region, bleeding decreased. About 96% of patients and about 97% of doctors were satisfied with the treatment. Application of both forms of Relief® The ABM was characterized by good tolerability: there were no adverse events associated, according to the researcher, with the studied drug.CONCLUSIONS: combined topical product Relief® Pro is effective for hemorrhoids.

Homeopathic therapy for patients with acute hemorrhoids

Introduction . The prevalence of hemorrhoids in the adult population, according to various authors, ranges from 15 to 90%. In case of exacerbation of external hemorrhoids, conservative or surgical treatment can be applied. Of particular and important interest is homeopathic ointment, has an analgesic, antimicrobial, anti-inflammatory effect, and also affects the tone of the venous vessel. The purpose of our study was to study the effectiveness of Fleming’s ointment for the treatment and prevention of patients with acute hemorrhoids. Materials and methods . A prospective comparative study was conducted with the participation of 154 patients with acute hemorrhoids. In the main group (n = 76) of patients, treatment was carried out using diosmin and homeopathic ointment, which was applied 2 times a day for 7 days. In the control group (n = 78) patients, treatment was carried out using enteral administration of diosmin at a dosage of 1000 mg 1 time per day for 30 days and direct-acting anticoagulants in the form of an ointment 2 times a day for 7 days. Results . Within 3 months after the end of treatment, 4 (5.3%) patients of the main group and 12 (15.4%) patients of the control group had exacerbations of hemorrhoids. After 3 months, a statistically significant difference was revealed in the indicator of the subjective impact of hemorrhoidal disease on everyday life, which is associated with the development of exacerbations of hemorrhoids. Conclusions . Homeopathic ointment is an effective and pathogenetically justified remedy for the conservative treatment of patients with acute hemorrhoids. Its use leads to a significant decrease in the severity of clinical symptoms of the disease and an improvement in the indicators of objective research methods with good tolerability, the absence of undesirable effects and better long-term results compared to the standard treatment regimen.

Clinical Pilot Study of Rectal Suppository Containing Combined Extract of Cissus quadrangularis Linn. and Acmella paniculata (Wall ex. DC.) R. K. Jansen in Acute Hemorrhoids.

Background Cissus quadrangularis Linn. (CQ) is a medicinal plant with good evidence for the treatment of hemorrhoids, listed in the Thai National List of Herbal Products in the oral dosage form. Acmella paniculata (Wall ex. DC.) R. K. Jansen. (AP) is a medicinal plant with a local anesthetic effect. Objective To investigate the potential of rectal suppositories containing CQ and AP extracts to alleviate symptoms of hemorrhoids compared with the commercialized rectal suppository containing hydrocortisone and cinchocaine. Materials and Methods Hemorrhoid outpatients (n = 105) with different severity grades (I, II, or III) from eight hospitals in northern Thailand were included in this study. Hemorrhoid severity was graded by proctoscopy associated with either anal pain or bleeding related to hemorrhoids or both. The patients were randomly allocated to two groups: CQ-AP group (n = 52) or the commercialized rectal suppository group (n = 53). One suppository was rectally administered twice daily in the morning and at bedtime for seven days. Evaluations were performed by physicians on days 1, 4, and 8 of the study. The primary endpoints were bleeding and prolapse size, while the secondary endpoint was anal pain. Results Baseline demographics, lifestyle, constipation, number of prolapses, grade of hemorrhoid severity, and duration of experiencing hemorrhoids were comparable in both groups of patients. The effects of CQ-AP and the commercialized rectal suppository on bleeding, prolapse size, and anal pain were comparable. The patients in both groups were satisfied with both products at comparable levels and stated a preference for further use in the case of hemorrhoids recurrence. In terms of safety, the patients in the commercialized rectal suppository group experienced a higher incidence of adverse events, including anal pain and bleeding. Conclusion Rectal suppositories containing a combined extract of CQ and AP show potential in alleviating hemorrhoidal symptoms with a good safety profile.

Пути оптимизации организации оказания амбулаторной колопроктологической помощи населению

The article substantiates the priority directions of optimization of the organization of outpatient coloproctological care to the population of the Perm Region. The purpose of the study is to substantiate the priority directions for optimizing the organization of outpatient coloproctological care to the population. Materials and methods. The data on the reasons for 4822 calls to outpatient polyclinic offices for specialized medical care in the profile of «Coloproctology» in the Perm Region in 2018, as well as about 2222 calls to the Center of Coloproctology with a day-long hospital stay were analyzed. Results. It is shown that the frequency of detection of DND in the center of coloproctology was 22.50%, with the frequency at polyclinic appointments‑11,83%, p<0,001. At polyclinic appointments, the frequency of detection of ZNO was 5,96%, in the center of coloproctology – 12,15%. The results obtained can be explained by the number and quality of diagnostic measures performed at the Coloproctology Center, which allows for almost complete coverage of all patients of the center with rigid rectoscopy – 98,38%, with 33,80% (at outpatient appointments (p<0,001). Sigmoscopy, which is not available in the coloproctologist’s offices at the Coloproctology Center, was performed in 7,02% of patients, FCS was performed in 34,29% of cases, compared to 9.49% in the polyclinic (p<0,001). The presence of an emergency appointment in the Center of Coloproctology explains the higher frequency of detection of acute hemorrhoids – 7,06%, versus 3,2% in polyclinics; acute paraproctitis – 2,29% and 0,62%, respectively; ECC – 1,53% and 0,5%, respectively; anal itching – 1,44% and 0,64%, respectively; proctitis – 0,99% and 0,16%, respectively; rectocele – 0,99% and 0,18%, respectively; injuries of the colon and rectum – 0,72% and 0,16%, respectively; anal insufficiency – 0,72% and 0,37%, respectively; p<0,005. Conclusions. The traditional model of providing outpatient coloproctological care (offices in polyclinics) is not effective even in diagnostics, since it does not have its own endoscopic and anesthesiological service, which significantly affects the volume and quality of the necessary studies. It is proposed to reorganize the service in order to organize a primary link on the basis of an outpatient coloproctology center with a day-long hospital, separate or at the coloproctology department of the State Clinical Hospital.

