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Long Q, Wen Y, Li J. Milligan-Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: a retrospective study. BMC Gastroenterol 2025; 25:355. [PMID: 40346473 PMCID: PMC12063411 DOI: 10.1186/s12876-025-03963-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 04/30/2025] [Indexed: 05/11/2025] Open
Abstract
BACKGROUND Hemorrhoids are one of the most common and annoying benign diseases in the field of colorectal surgery. A Milligan-Morgan hemorrhoidectomy (MMH) is the most frequently applied surgical technique due to its clear efficacy and high success rate, but the reported postoperative complications remain a major problem. This study aimed to retrospectively evaluate the efficacy and safety of a MMH combined with rubber band ligation and polidocanol foam sclerotherapy (MMH + RBL + PFS) for the management of grade III/IV hemorrhoids. METHODS This was a single-center retrospective study. A total of 255 patients with grade III/IV hemorrhoids who underwent MMH + RBL + PFS (n = 128) or MMH (n = 127) between May 2022 and June 2023 were included in the study. The primary outcomes included recurrence rates, hemorrhoid severity score (HSS), and patient satisfaction 12 months after surgery. Secondary outcomes included intraoperative outcomes and postoperative outcomes. RESULTS Follow-up was conducted by telephone or outpatient visit 12 months after surgery. The recurrence rate was lower in the MMH + RBL + PFS group than in the MMH group (p < 0.05). The patient satisfaction score was higher in the MMH + RBL + PFS group than in the MMH group (p < 0.05), and there was no significant difference in the HSS between the two groups (p > 0.05). The median operation time in the two groups was similar (16 min (15-20 min) vs.16 min (15-18 min), p > 0.05). The median number of incisions in the the MMH + RBL + PFS group was 3 (2-3), while that in the MMH group was 3 (3-4) (p < 0.05). There was no significant difference in intraoperative blood loss between the two groups (p > 0.05). Visual analog scale pain scores were lower in the MMH + RBL + PFS group than in the MMH group at the first postoperative defecation at 12 h and at 1, 3, and 7 days (all p < 0.05). The wound healing time was shorter in the MMH + RBL + PFS group than in the MMH group (27.62 ± 3.74 vs. 28.73 ± 4.48 days, respectively, p < 0.05). The incidence of urinary retention was lower in the MMH + RBL + PFS group than in the MMH group (5.47% vs. 12.60, respectively, p < 0.05). Nine patients (one case in the MMH + RBL + PFS group and eight cases in the MMH group (p < 0.05)) had delayed bleeding and were successfully controlled with manual compression or surgical hemostasis. No cases had anal stenosis in the MMH + RBL + PFS group, and six cases (4.72%) had it in the MMH group, all with mild anal stenosis and successfully treated by dilatation alone (p < 0.01). No incision infection or anal incontinence occurred in either group. At the 12-month follow-up after surgery, the recurrence rate was lower in the MMH + RBL + PFS group (0.78%) than in the MMH group (7.09%) (p < 0.05). The patient satisfaction score was higher in the MMH + RBL + PFS group (91.41%) than in the MMH group (81.10%) (p < 0.05), and there was no significant difference in the HSS between the two groups (p > 0.05). CONCLUSIONS Compared with the MMH, the MMH + RBL + PFS surgical procedure is safe and effective for grade III/IV hemorrhoids, which is associated with a lower recurrence rate, a higher patient satisfaction score, a lower postoperative pain score, fewer postoperative complications, and a shorter wound healing time.
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Affiliation(s)
- Qing Long
- Department of Traditional Chinese Medicine, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan province, 646000, China
| | - Yong Wen
- Department of Traditional Chinese Medicine, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan province, 646000, China
| | - Jun Li
- Department of Traditional Chinese Medicine, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan province, 646000, China.
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Fišere I, Edelmers E, Svirskis Š, Groma V. Utilisation of Deep Neural Networks for Estimation of Cajal Cells in the Anal Canal Wall of Patients with Advanced Haemorrhoidal Disease Treated by LigaSure Surgery. Cells 2025; 14:550. [PMID: 40214502 PMCID: PMC11989036 DOI: 10.3390/cells14070550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2025] [Revised: 03/31/2025] [Accepted: 04/03/2025] [Indexed: 04/14/2025] Open
Abstract
Interstitial cells of Cajal (ICCs) play a key role in gastrointestinal smooth muscle contractions, but their relationship with anal canal function in advanced haemorrhoidal disease (HD) remains poorly understood. This study uses deep neural network (DNN) models to estimate ICC presence and quantity in anal canal tissues affected by HD. Haemorrhoidectomy specimens were collected from patients undergoing surgery with the LigaSure device. A YOLOv11-based machine learning model, trained on 376 immunohistochemical images, automated ICC detection using the CD117 marker, achieving a mean average precision (mAP50) of 92%, with a recall of 86% and precision of 88%. The DNN model accurately identified ICCs in whole-slide images, revealing that one-third of grade III HD patients and 60% of grade IV HD patients had a high ICC density. Preoperatively, pain was reported in 35% of grade III HD patients and 41% of grade IV patients, with a significant reduction following surgery. A significant decrease in bleeding (p < 0.0001) was also noted postoperatively. Notably, patients with postoperative bleeding, diagnosed with stage IV HD, had high ICC density in their anorectal tissues (p = 0.0041), suggesting a potential link between ICC density and HD severity. This AI-driven model, alongside clinical data, may enhance outcome prediction and provide insights into HD pathophysiology.
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Affiliation(s)
- Inese Fišere
- Department of Doctoral Studies, Rīga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
- Surgery Clinic, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia
| | - Edgars Edelmers
- Medical Education Technology Centre, Rīga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia
- Faculty of Computer Science Information Technology and Energy, Riga Technical University, LV-1048 Riga, Latvia
- Institute of Electronics and Computer Science, Dzerbenes Street 14, LV-1006 Riga, Latvia
| | - Šimons Svirskis
- Institute of Microbiology and Virology, Rīga Stradiņš University, Ratsupītes Street 5, LV-1067 Riga, Latvia;
| | - Valērija Groma
- Institute of Anatomy and Anthropology, Rīga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia
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Mahassadi AK, Motcheyo HC, Kouame DH, Yao-Bathaix FM. The Perception and Practices of Black African Subjects Toward Hemorrhoidal Disease: The Relevant Effects of Beliefs and Misconceptions in Côte d'Ivoire, West Africa. Res Rep Trop Med 2025; 16:11-23. [PMID: 40123652 PMCID: PMC11928437 DOI: 10.2147/rrtm.s498009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 02/06/2025] [Indexed: 03/25/2025] Open
Abstract
Background The perception of black African subjects toward hemorrhoidal disease is surrounded by myths and misconceptions in sub-Saharan Africa. This study aimed to determine the magnitude of knowledge, attitudes, and practices (KAPs) of black African subjects toward hemorrhoidal disease and the impact of knowledge on their attitudes and practices. Methods A cross-sectional KAP survey was conducted through convenience sampling of 735 participants (mean age, 38.8 years; men, 59.2%) from urban and rural areas in Côte d'Ivoire. They received an auto questionnaire of 25 items on Likert scales depicting their KAP toward hemorrhoidal disease. A mean score of KAP < 50 points was considered low. Logistic and linear regression models were used to determine the factors associated with self-reported hemorrhoidal disease and the impact of knowledge on attitudes and practices. Results The overall Cronbach score was 0.75, and the sample proportions of self-reported or symptom-based hemorrhoidal disease were 44.4% (9% CI: 41-48) and 21.2% [95% CI: 18.4-24.4], respectively. The overall mean (SD) scores of KAP were low: 49 (34.4), 43.4 (18.7), and 33.6 (21.7), respectively. The attitudes and practices of the participants remained unchanged regardless of their knowledge. Hemorrhoidal disease was negatively associated with attitudes (beta = -3.1, p = 0.02) or practices (beta = -3.4, p < 0.05). Overall, the participants agreed that hemorrhoidal disease led to sexual dysfunction (85.2%) and infertility (67.1%). They preferred indigenous (52.4%) over modern treatments (30.2%) and perceived surgery for hemorrhoidal disease to be dangerous (24.4%) and not recommended (56.6%). Conclusion Knowledge did not change the attitudes and practices of black African subjects toward hemorrhoidal disease.
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Affiliation(s)
- Alassan Kouame Mahassadi
- Gastroenterology and Medicine Unit, Yopougon Teaching Hospital, Abidjan, Côte d’Ivoire
- Gastroenterology and Endoscopy Unit, Abobo General Hospital, Abidjan, Côte d’Ivoire
- Departement des maladies de l’appareil digestif, Faculty of Medicine, Felix Houphouët Boigny University, Abidjan, Côte d’Ivoire
| | | | - Dimitri Hatrydt Kouame
- Gastroenterology and Medicine Unit, Yopougon Teaching Hospital, Abidjan, Côte d’Ivoire
- Gastroenterology and Endoscopy Unit, Abobo General Hospital, Abidjan, Côte d’Ivoire
- Departement des maladies de l’appareil digestif, Faculty of Medicine, Felix Houphouët Boigny University, Abidjan, Côte d’Ivoire
| | - Fulgence Mamert Yao-Bathaix
- Gastroenterology and Medicine Unit, Yopougon Teaching Hospital, Abidjan, Côte d’Ivoire
- Gastroenterology and Endoscopy Unit, Abobo General Hospital, Abidjan, Côte d’Ivoire
- Departement des maladies de l’appareil digestif, Faculty of Medicine, Felix Houphouët Boigny University, Abidjan, Côte d’Ivoire
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SONULE B, KHAIRNAR Y, MEHETRE N, KUMAR S, KUMAR L. Formulation and Characterization of Etoricoxib Suppositories for the Management of Hemorrhoids. Turk J Pharm Sci 2025; 22:46-54. [PMID: 40052380 PMCID: PMC11887588 DOI: 10.4274/tjps.galenos.2024.83583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 12/14/2024] [Indexed: 03/09/2025]
Abstract
Objectives This study aimed to formulate and evaluate etoricoxib suppositories to improve patient compliance and drug efficacy in the management of hemorrhoids. Materials and Methods Suppositories were prepared using glycerin and gelatin. The prepared suppositories were evaluated for content uniformity, homogenization, hardness, weight variation, disintegration time, texture analysis, and in vitro drug release. Results Hardness, weight variation, disintegration time, and content uniformity values were found in the range of 4.00±0.50 to 7.50±0.50 kg/cm3, 1.20±0.03 to 1.31±0.01 g, 11.00 to 19.05 min, and 66.98±0.86 to 80.76±3.60%, respectively. The SB3 gave 91.47±17.74% drug release in 6 h, whereas the SB1 gave 99.08±3.40% drug release in 12 h. Drug release from all formulations of suppositories was supported by zero-order, first-order, and Higuchi plots, except for SB4. The mechanism of drug release from all suppositories was fickian diffusion-based. The SB2 results were found to be more appropriate than those of the other batches. Conclusion These results confirm that the prepared formulation has a future scope and should be further explored in in vitro cell lines and animal studies.
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Affiliation(s)
- Bhavna SONULE
- National Institute of Pharmaceutical Education and Research Department of Pharmaceutics, Hajipur, India
| | - Yogesh KHAIRNAR
- National Institute of Pharmaceutical Education and Research Department of Pharmaceutics, Hajipur, India
| | - Nikhil MEHETRE
- National Institute of Pharmaceutical Education and Research Department of Pharmaceutics, Hajipur, India
| | - Suraj KUMAR
- National Institute of Pharmaceutical Education and Research Department of Pharmaceutics, Hajipur, India
| | - Lalit KUMAR
- National Institute of Pharmaceutical Education and Research Department of Pharmaceutics, Hajipur, India
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Zakavi SS, Mirza-Aghazadeh-Attari M, Mansur A, Habibollahi P, Nezami N, Camacho JC. Rectal Artery Embolization for the Treatment of Hemorrhoidal Disease. Semin Intervent Radiol 2025; 42:93-100. [PMID: 40342391 PMCID: PMC12058288 DOI: 10.1055/s-0044-1801360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2025]
Abstract
The term "hemorrhoid" is commonly invoked to characterize the pathologic process of symptomatic hemorrhoidal disease instead of the normal anatomic structure. While often treated with conservative measures, rectal artery embolization offers a minimally invasive alternative for patients with persistent or severe symptoms. This technique involves blocking the blood supply to the hemorrhoids using embolic agents, reducing blood flow, and alleviating symptoms. This review explores the clinical evaluation, techniques, and outcomes associated with rectal artery embolization for the treatment of hemorrhoidal disease. A discussion of the pathophysiology of hemorrhoids, the anatomy of rectal arteries, and the embolization procedure is provided in detail. Additionally, the safety and efficacy of the technique, including potential complications and outcomes, are reviewed.
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Affiliation(s)
- Seyed S. Zakavi
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Mirza-Aghazadeh-Attari
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland
| | | | - Peiman Habibollahi
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Radiology, MedStar Georgetown University Hospital, Washington, District of Columbia
- Department of Radiology, Georgetown University School of Medicine, Washington, District of Columbia
- Lombardi Comprehensive Cancer Center, Washington, District of Columbia
- The Fischell Department of Bioengineering, University of Maryland College Park, College Park, Maryland
| | - Juan C. Camacho
- Vascular and Interventional Radiology, Radiology Associates of Florida, Sarasota, Florida
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Mashbari H, Iskander O, Alyahyawi K, AlMarei SO, Maashi AQ, Mahnashi MS, Allami MY, Ageeli FK, Ashiri AM, Homadi JM, Thakir MAA, Abujabir EI. Prevalence and risk factors of hemorrhoids in Jazan Region, Saudi Arabia: A cross-sectional study. J Family Med Prim Care 2025; 14:662-666. [PMID: 40115576 PMCID: PMC11922381 DOI: 10.4103/jfmpc.jfmpc_1144_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 09/03/2024] [Accepted: 09/17/2024] [Indexed: 03/23/2025] Open
Abstract
Background Hemorrhoids a prevalent anorectal disorder, have gained rising attention due to their impact on public health and quality of life. Despite their significance, limited research has addressed their prevalence and associated risk factors in the Jazan Region, Saudi Arabia. Thus, this study was designed to determine the prevalence and risk factors of hemorrhoids in Jazan region, Saudi Arabia. Methods This was a cross-sectional study conducted in the Jazan region, Saudi Arabia, from January to June 2023. Encompassing both urban and rural areas, the study focused on individuals aged 18 and above, excluding those with communication difficulties, mental illness, or severe conditions. Employing random sampling, a sample size of 420 was determined to ensure representation, and participants were selected using a systematic random sampling technique. The analysis was performed using R version 4.2.3. Results The study included 475 participants, predominantly females (72.57%), aged 25 to 44 (53.38%), with higher education (82.28%) and Saudi nationality (98.31%). Prevalence of hemorrhoids was 13.29%, with 5.27% external, 2.53% internal, and 0.21% thrombosed hemorrhoids. Constipation (OR: 2.28, P = 0.001) and family history (OR: 4.77, P < 0.001) were significant risk factors. Complications were reported by 5.70%, including ulceration (1.05%) and severe bleeding (1.05%). Social norms hindered treatment seeking for 55.49%. While age correlated (P = 0.002 and P = 0.003) with increased odds of hemorrhoids, gender, marital status, nationality, education, employment, smoking, exercise, and fiber intake showed no significant associations. Conclusion In conclusion, the study revealed a 13.2% prevalence of hemorrhoids mostly external underscoring the significance of factors such as constipation age group, fiber intake, and family history in increasing susceptibility.
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Affiliation(s)
- Hassan Mashbari
- Department of Surgery, Jazan University, Jazan, Saudi Arabia
| | - Othman Iskander
- Department of Surgery, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Khalid Alyahyawi
- Department of Surgery, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Shahd O AlMarei
- Standing Committee for Scientific Research, Jazan University, Jazan, Saudi Arabia
| | - Afnan Q Maashi
- Standing Committee for Scientific Research, Jazan University, Jazan, Saudi Arabia
| | - Mashael S Mahnashi
- Standing Committee for Scientific Research, Jazan University, Jazan, Saudi Arabia
| | - Maram Y Allami
- Standing Committee for Scientific Research, Jazan University, Jazan, Saudi Arabia
| | - Fadiyah K Ageeli
- Standing Committee for Scientific Research, Jazan University, Jazan, Saudi Arabia
| | - Asma M Ashiri
- Standing Committee for Scientific Research, Jazan University, Jazan, Saudi Arabia
| | - Jawahir M Homadi
- Standing Committee for Scientific Research, Jazan University, Jazan, Saudi Arabia
| | - Mawaeed A A Thakir
- Standing Committee for Scientific Research, Jazan University, Jazan, Saudi Arabia
| | - Ethar I Abujabir
- Standing Committee for Scientific Research, Jazan University, Jazan, Saudi Arabia
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Romano L, Giuliani A, Paniccia F, Masedu F, Tersigni L, Padula M, Pietroletti R, Clementi M, Vistoli F. Sport practice and hemorrhoidal disease: results from a self-assessment questionnaire among athletes. Int J Colorectal Dis 2025; 40:8. [PMID: 39775136 PMCID: PMC11706884 DOI: 10.1007/s00384-024-04797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2024] [Indexed: 01/11/2025]
Abstract
BACKGROUND Hemorrhoidal disease (HD) is a common proctologic disease. Dietary and lifestyle play a role in the genesis of the disease or in its progression to more severe forms, although the exact mechanism is still not fully understood. We performed a pilot observational cross-sectional analytical association study to evaluate the possible association between sport activities and HD. METHODS We included subjects aged 18 years old or more, competitive and non-competitive, practicing at least one sport activity, at least twice a week. Data were collected using an online questionnaire, developed on the Microsoft Teams communication platform. RESULTS Out of the 312 study participants, 34% reported HD. Among subjects who practiced cycling or horseback riding, 57% reported suffering from HD; among those practicing bodybuilding, 48% complained of HD. In the multivariate logistic regression analysis, age and bodybuilding practice showed a statistically significant association with HD. CONCLUSIONS Some sport activities could play a role in the onset or worsening of HD. Our results showed a positive association between cycling, horseback riding, bodybuilding, and HD occurrence. Given the numerous health benefits of physical activity, patients should be provided with correct information regarding the practice of sports in relation to their pathology.