Outpatient treatment and prevention of acute hemorrhoids with sulodexide

Outpatient treatment and prevention of acute hemorrhoids with sulodexide

Clinical current features and treatment tactics of acute external hemorrhoids in outpatient and polyclinic conditions

Purpose of the study. The study of the current problems for acute external hemorrhoids (AEH) diagnosis and treatment from the point of view of a practicing ambulatory coloproctologist in the Tver region (based on an analysis of the clinical features of the disease, its course and the applied tactics of the coloproctologist) was made.Patients and methods. A retrospective study with continuous series of 124 patients (2016–2017), using clinical and statistical research methods.Results. Acute external hemorrhoids (AEH) is a painful formation that suddenly arises due to acute thrombosis of the external hemorrhoid plexus, located near the anus, mainly at 3, 5, 7 hours on the proctological dial, with a free space between the hemorrhoid and the mucous membrane of the anal canal. Patients with AEH turned to the ambulatory coloproctologist at a later date (on average 11.7 days after the onset of the disease), most often without pain or with slight pain in the anus, with mild and moderate severity of the disease. The main complications of AEH were necrosis and hemorrhoidal wall rupture with bleeding from it. Conservative treatment of patients with AEH was due to clinical guidelines of the Russian Coloproctologists Association (RCA); it was ineffective in 11.3% of patients, who underwent outpatient surgery. All patients with severe pain, high grades of AEH, were offered for hospitalization to the surgical department (including coloproctologcal), but they refused. Low operative activity and late surgery in patients with AEH, who applied to the polyclinic, were due to the fact that only 12 (9.7%) patients sought help within the first 72 hours of the onset of the disease, low severity of pain, as well as the patients refused the proposed operations.Conclusions. The studied features of the outpatient coloproctologic service in AEH reveal the inadequate availability of system resources for patients, inappropriate informing the population with «mass-media» technologies; it makes difficulties to implement the recommendations of the RCA.

HEMORRHOIDS IN THE PEDIATRIC POPULATION: CLINICAL MANIFESTATIONS, DIAGNOSTICS AND TREATMENT

Introduction. Hemorrhoids in childhood is a rare disease. That is why one can find only few works on this problem. Material and methods. 56 children with diagnosed hemorrhoids aged 4-18 were taken into the study. They had various clinical manifestations of the disease: perianal protrusion (76.4%), bleeding (82.3%), pain syndrome (71.5%). 51 patient (91.1%) had external hemorrhoids; 3 children (5.3%) - internal; 2 children (3.6%) - combined. Patients, by their clinical course, were distributed as follows: acute hemorrhoids - 33 children (58.9%), chronic one - 23 (41.1%). Ultrasound examination and sigmoidoscopy were used for diagnostics. Different curative techniques followed the developed curative algorithm: conservative therapy and surgery (open surgery and with the LigaSure apparatus) as well as sclerotherapy. Results. The most effective technique, having better cosmetic and clinical outcomes, was hemorrhoidectomy. Conservative treatment (more than 80%) can be a method of choice at early stages of the disease and at younger age groups. Outcomes after sclerotherapy are comparable with outcomes of conservative and surgical treatment. Sclerotherapy is recommended at the internal stages of hemorrhoids and in case of any contraindications to surgical treatment.

The optimal choice of therapy for acute hemorrhoids

The article presents the results of conservative therapy of patients with acute hemorrhoids, with a 10-day follow-up period, the purpose of which is to improve the results of treatment of this category of patients. The patients of Group I received conservative therapy with heparin ointment and Relief Pro® suppositories; Group II received local therapy with heparin ointment without rectal suppositories. Design: a single-center randomized controlled follow-up study. The study showed the efficacy of Relief Pro® suppositories in patients with acute haemorrhoids. The use of suppositories allowed to statistically reliably reduce the level of pain (2.59 ± 0.6 points in Group I versus 3.87 ± 0.7 points in Group II (p < 0.05)) on Day 3 of the therapy, reduce the frequency of blood excretion on Day 2 of the therapy (83% and 32% of patients, respectively (p <0.05)) and eliminate the discomfort in the anus (100% observations in Group I by Day 5 of the therapy and 67% in Group 2 by Day 10 of the therapy (p <0.05)).