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Affiliation(s)
- Lucia Romano
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Giuliani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Federico Paniccia
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Masedu
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Leonardo Tersigni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Martina Padula
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Renato Pietroletti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Clementi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Fabio Vistoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Abu-Freha N, Guterman R, Elhayany R, Cohen DL, Munteanu D, Dizengof V, Yitzhak A, Hazzan R, Fich A. Sex Differences in Colonoscopy Indications and Findings: Results from a Large Multicenter Database. J Womens Health (Larchmt) 2024; 33:1442-1448. [PMID: 39445639 DOI: 10.1089/jwh.2024.0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024] Open
Abstract
Background: Sex-based differences are common among diseases. We aimed to investigate the differences in colonoscopy indications and its findings between males and females. Methods: A large, multi-center, cross-sectional, retrospective study included all colonoscopies performed between 2016 and 2021 in seven endoscopy departments. The indications and findings of the procedures were compared between males and females. Results: A total of 151,411 (52.6%) women and 136,519 (47.4%) men were included, aged 56.54 ± 12.9 years and 56.59 ± 12.7. Cecal intubation was similar (95.6% vs 95.5%, p = 0.251). More females had excellent or good bowel preparation compared to males (71.4% vs 65.6%). Colonoscopy due to abdominal pain, constipation, diarrhea, and anemia was higher in females compared to males (15% vs 9.9%, 3.9% vs 2.2%, and 7.6% vs 4.9%, p < 0.001, respectively), while positive FOBT, rectal bleeding and post-polypectomy surveillance and screening were more common indications among males (9.5% vs 7.8%, 10.7% vs 7.8%, and 10.8% vs 7.1%, respectively). On colonoscopy, males were found to have significantly higher colorectal cancer and polyps (0.5% vs 0.4% and 35.1% vs 24.6%). Polyp detection rates were lower in females across all indications, whereas diverticulosis rates were higher in males. However, a clinically significant difference regarding diverticulosis was observed only in patients with anemia as the indication. Conclusions: Notable differences exist between males and females in terms of the indications and findings on colonoscopy. This highlights the need for identifying the factors contributing to these differences and the developing sex-specific approaches for the diagnosis and management of gastrointestinal diseases.
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Affiliation(s)
- Naim Abu-Freha
- Assuta Hospital, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | | | | | - Daniel L Cohen
- Shamir (Assaf Harofeh) Medical Center, The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Zerifin, Israel
| | | | | | | | - Rawi Hazzan
- Assuta centers, gastroenterology institute, Haifa, Israel
- Azrieli Faculty of Medicine, Bar-Ilan university, Safed, Israel
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Kusumo MHB, Prayitno A, Soetrisno, Laqif A. Synergistic therapeutic approach for hemorrhoids: integrating mesenchymal stem cells with diosmin-hesperidin to target tissue edema and inflammation. Arch Med Sci 2024; 20:1556-1566. [PMID: 39649264 PMCID: PMC11623161 DOI: 10.5114/aoms/183465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/30/2024] [Indexed: 12/10/2024] Open
Abstract
Introduction Mesenchymal stem cells (MSCs) have promising regenerative properties in tissue repair and anti-inflammatory responses. This study aimed to investigate the effects of MSCs and their combination with micronized purified flavonoid fraction (MPFF) in a croton oil-induced hemorrhoids model on tissue edema, inflammation, and underlying molecular mechanisms. Material and methods MSCs were isolated and characterized for their adherence, differentiation capacity, and immunophenotyping. Croton oil-induced hemorrhoid mouse models were established to assess tissue edema, inflammation, tumor necrosis factor (TNF-α) expression, transforming growth factor-β (TGF-β) expression, collagen ratio, and MMP-9 activity. The effects of MSCs and their combination with MPFF (diosmin-hesperidin) were evaluated through histological examinations, western blot analysis, and gelatin zymography. Results Characterization confirmed the MSCs' plastic adherence, osteogenic differentiation potential, and immunophenotype (positive for CD90 and CD29, negative for CD45 and CD31). Treatment with MSCs alone or in combination with MPFF significantly reduced tissue edema, inflammation, TNF-α expression, and MMP-9 activity. Additionally, MSCs increased TGF-β expression, and collagen type I/III ratio, and accelerated wound healing by resolving inflammation. Conclusions These findings suggest that MSCs play a crucial role in modulating TNF-α, TGF-β, collagen remodeling, and MMP-9 activity, highlighting their promising role in hemorrhoid treatment and wound healing processes. Further research is warranted to fully elucidate the intricate mechanisms and optimize MSC-based therapies for clinical applications in hemorrhoidal disease management.
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Affiliation(s)
- M. Hidayat Budi Kusumo
- Doctoral program of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Department of Surgery, Faculty of Medicine, Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia
| | - Adi Prayitno
- Doctoral program of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Department of Oral and Maxillofacial Pathology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Soetrisno
- Doctoral program of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Abdurahman Laqif
- Doctoral program of Medical Sciences, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Department of Obstetrics and Gynaecology, Moewardi General Hospital, Surakarta, Indonesia
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Godeberge P, Csiki Z, Zakharash M, Opot EN, Shelygin YA, Nguyen TT, Amir A, Konaté I, Momoh M, Chirol J, Blanc-Guillemaud V, Donglin R. An international observational study assessing conservative management in hemorrhoidal disease: results of CHORALIS (aCute HemORrhoidal disease evALuation International Study). J Comp Eff Res 2024; 13:e240070. [PMID: 39132755 PMCID: PMC11426285 DOI: 10.57264/cer-2024-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/26/2024] [Indexed: 08/13/2024] Open
Abstract
Aim: Real-world evidence on the management of hemorrhoidal disease (HD) is limited. This international study collected clinical practice data on the effectiveness of conservative treatments for acute HD on symptoms and quality of life (QoL), providing perspectives of treatment modalities from different continents. Patients & methods: The 4-week observational prospective CHORALIS study involved adult outpatients consulting for spontaneous complaints of hemorrhoids (graded using Goligher classification) and prescribed conservative treatments according to usual clinical practice. Assessments were: anal pain/discomfort (visual analog scale [VAS]), other signs/symptoms (patient questionnaire), Patient Global Impression of Change (PGI-C) questionnaire and disease-specific QoL (HEMO-FISS-QoL questionnaire). Results: Of 3592 participants, 3505 were analyzed (58.4% male; age 40.5 ± 13.7 years; history of HD in 48.4%; 72.1% Goligher grade I and II). Pain and discomfort were the most common symptoms. Most treatments were venoactive drugs (VADs; 90.9%), particularly micronized purified flavonoid fraction (MPFF; 73.7%) and diosmin (14.6%). All VAD-based therapies improved signs/symptoms (number/intensity/frequency of pain, discomfort, bleeding, swelling, itching and soiling) and QoL. MPFF was associated with a significantly greater proportion of patients with no symptoms (48.8 vs diosmin 34.4%, p < 0.001), pain disappearance (69.7 vs diosmin 52.8%, p < 0.001), treatment impact at 1 week rated on PGI-C as 'very much better' (30.5 vs diosmin 17.9%, p < 0.001) and shorter times to improvement (mean ± SD 3.9 ± 1.5 days vs diosmin 4.2 ± 1.7 days). Conclusion: In this prospective real-world study of patients with acute HD, conservative therapies consisting mainly of VADs, including MPFF, improved the clinical signs and symptoms of disease, as well as QoL. This study evidence supports clinical advantages associated with VADs, mostly MPFF, for effectively managing acute HD.
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Affiliation(s)
- Philippe Godeberge
- Department of Gastroenterology, Institut Mutualiste Montsouris, Paris Descartes University, 42 Bd Jourdan, 75014, Paris, France
| | - Zoltan Csiki
- University of Debreceni, Faculty of Medicine, Nagyerdei krt. 94, 4032, Debrecen, Hungary
- Debreceni Clinic, Nagyerdei krt. 98, 4032, Debrecen, Hungary
| | - Mykhailo Zakharash
- Department of Surgery, No.1 Bogomolets National Medical University, Tarasa Shevchenko Blvd, 13, Kyiv, Ukraine
| | - Elly Nyaim Opot
- University of Nairobi, Faculty of Health Sciences, Department of Surgery, Kenyatta National Hospital, PO Box 19676-00202, Nairobi, Kenya
| | - Yuri A Shelygin
- Ryzhikh National Medical Research Centre of Coloproctology, Ulitsa Salyama Adilya, 2, Moscow, 123423, Russia
| | - Trung Tin Nguyen
- University Medical Center, 215 Hong Bang Street, Ward 11, District 5, Ho Chi Minh, Vietnam
| | - Ashraf Amir
- International Medical Center Hospital, Hail Street, Al-Ruwais, PO Box 2172 Jeddah 21451, Saudi Arabia
| | - Ibrahima Konaté
- Faculty of Health Sciences University Gaston Berger, PO Box 234, Saint-Louis, Senegal
| | - Moses Momoh
- Department of Surgery, University of Benin, PMB1111 Ugbowo Lagos Express Road, Benin, Nigeria
| | - Joanna Chirol
- Servier Medical Affairs, 35 rue de Verdun, 92284 Suresnes Cedex, France
| | | | - Ren Donglin
- The Sixth Affiliated Hospital of Sun Yat-Sen University, 17 Shougouling Rd, Tianhe District, Guangzhou, Guangdong Province, 510507, China
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Samalavicius NE, Gupta RK, Nunoo-Mensah J, Fortunato R, Lohsiriwat V, Khanal B, Kumar A, Sah B, Cerkauskaite D, Dulskas A. Global treatment of haemorrhoids-A worldwide snapshot audit conducted by the International Society of University Colon and Rectal Surgeons. Colorectal Dis 2024; 26:1797-1804. [PMID: 39169548 DOI: 10.1111/codi.17140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 07/13/2024] [Accepted: 07/30/2024] [Indexed: 08/23/2024]
Abstract
AIM There is no universally accepted treatment consensus for haemorrhoids, and thus, management has been individualized all over the world. This study was conducted to assess a global view of how surgeons manage haemorrhoids. METHODS The research panel of the International Society of University Colon and Rectal Surgeons (ISUCRS) developed a voluntary, anonymous questionnaire evaluating surgeons' experience, volume and treatment approaches to haemorrhoids. The 44 multiple-choice questionnaire was available for one month via the ISUCRS email database and the social media platforms Viber and WhatsApp. RESULTS The survey was completed by 1005 surgeons from 103 countries; 931 (92.6%) were in active practice, 819 (81.5%) were between 30 and 60 years of age, and 822 (81.8%) were male. Detailed patient history (92.9%), perineal inspection (91.2%), and digital rectal examination (91.1%) were the most common assessment methods. For internal haemorrhoids, 924 (91.9%) of participants graded them I-IV, with the degree of haemorrhoids being the most important factor considered to determine the treatment approach (76.3%). The most common nonprocedural/conservative treatment consisted of increased daily fibre intake (86.9%), increased water intake (82.7%), and normalization of bowel habits/toilet training (74.4%). Conservative treatment was the first-line treatment for symptomatic first (92.5%), second (72.4%) and third (47.3%) degree haemorrhoids; however, surgery was the first-line treatment for symptomatic fourth degree haemorrhoids (77.6%). Rubber band ligation was the second-line treatment in first (50.7%) and second (47.2%) degree haemorrhoids, whereas surgery was the second-line treatment in third (82.9%) and fourth (16.7%) degree symptomatic haemorrhoids. Rubber band ligation was performed in the office by 645(64.2%) of the participants. The most common surgical procedure performed for haemorrhoids was an excisional haemorrhoidectomy for both internal (87.1%) and external (89.7%) haemorrhoids - with 716 (71.2%) of participants removing 1, 2 or 3 sectors as necessary. CONCLUSION Although there is no global haemorrhoidal treatment consensus, there are many practice similarities among the different cultures, resources, volume and experience of surgeons around the world. With additional studies, a consensus statement could potentially be developed.
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Affiliation(s)
- Narimantas E Samalavicius
- Department of Surgery, Republican Vilnius University Hospital, Vilnius, Lithuania
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- Hila, Medical Diagnostics and Treatment Center, Vilnius, Lithuania
| | - Rakesh Kumar Gupta
- Department of Surgery, Gastrointestinal Unit, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Joseph Nunoo-Mensah
- Department of Colorectal Surgery, King's College Hospital Foundation NHS Trust, London, UK
- Cleveland Clinic, London, UK
| | - Richard Fortunato
- Department of Colorectal Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Varut Lohsiriwat
- Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bhawani Khanal
- Department of Surgery, Gastrointestinal Unit, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Abhijeet Kumar
- Department of Surgery, Gastrointestinal Unit, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Bikash Sah
- Department of Surgery, Gastrointestinal Unit, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Dovile Cerkauskaite
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- Department of Surgical Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Audrius Dulskas
- Department of Surgery, Republican Vilnius University Hospital, Vilnius, Lithuania
- Department of Surgical Oncology, National Cancer Institute, Vilnius, Lithuania
- SMK, University of Applied Social Sciences, Vilnius, Lithuania
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12
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Annana SK, Ferdoush J, Lamia F, Roy A, Kar P, Nandi M, Kabir M, Saha A. Computational Insights into Captopril's Inhibitory Potential Against MMP9 and LCN2 in Bladder Cancer: Implications for Therapeutic Application. Cancer Inform 2024; 23:11769351241276759. [PMID: 39315330 PMCID: PMC11418319 DOI: 10.1177/11769351241276759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 07/31/2024] [Indexed: 09/25/2024] Open
Abstract
Objectives Captopril is a commonly used therapeutic agent in the management of renovascular hypertension (high blood pressure), congestive heart failure, left ventricular dysfunction following myocardial infarction, and nephropathy. Captopril has been found to interact with proteins that are significantly associated with bladder cancer (BLCA), suggesting that it could be a potential medication for BLCA patients with concurrent hypertension. Methods DrugBank 5.0 was utilized to identify the direct protein targets (DPTs) of captopril. STRING was used to analyze the multiple protein interactions. TNMPlot was used for comparing gene expression in normal, tumor, and metastatic tissue. Then, docking with target proteins was done using Autodock. Molecular dynamics simulations were applied for estimate the diffusion coefficients and mean-square displacements in materials. Results Among all these proteins, MMP9 is observed to be an overexpressed gene in BLCA and its increased expression is linked to reduced survival in patients. Our findings indicate that captopril effectively inhibits both the wild type and common mutated forms of MMP9 in BLCA. Furthermore, the LCN2 gene, which is also overexpressed in BLCA, interacts with captopril-associated proteins. The overexpression of LCN2 is similarly associated with reduced survival in BLCA. Through molecular docking analysis, we have identified specific amino acid residues (Tyr179, Pro421, Tyr423, and Lys603) at the active pocket of MMP9, as well as Tyr78, Tyr106, Phe145, Lys147, and Lys156 at the active pocket of LCN2, with which captopril interacts. Thus, our data provide compelling evidence for the inhibitory potential of captopril against human proteins MMP9 and LCN2, both of which play crucial roles in BLCA. Conclusion These discoveries present promising prospects for conducting subsequent validation studies both in vitro and in vivo, with the aim of assessing the suitability of captopril for treating BLCA patients, irrespective of their hypertension status, who exhibit elevated levels of MMP9 and LCN2 expression.
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Affiliation(s)
- Sanjida Kabir Annana
- Department of Genetic Engineering and Biotechnology, East West University, Dhaka, Bangladesh
| | - Jannatul Ferdoush
- Department of Biology, Geology and Environmental Science, University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Farzia Lamia
- Department of Genetic Engineering and Biotechnology, East West University, Dhaka, Bangladesh
| | - Ayan Roy
- Department of Bioinformatics and Biotechnology, Asian University for Women, Chattogram, Bangladesh
| | - Pallab Kar
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Monisha Nandi
- Department of Pharmacy, BGC Trust University Bangladesh, Chattogram, Bangladesh
| | - Maliha Kabir
- Department of Bioinformatics and Biotechnology, Asian University for Women, Chattogram, Bangladesh
| | - Ayan Saha
- Department of Bioinformatics and Biotechnology, Asian University for Women, Chattogram, Bangladesh
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13
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Salih ME, Alshumrani AS, Alodhayqi AAA, Almdawsi MA, Almarhabi AK, Alkhairi HA, Alomary TQ, Alshuqayfi SA. Public Knowledge and Awareness About Hemorrhoids and the Reasons for Late Presentation to Local Doctors in Makkah Region, Saudi Arabia: A Cross-Sectional Exploratory Study. Cureus 2024; 16:e70349. [PMID: 39463499 PMCID: PMC11513179 DOI: 10.7759/cureus.70349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2024] [Indexed: 10/29/2024] Open
Abstract
Background Hemorrhoids, also known as piles, manifest as anal lumps with or without bleeding. This study aims to explore and assess the public knowledge and awareness about hemorrhoids and the factors leading to late presentation to local doctors in the Makkah region of Saudi Arabia. Methodology A questionnaire-based, cross-sectional study was conducted targeting the Saudi population aged 18 years and more living in the Makkah region. The study was conducted from May 1 to May 29, 2023. Data collection was done using electronic Google Forms for data collection. The questionnaire was divided into three main sections covering demographics, knowledge items, and personal and family history of hemorrhoids. Results A total of 495 participants completed the study questionnaire. Participants' ages ranged from 18 to 65 years with a mean age of 25.1 ± 13.7 years old. Overall, 414 (83.6%) were males. Only 106 (21.4%) had an overall good knowledge level. The majority of the participants (78.6%, 389) had poor knowledge. Pain (78% of the participants) was the most common reason for seeking medical advice, followed by feeling uncomfortable (43.3%), and the presence of blood or blood spots in the stool (41.1%). Among others who never sought medical advice, the most reported reason was being embarrassed (66.7%). Conclusions This study revealed that the prevalence of early seeking medical advice was low as many did not because of stigma. The main reasons for seeking medical care were disease-related symptoms, and embarrassment was the main reported barrier.