Modern treatment of acute hemorrhoids

The article is devoted to the topical issue of increasing prevalence of hemorrhoid disease in modern society. It provides the detailed description of pathogenesis of the disease and clinical manifestations of hemorrhoids. Particular attention is paid to diagnostic tests and procedures that help physicians to diagnose a disease and choose a therapy, including diet, improvement of bowel habits and function, normalization of the blood flow rate in haemorrhoidal plexuses by prescription of phlebotropic drugs. Among them, the combined topical drugs that have a thrombolytic, anti-inflammatory and hemostatic effect hold pride of place in the treatment of hemorrhoid disease.

CONSERVATIVE LOCAL AND SYSTEMATIC TREATMENT OF ACUTE HEMORRHOIDS (RESULTS OF AN ANONYMOUS SURVEY OF SURGEONS IN RUSSIA)

AIM: to clarify surgeon's preferences for the acute hemorrhoids conservative treatment. MATERIALS AND METHODS: an anonymous survey of 102 experienced colorectal surgeons was performed to reveal preferences in acute hemorrhoids treatment. Questionnaire in Russian included 8 items for assessment. RESULTS: the surgeons reported more than 30 different drugs for the local treatment of acute hemorrhoids. A majority of them consider necessity of systemic phlebotonics. The «Detralex» was most often prescribed. CONCLUSION: a majority of surgeons use effective drugs for acute hemorrhoids treatment. In some cases specialists has less knowledge on this problem.

IS THERE A PLACE FOR HIGH-RESOLUTION ANOSCOPY IN THE DIAGNOSTICS OF INFLAMMATORY CHANGES IN PATIENTS WITH CHRONIC HEMORRHOIDS?

AIM: to evaluate the significance of high-resolution anoscopy (HRA) in diagnostics of inflammatory and thrombotic changes in hemorrhoid piles and to assess the efficacy of micronized purified favonoid fraction (MPFF) in patients with inflammatory thrombotic changes of hemorrhoids according to HRA results in the preoperative conservative treatment of hemorrhoids. PATIENTS AND METHODS: a prospective cohort study included 77 patients with grade III chronic hemorrhoids. Patients were divided into 3 groups depending on the degree of development of inflammatory and thrombotic changes according to the HRA. The 3 group included patients with preoperative conservative treatment by MPFF. All patients underwent Milligan-Morgan procedure with further histological study of removed piles. RESULTS: it was found that the diagnostic sensitivity of the HRA in detection of inflammatory thrombotic changes was 91.3 % (CI=83.6-96.2 %), and diagnostic specificity - 40 % (CI=19-64 %). HRA diagnostic accuracy was 82.1 % (p=0.001). A 30 % decrease in the number of removed piles with moderate inflammatory thrombotic changes after MOFF therapy has also been revealed. CONCLUSION: HRA permits to determine the severity of thrombotic inflammatory changes, which is extremely importantfor the management of patients with acute hemorrhoids.

ADMINISTRATION OF PHLEBOTROPIC DRUGS DURING COMPLEX TREATMENT OF ACUTE HEMORRHOIDS

OBJECTIVES OF RESEARCH. To assess the clinical effectiveness of phlebotrophic drug Detralex (Micronized purifiedflavonoid fraction (MPFF)) during complex treatment of patients with acute hemorrhoids. MATERIALS AND METHODS. A comparative analysis of treatment outcomes of 293 patients with acute hemorrhoids was conducted. All patients were divided into two groups for further clinical observations. Standard drug therapy was performedfor 145 patients (group I). For 148 patients (group II), in addition to the standard treatment, phlebotrophic drug Detralex was additionally initiated. Research program included detection of content of acute inflammatory phase reactants and pro-inflammatory cytokines in blood plasma, evaluation of pain syndrome severity (VRS) and quality of life parameters (SF-36 questionnaire). RESULTS. Initiation of MPFF with complex treatment of patients with acute hemorrhoids was found to be contributed to faster elimination of edema and inflammation, a decrease in severity of hemorrhoids thrombosis, relief of pain syndrome and improvement in patients'quality of life, along withwell-marked regression of laboratory markers of inflammatory reaction This allows to increase the number of good outcomes of acute hemorrhoids treatment from 66,2% to 89,9%, that is by 23,7% and to reduce the number of unsatisfactory outcomes from 4,2% to 1,3%, that is by 2,9%. CONCLUSION. Inclusion of Detralex into program of acute hemorrhoids treatment contributes to a faster elimination of clinical and laboratory manifestations of the disease and allows improving the results of treatment for this category of patients.

Choosing conservative therapy in acute hemorrhoids

The article presents the results of conservative therapy in patients with acute hemorrhoids over a 7-day follow-up period. A prospective, randomized study was based on the evidence base for the efficacy of the micronized purified flavonoid fraction (MPFF) used for the treatment of patients with hemorrhoidal disease. The use of MPFF in patients with acute hemorrhoids showed a statistically significant reduction of pain intensity, analgesics consumption, and intensity of bleeding.