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Affiliation(s)
- Mohamed E Salih
- Surgery, Umm Al-Qura University, Al Qunfudhah, SAU
- General and Colorectal Surgery, Wad-Medani Hospital, Medani, SDN
| | | | | | - Majed A Almdawsi
- Al-Qunfudah College of Medicine, Umm Al-Qura University, Al Qunfudhah, SAU
| | - Ali K Almarhabi
- Al-Qunfudah College of Medicine, Umm Al-Qura University, Al Qunfudhah, SAU
| | - Hussein A Alkhairi
- Al-Qunfudah College of Medicine, Umm Al-Qura University, Al Qunfudhah, SAU
| | - Talal Q Alomary
- Al-Qunfudah College of Medicine, Umm Al-Qura University, Al Qunfudhah, SAU
| | - Saud A Alshuqayfi
- Al-Qunfudah College of Medicine, Umm Al-Qura University, Al Qunfudhah, SAU
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14
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Wang Y, Su W, Zeng X, Liu Z, Zhu J, Wang M, Li L, Shen W. Surprising diversity of new plasmids in bacteria isolated from hemorrhoid patients. PeerJ 2024; 12:e18023. [PMID: 39224828 PMCID: PMC11368089 DOI: 10.7717/peerj.18023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
Background Hemorrhoids are common conditions at or around the anus, to which numerous people suffer worldwide. Previous research has suggested that microbes may play a role in the development of hemorrhoids, and the origins of these microbes have been preliminarily investigated. However, no detailed research on the microbes related to hemorrhoid patients has been conducted. This work aims to provide an initial investigation into the microbes related to hemorrhoid patients with high quality whole genome sequencing. Methods Forty-nine bacterial strains were isolated from seven hemorrhoid patients. Third-generation nanopore sequencing was performed to obtain high quality whole genome sequences. The presence of plasmids, particularly new plasmids, along with antibiotic resistance genes, was investigated for these strains. Phylogenetic analysis and genome comparisons were performed. Results Out of the 31 plasmids found in the strains, 15 new plasmids that have not been observed previously were discovered. Further structural analysis revealed new multidrug-resistant conjugative plasmids, virulent plasmids, and small, high-copy mobile plasmids that may play significant functional roles. These plasmids were found to harbor numerous integrases, transposases, and recombinases, suggesting their ability to quickly obtain genes to change functions. Analysis of antibiotic resistance genes revealed the presence of antibiotic resistant-integrons. Together with the surprising number of new plasmids identified, as well as the finding of transmission and modification events for plasmids in this work, we came to the suggestion that plasmids play a major role in genetic plasticity. Conclusion This study reveals that the diversity of plasmids in human-associated microbes has been underestimated. With the decreasing cost of whole-genome sequencing, monitoring plasmids deserves increased attention in future surveillance efforts.
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Affiliation(s)
- Yihua Wang
- Department of Anorectal Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Wenya Su
- State Key Laboratory of Microbial Technology, Microbial Technology Institute, Shandong University, Qingdao, China
| | - Xiang Zeng
- Department of Anorectal Surgery, Chengyang District People’s Hospital, Qingdao, China
| | - Zhaopeng Liu
- Department of Anorectal Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Jiaming Zhu
- School of Life Sciences, Shandong University, Qingdao, China
| | - Mingyu Wang
- State Key Laboratory of Microbial Technology, Microbial Technology Institute, Shandong University, Qingdao, China
| | - Ling Li
- State Key Laboratory of Microbial Technology, Microbial Technology Institute, Shandong University, Qingdao, China
| | - Wenlong Shen
- Department of Anorectal Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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15
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Sanmee S, Vipudhamorn W, Sutharat P, Supatrakul E. The efficacy of Aescin combined with MPFF for early control of bleeding from acute hemorrhoids, A randomized controlled trial. Asian J Surg 2024:S1015-9584(24)01711-1. [PMID: 39153932 DOI: 10.1016/j.asjsur.2024.07.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/22/2024] [Accepted: 07/29/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Hemorrhoidal 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. METHOD This 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. RESULTS Of 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. CONCLUSION Combining 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.
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Affiliation(s)
- Suwan Sanmee
- Division of Colorectal Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Witcha Vipudhamorn
- Division of Colorectal Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand.
| | - Pawit Sutharat
- Division of Colorectal Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand
| | - Ekkarin Supatrakul
- Division of Colorectal Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand
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16
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Chen PC, Chen CI. Exploring factors impacting patient decisions in hemorrhoid surgery: A questionnaire survey in Taiwan. Surg Open Sci 2024; 20:214-221. [PMID: 39156488 PMCID: PMC11327606 DOI: 10.1016/j.sopen.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 07/05/2024] [Accepted: 07/19/2024] [Indexed: 08/20/2024] Open
Abstract
Background Minimally invasive hemorrhoid surgeries like Doppler-Guided Hemorrhoidal Artery Ligation (DGHAL) and Stapled Hemorrhoidopexy (PPH) offer benefits over traditional methods. This study investigated public perceptions and attitudes towards these surgeries, exploring awareness, preferences, and influencing factors. Methods A detailed questionnaire was disseminated to 2011 participants from various regions of Taiwan in December 2023, gathering data on demographics, understanding of minimally invasive surgery, and attitudes towards hemorrhoid surgery. Chi-square tests were used for analysis (p < 0.05). Results Hemorrhoid prevalence was similar across sexes and age groups. About 70 % preferred medical centers or district hospitals for surgery. Postoperative complications were a primary concern, with significant sex differences. Approximately 70 % preferred minimally invasive surgery if costs were below NT$50,000. Medical personnel showed higher awareness of minimally invasive surgery benefits. Most participants relied on personal networks and medical social media for information. Conclusions The study revealed generally positive perceptions of minimally invasive hemorrhoid surgery, with cost being a significant factor. Knowledge gaps exist, particularly among non-medical personnel. Future initiatives should aim to enhance public awareness of minimally invasive surgery benefits, and policy considerations should address financial aspects of healthcare decisions.
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Affiliation(s)
- Pin-Chun Chen
- Division of Colon and Rectal Surgery, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chih-I Chen
- Division of Colon and Rectal Surgery, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- Executive Master of Business Administration, National Sun Yat-sen University, Kaohsiung, Taiwan
- Division of General Surgery Medicine, Department of Surgery, E-Da hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
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17
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Kostev K, Konrad M, Smith L, Krieg S. Hemorrhoids are associated with an increased risk of depression in Germany: A retrospective cohort study in primary care outpatients. J Psychiatr Res 2024; 175:381-385. [PMID: 38772129 DOI: 10.1016/j.jpsychires.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND The aim of the present study was to analyze the cumulative incidence of depression diagnosis in patients with hemorrhoids and to evaluate the association between hemorrhoids and subsequent depression diagnosis. METHODS This retrospective cohort study was based on electronic medical records from the Disease Analyzer database (IQVIA) and included 87,264 individuals with hemorrhoids (mean age: 54.2 years; 42% women) and 87,264 propensity score-matched individuals without hemorrhoids in 1284 general practices in Germany between January 2005 and December 2021. Univariable Cox regression analysis was conducted to assess the association between hemorrhoids and depression. RESULTS After up to 10 years of follow-up, 21.4% of patients with hemorrhoids versus 16.3% of the matched cohort (p < 0.001) were diagnosed with depression. There was a significant association between hemorrhoids and a subsequent diagnosis of depression (HR: 1.32; 95% CI: 1.28-1.37), which was confirmed in age- and sex-stratified analyses. The association was stronger with increasing degree of hemorrhoids, from HR: 1.29 (95% CI: 1.15-1.45) for Grade 1 to HR: 1.73 (95% CI: 1.11-2.69) for Grade 4 compared to no hemorrhoids. CONCLUSIONS The present study provides compelling evidence of an association between hemorrhoids and subsequent depression. Addressing the mental health of individuals with hemorrhoids may not only improve their overall well-being but could also lead to better treatment outcomes for the primary condition.
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Affiliation(s)
| | - Marcel Konrad
- Health & Social, FOM University of Applied Sciences for Economics and Management, 60486, Frankfurt am Main, Germany
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Sarah Krieg
- Department of Inclusive Medicine, University Hospital Ostwestfalen-Lippe, Bielefeld University, 33617, Bielefeld, Germany
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18
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Dickstein DR, Edwards CR, Rowan CR, Avanessian B, Chubak BM, Wheldon CW, Simoes PK, Buckstein MH, Keefer LA, Safer JD, Sigel K, Goodman KA, Rosser BRS, Goldstone SE, Wong SY, Marshall DC. Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus. Nat Rev Gastroenterol Hepatol 2024; 21:377-405. [PMID: 38763974 DOI: 10.1038/s41575-024-00932-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/21/2024]
Abstract
The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI - encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable.
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Affiliation(s)
- Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Collin R Edwards
- Department of Radiology, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Catherine R Rowan
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Bella Avanessian
- Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Barbara M Chubak
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher W Wheldon
- Department of Social and Behavioral Sciences, College of Public Health at Temple University, Philadelphia, PA, USA
| | - Priya K Simoes
- The Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael H Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurie A Keefer
- The Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua D Safer
- Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Endocrinology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Keith Sigel
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Karyn A Goodman
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - B R Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health at University of Minnesota, Minneapolis, MN, USA
| | - Stephen E Goldstone
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Serre-Yu Wong
- The Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Morsi S, Linares Bolsegui M, Kobeissi H, Ghozy S, Kallmes DF, Kelley SR, Mathis KL, Dozois EJ, Loftus CG, Bendel EC, Vidal V, Thompson SM. Common design and data elements on rectal artery embolization for treatment of symptomatic internal hemorrhoidal disease: an interactive systematic review of clinical trials. CVIR Endovasc 2024; 7:45. [PMID: 38733497 PMCID: PMC11088570 DOI: 10.1186/s42155-024-00458-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Internal hemorrhoids (IH) is a common medical condition that can result in morbidity secondary to bleeding and discomfort. Treatment for IH has traditionally consisted of dietary and conservative medical management, focal treatments including banding and sclerotherapy or hemorrhoidectomy. Recently, rectal artery embolization (RAE) has been studied as a potential treatment for bleeding predominant IH. We performed a common design and data element analysis of studies that report on RAE. MATERIALS AND METHODS We conducted a qualitative systematic literature review for rectal artery embolization (RAE) for symptomatic hemorrhoidal disease. The screening process involved five online databases (PubMed, Embase, Google Scholar, DOAJ, and Scopus). Additionally, ClinicalTrials.gov was examined for active, unpublished completed studies. The initial search yielded 2000 studies, with 15 studies meeting the inclusion criteria after screening and assessment. The included studies comprised one RCT, one case series, one pilot study and 12 cohort studies. RESULTS The population analysis revealed a male predominance across all studies, with varying cohort sizes. The baseline Goligher hemorrhoid grade was utilized in 80% of studies. The majority (73.3%) employed a transfemoral approach, and coils were the primary embolic material in 60% of studies, 26.6% were combination of coils and particles, and 6.6% were particles only. Patient selection criteria highlighted RAE's applicability for high surgical risk patients and those with anemia, chronic hematochezia, or treatment-refractory cases. Exclusion criteria emphasized factors such as previous surgeries, colorectal cancer, rectal prolapse, acute hemorrhoidal complications, and contrast allergy. Study designs varied, with cohort studies being the most common (12/15; 80%). Procedural details included the use of metallic coils and detachable micro-coils, with a high technical success rate reported in most studies ranging from 72 to 100%. The follow-up ranged from 1 to 18 months. The majority of studies reported no major immediate or post-procedural complications. CONCLUSION While all studies focused on RAE as a treatment for IH, there was a great degree of heterogeneity among included studies, particularly regarding inclusion criteria, exclusion criteria, outcomes measures and timeframe. Future literature should attempt to standardize these design elements to help facilitate secondary analyses and increase understanding of RAE as a treatment option.
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Affiliation(s)
- Samah Morsi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
| | - Marisabel Linares Bolsegui
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Hassan Kobeissi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Scott R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eric J Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Conor G Loftus
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Emily C Bendel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Vincent Vidal
- Department of Vascular and Interventional Radiology, Hôpital de La Timone, Marseille, France
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20
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Yu M, Shang Y, Han L, Yu X. Bowel Habits, Obesity, Intestinal Microbiota and Their Influence on Hemorrhoidal Disease: a Mendelian Randomization Study. Clin Exp Gastroenterol 2024; 17:157-164. [PMID: 38745764 PMCID: PMC11093121 DOI: 10.2147/ceg.s450807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Purpose Hemorrhoids (HEM) are the most common perianal disease, but current observational studies have yielded inconsistent results in investigating the risk factors. Our further exploration of the risk factors will help prevent the disease. Patients and Methods We conducted a two-sample bidirectional Mendelian randomization (MR) analysis using publicly available genome-wide association studies (GWAS) statistics from multiple consortia. The inverse-variance weighted (IVW) method was used for the primary analysis. We applied four complementary methods, including weighted median, weighted mode, MR-Egger regression, and Cochrane's Q value, to detect and correct the effects of horizontal pleiotropy. Results Genetically determined constipation (OR = 0.97, 95% CI: 0.91-1.03, P = 0.28) and diarrhea (OR = 1.00, 95% CI: 0.99-1.01, P = 0.90) did not have a causal effect on HEM but stool frequency (OR = 1.28, 95% CI: 1.05-1.55, P = 0.01), waist-to-hip ratio adjusted for BMI (OR = 1.11, 95% CI: 1.06-1.64, P = 1.59×10-5), and order Burkholderiales (OR = 1.09, 95% CI = 1.04-1.14, p = 1.63×10-4) had a causal effect on. Furthermore, we found a significant causal effect of constipation on HEM in the reverse MR analysis (OR = 1.21, 95% CI: 1.13-1.28, P = 3.72×10-9). The results of MR-Egger regression, Weighted Median, and Weighted Mode methods were consistent with those of the IVW method. Horizontal pleiotropy was unlikely to distort the causal estimates, as indicated by the sensitivity analysis. Conclusion Our MR analysis reveals a causal association between stool frequency and waist-to-hip ratio with HEM, despite variations in results reported by observational studies. Unexpectedly, we found a relationship between the order Burkholderiales in the gut flora and HEM, although the mechanism is unclear.
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Affiliation(s)
- Miaozhi Yu
- Department of General Surgery, Xinhua Hospital Affiliated to Dalian University, Dalian, 116011, People’s Republic of China
| | - Yuan Shang
- Department of General Surgery, Xinhua Hospital Affiliated to Dalian University, Dalian, 116011, People’s Republic of China
| | - Lingling Han
- Department of General Surgery, Xinhua Hospital Affiliated to Dalian University, Dalian, 116011, People’s Republic of China
| | - Xi Yu
- Department of General Surgery, Xinhua Hospital Affiliated to Dalian University, Dalian, 116011, People’s Republic of China
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Sabonyte-Balsaitiene Z, Poskus T, Jasiunas E, Ramasauskaite D, Drasutiene G. Incidence and Risk Factors of Perianal Pathology during Pregnancy and Postpartum Period: A Prospective Cohort Study. J Clin Med 2024; 13:2371. [PMID: 38673644 PMCID: PMC11051428 DOI: 10.3390/jcm13082371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE We aimed to identify the incidence and risk factors of perianal pathology during pregnancy and the postpartum period. METHODS A prospective cohort study was conducted in three institutions in Lithuania. A total of 190 patients were examined and interviewed three times (<12, 18-20 weeks of gestation, and during the first 2 months after delivery). They completed a questionnaire including demographic, obstetric, coloproctological, and birth data. RESULTS A total of 73 (34.59%) women developed hemorrhoidal disease after delivery, and 120 (56.87%) developed perianal pathology. Multivariate analysis identified a neonatal birth weight ≥3380 g (OR 4.22; 95% CI 1.83-9.71, p < 0.001) and consumption of eggs (OR 3.10; 95% CI 1.13-8.53, p = 0.028) or cereals (OR 2.87; 95% CI 1.32-6.25, p = 0.008) several times per week as significant risk factors for hemorrhoidal disease. Neonatal birth weight ≥3380 g (OR 3.95; 95% CI 1.47-10.59, p = 0.006), maternal BMI ≥ 21.48 (OR 3.58; 95% CI 1.51-8.47, p = 0.004), the duration of the second labor period ≥38 min (OR 2.81; 95% CI 1.09-7.23, p = 0.032), and consumption of flour products several times per week (OR 2.77; 95% CI 1.10-6.98, p = 0.030) were associated with a higher risk of perianal pathology. Daily consumption of fruits and vegetables (OR 0.35; 95% CI 0.15-0.81, p = 0.014) and less frequent consumption of eggs were protective factors (OR 0.18; 95% CI 0.06-0.56, p = 0.003). CONCLUSIONS Perianal diseases, especially hemorrhoidal disease, are common during pregnancy and the postpartum period. A neonatal birth weight ≥ 3380 g, a maternal BMI of ≥21.48, duration of the second labor period of ≥38 min, and consumption of flour products and cereals several times a week are risk factors for developing these diseases.
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Affiliation(s)
- Zivile Sabonyte-Balsaitiene
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, 03101 Vilnius, Lithuania; (D.R.); (G.D.)
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, 03101 Vilnius, Lithuania;
| | - Eugenijus Jasiunas
- Centre for Informatics and Development, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania;
| | - Diana Ramasauskaite
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, 03101 Vilnius, Lithuania; (D.R.); (G.D.)
| | - Grazina Drasutiene
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, 03101 Vilnius, Lithuania; (D.R.); (G.D.)
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22
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Al-Masoudi RO, Shosho R, Alquhra D, Alzahrani M, Hemdi M, Alshareef L. Prevalence of Hemorrhoids and the Associated Risk Factors Among the General Adult Population in Makkah, Saudi Arabia. Cureus 2024; 16:e51612. [PMID: 38318578 PMCID: PMC10840063 DOI: 10.7759/cureus.51612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Hemorrhoidal disease is one of the most common benign anorectal conditions. It is described as the symptomatic enlargement and abnormally downward displacement of anal cushions. Its effect on the quality of life of patients is significantly negative and is considered one of the leading causes of lower gastrointestinal bleeding. However, studies that determine the prevalence of and risk factors associated with hemorrhoidal disease are limited. Therefore, this study aimed to evaluate the prevalence of and risk factors for hemorrhoids among the general adult population in the city of Makkah, Saudi Arabia. METHODS A descriptive cross-sectional study was conducted with a structured, prevalidated questionnaire and was used with some modifications. It was created using Google Forms (Google, Mountain View, CA) and distributed via social media platforms in Arabic along with the English version of each question. All data from the returned survey were encrypted. IBM SPSS Statistics, version 21 (IBM Corp., Armonk, NY) was used to analyze the data. RESULTS A total of 400 participants completed the study questionnaire. Regarding the prevalence of hemorrhoids among the general population in Makkah, 64 participants (16%) reported that they were diagnosed with hemorrhoid disorder. The most reported symptoms among participants with hemorrhoids were pain with defecation (76.2%), discomfort (63.5%), and swelling (55.6%). CONCLUSION Hemorrhoids are one of the most common complaints among surgical patients and are more prevalent in men. The risk of hemorrhoids is significantly higher in married women with a history of pregnancy, who are overweight, and who consume low-fiber diets. It is better to practice close follow-up of patients with hemorrhoids to avoid complications, particularly, patients with chronic diseases who are at a high risk.
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Affiliation(s)
| | - Raghad Shosho
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Dhuha Alquhra
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | | | - Mohanned Hemdi
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
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Oberi IA, Omar Y, Alfaifi AJ, Ayoub RA, Ajeebi Y, Moafa SH, Elhilu AH, Ayoub AH, Gosadi IM. Prevalence of Hemorrhoids and Their Risk Factors Among the Adult Population in Jazan, Saudi Arabia. Cureus 2023; 15:e45919. [PMID: 37885500 PMCID: PMC10599269 DOI: 10.7759/cureus.45919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions. They can be either internal, external, or internoexternal, according to their position in relation to the dentate line. They can cause significant financial burdens and personal discomfort. However, the typical symptoms of hemorrhoids include bleeding, pain, skin irritation, fecal leakage, prolapse, mucus secretion, and developing a thrombosed hernia. Nonetheless, research has shown that individuals with and without hemorrhoids equally report these symptoms. This study aims to investigate the prevalence of hemorrhoids and their risk factors among adult subjects in Jazan, Saudi Arabia. METHODS This investigation was a cross-sectional study targeting adults diagnosed with hemorrhoids in the Jazan region. Data collection was performed via a self-administered questionnaire to measure sociodemographic data of the participants, lifestyle factors associated with hemorrhoids, clinical presentations of the disease, and Rome IV criteria for diagnosis of functional constipation. The chi-squared test was used to assess the frequency of hemorrhoid symptoms according to the participants' sociodemographic and lifestyle characteristics. RESULTS In the current study, which recruited 361 participants, 59% (216 individuals) reported experiencing at least one symptom of hemorrhoids. The majority of the sample were females (60%), Saudis (96%), and living in urban areas (59%) and had a university education (77.3%). The most common risk factors identified were lack of regular physical activity (83%), prolonged sitting during office work (51%), and consuming food with saturated fat (50%). A total of 44% (159 participants) had a family history of hemorrhoids, and 40% reported suffering from constipation three times or more per week. Only 34% (123 participants) had been diagnosed with hemorrhoids by a physician. Interestingly, the majority of participants (57%) preferred using home remedies instead of seeking medical care from a healthcare professional. When assessing factors associated with experiencing a minimum of six hemorrhoid symptoms per month, age, lifestyle factors, family history of hemorrhoids, and defecation practices were found to be significantly correlated with a higher occurrence of symptoms (with a p-value of less than 0.05). CONCLUSION The current study identified a high prevalence of hemorrhoid symptoms and their risk factors among the adult population in the Jazan region of Saudi Arabia. The findings suggest a need to increase the awareness of the public about hemorrhoids risk factors and the importance of seeking healthcare at an early stage of the disease.
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Affiliation(s)
| | - Yazan Omar
- Faculty of Medicine, Jazan University, Jazan, SAU
| | | | - Raum A Ayoub
- Faculty of Medicine, Jazan University, Jazan, SAU
| | - Yara Ajeebi
- Faculty of Medicine, Jazan University, Jazan, SAU
| | | | | | - Abdu H Ayoub
- Department of Surgery, Jazan General Hospital, Jazan, SAU
| | - Ibrahim M Gosadi
- Department of Family and Community Medicine, Jazan University, Jazan, SAU
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24
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Yalcinkaya A, Yalcinkaya A, Atici SD, Sahin C, Leventoglu S. Local excision versus thrombectomy in thrombosed external hemorrhoids: a multicenter, prospective, observational study. BMC Surg 2023; 23:228. [PMID: 37563701 PMCID: PMC10413608 DOI: 10.1186/s12893-023-02105-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/13/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Available guidelines describing the procedural treatment of thrombosed external hemorrhoids (TEH) rely solely on expert opinion. We aimed to compare local excision (LE) and thrombectomy (incision) in terms of treatment success, factors affecting success, and outcomes. METHODS This was a multicenter, prospective, observational study conducted in eight centers from September 2020 to September 2021. A total of 96 patients (58 LE, 38 thrombectomy) were included. Risk factors, demographics and clinical characteristics were recorded. Follow-up studies were scheduled for the 1st week, 1st, 3rd and 6th months. Surgical success was assessed at 1 month. Hemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale (SHS) were applied at baseline and the 6th month. Wexner fecal incontinence score was applied at all follow-up studies. RESULTS Overall mean age was 41.5 ± 12.7 years. At baseline, groups were similar with regard to demographics and disease severity (HDSS) (p > 0.05 for all). Success was relatively higher in the thrombectomy group (86.8%) compared to the LE group (67.2%) (p = 0.054). Constipation and travel history were significantly associated with lower likelihood of LE success. Symptoms during follow-up were similarly distributed in the groups. Both methods yielded significant improvements in HDSS, SHS and Wexner scores; however, SHS scores (6 months) and Wexner scores (all time points) were significantly better in the thrombectomy group. CONCLUSION The in-office thrombectomy procedure may have better short-term outcomes compared to LE in terms of relative success, recurrence and quality of life-despite the fact that success rates were statistically similar with the two interventions. LE may yield particularly worse results in patients with constipation and travel history; thus, thrombectomy appears to be especially advantageous in these patient subsets.
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Affiliation(s)
- Ali Yalcinkaya
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Ahmet Yalcinkaya
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Sıhhiye, Ankara, Turkey
- Department of Medical Biochemistry and Microbiology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Can Sahin
- Department of General Surgery, Ankara Yenimahalle Training and Research Hospital, Ankara, Turkey
| | - Sezai Leventoglu
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
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Fišere I, Groma V, Svirskis Š, Strautmane E, Gardovskis A. Evaluation of Clinical Manifestations of Hemorrhoidal Disease, Carried Out Surgeries and Prolapsed Anorectal Tissues: Associations with ABO Blood Groups of Patients. J Clin Med 2023; 12:5119. [PMID: 37568521 PMCID: PMC10420034 DOI: 10.3390/jcm12155119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Hemorrhoidal disease (HD) is a chronic multifactorial disease. Increased abdominal pressure, along with hyperperfusion, neovascularization, overexpression of inflammatory mediators, and dysbiosis, contributes to the development of HD. The deterioration of the anchoring connective tissue with reduced collagen content and altered collagen ratios, dilatation of blood vessels and thrombosis, muscle injury, and inflammation gradually lead to clinically manifesting prolapse and bleeding from hemorrhoids. The associations of the ABO blood types with a disease have been investigated for the upper gastrointestinal tract only. This study aimed to evaluate HD clinical manifestations, surgeries carried out, and the status of prolapsed anorectal tissues by exploring the associations with the patients' ABO blood groups. Clinical and various morphological methods, combined with extensive bioinformatics, were used. The blood type 0, grade III and IV HD individuals constituted the largest group in a moderately-sized cohort of equally represented males and females studied and submitted to surgical treatment of hemorrhoids. There were significantly more complaints reported by HD females compared to males (p = 0.0094). The Longo technique appeared mostly used, and there were proportionally more surgeries performed below the dentate line for HD individuals with blood type 0 compared to other blood type patients (24% vs. 11%). HD males were found to present with significantly more often inflamed rectal mucosa (p < 0.05). Loosening and weakening of collagenous components of the rectal wall combined with vascular dilation and hemorrhage was found to differ in 0 blood type HD individuals compared to other types. HD males were demonstrated to develop the ruptures of vascular beds significantly more often when compared to HD females (p = 0.0165). Furthermore, 0 blood type HD males were significantly more often affected by a disease manifested with tissue hemorrhage compared to the 0 blood type HD females (p = 0.0081). Collectively, the local status of chronically injured anorectal tissue should be considered when applying surgical techniques. Future studies could include patients with HD grades I and II to gain a comprehensive understanding of the disease progression, allowing for a comparison of tissue changes at different disease stages.
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Affiliation(s)
- Inese Fišere
- Department of Doctoral Studies, Rīga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia
- Surgery Clinic, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia;
| | - Valērija Groma
- Institute of Anatomy and Anthropology, Rīga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia
| | - Šimons Svirskis
- Institute of Microbiology and Virology, Rīga Stradiņš University, Ratsupītes Street 5, LV-1067 Riga, Latvia;
| | - Estere Strautmane
- Medical Faculty, Rīga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
| | - Andris Gardovskis
- Surgery Clinic, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia;
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Fallah Tafti SP, Foroutani L, Safari R, Hadizadeh A, Behboudi B, Ahmadi Tafti SM, Keramati MR, Fazeli MS, Keshvari A, Kazemeini A. Evaluation of the Farsi-translated Hemorrhoidal Disease Symptom Score and Short Health Scale questionnaires in patients with hemorrhoid disease: A cross-sectional study. Health Sci Rep 2023; 6:e1363. [PMID: 37359414 PMCID: PMC10290184 DOI: 10.1002/hsr2.1363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/13/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Background and Aims The Hemorrhoidal Disease Symptom Score (HDSS) is a tool that is scored based on five main symptoms: pain, bleeding, itching, soiling, and prolapse. Furthermore, the Short Health Scale (SHS) is a measurement tool of subjective health and health-related quality of life. This study was performed to validate the Farsi-translated Hemorrhoidal Disease Symptom Score (HDSS), and Scale Short Health Scale adapted for hemorrhoidal disease (SHS-HD) as a measure of symptom severity in patients with hemorrhoid disease. Methods In this study, HDSS and SHS-HD were translated into Farsi. Participants with confirmed hemorrhoid disease completed the questionnaire. Subsequently, the questionnaire's discriminative validity, convergent validity, reliability, sensitivity, and specificity were evaluated. Results Data from 31 patients were analyzed (mean age 39.68; 71% male). The results of the analysis showed good internal consistency as Cronbach's α for HDSS and SHS were 0.994 and 0.995 respectively. Spearman's correlation coefficient for the test-retest comparison was 0.986 (p < 0.01). The responses demonstrated good convergent validity. Moreover, the comprehension and suitability of each question were rated as excellent (Pearson's correlation coefficient = 0.3). Conclusions Our findings revealed that the Farsi translation of the HDSS and SHS-HD can be a valuable tool for evaluating the symptom severity in patients with hemorrhoid disease.
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Affiliation(s)
- Seyedeh Parisa Fallah Tafti
- Department of Surgery, Division of Colorectal Surgery, Colorectal Research Center, Imam Hospital ComplexTehran University of Medical SciencesTehranIran
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Research InstituteTehran University of Medical SciencesTehranIran
| | - Laleh Foroutani
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Research InstituteTehran University of Medical SciencesTehranIran
| | - Roxana Safari
- Department of Surgery, Division of Colorectal Surgery, Colorectal Research Center, Imam Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Alireza Hadizadeh
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Research InstituteTehran University of Medical SciencesTehranIran
| | - Behnam Behboudi
- Department of Surgery, Division of Colorectal Surgery, Colorectal Research Center, Imam Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Seyed Mohsen Ahmadi Tafti
- Department of Surgery, Division of Colorectal Surgery, Colorectal Research Center, Imam Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Mohammad Reza Keramati
- Department of Surgery, Division of Colorectal Surgery, Colorectal Research Center, Imam Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Mohammad Sadegh Fazeli
- Department of Surgery, Division of Colorectal Surgery, Colorectal Research Center, Imam Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Amir Keshvari
- Department of Surgery, Division of Colorectal Surgery, Colorectal Research Center, Imam Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Alireza Kazemeini
- Department of Surgery, Division of Colorectal Surgery, Colorectal Research Center, Imam Hospital ComplexTehran University of Medical SciencesTehranIran
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Christodoulou P, Baloyiannis I, Perivoliotis K, Symeonidis D, Tzovaras G. The role of the Rafaelo procedure in the management of hemorrhoidal disease: a systematic review and meta-analysis. Tech Coloproctol 2023; 27:103-115. [PMID: 36371772 DOI: 10.1007/s10151-022-02730-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this study was to summarize the current evidence regarding the role of the Rafaelo procedure in the management of hemorrhoidal disease (HD). METHODS This study was based on the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed (Medline, Scopus, CENTRAL, and Web of Science) from inception to 25/09/2022. Grey literature databases were also reviewed. The primary endpoint was the pooled complications rate of the Rafaelo procedure in patients with HD. Secondary endpoints included short- (bleeding, pain, thrombosis, necrosis, urinary retention, fever, oedema, anal fissure, and readmission) and long-term (stenosis, meteorism, constipation, anal tags, anal hyposensibility, reoperation, and recurrence) postoperative complication rates. Both prospective and retrospective studies were considered. Quality evaluation was performed via the ROBINS-I tool. Certainty of Evidence was based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. RESULTS Overall, 6 non-randomized studies and 327 patients were included. The overall complication rate was 17.6% (95% CI 8.8-26.3%). Short-term complications were bleeding (7.5%, 95% CI 2.5-12.5%), thrombosis (2.2%, 95% CI 0.4-4.8%), and pain (1.6%, 95% CI 0.2-3.3%). Reoperation and recurrence rates were 1.8% (95% CI 0.3-3.4%) and 4.8% (95% CI 1.2-8.4%), respectively. A significant improvement in the presenting symptoms was noted. Method approval and patient satisfaction rates were 89.1% (95% CI 81.7-96.6%) and 95% (95% CI 89.8-100%), correspondingly. Overall CoE was "Very Low". CONCLUSIONS Further randomized controlled trials are required to delineate the exact role of the Rafaelo procedure in HD.
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Affiliation(s)
| | | | | | | | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
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Wang G, Wu Y, Cao Y, Zhou R, Tao K, Wang L. Psychological states could affect postsurgical pain after hemorrhoidectomy: A prospective cohort study. Front Surg 2023; 9:1024237. [PMID: 36684369 PMCID: PMC9852767 DOI: 10.3389/fsurg.2022.1024237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/21/2022] [Indexed: 01/09/2023] Open
Abstract
Background Open hemorrhoidectomy is one of the standard procedures for grade IV hemorrhoids. Postsurgical pain is a common problem for patients. We aim to prospectively evaluate potential factors affecting postoperative pain among hemorrhoidectomy patients. Methods An observational study was conducted on 360 patients who had undergone Milligan-Morgan open hemorrhoidectomy. Details of the surgery and baseline information were recorded. Preoperative anxiety and depression were analyzed via the self-rating anxiety scale 20 (SAS-20) and self-rating depression scales 20 (SDS-20), respectively. Postoperative pain score was performed daily after surgery until the patient was discharged. The numerical pain score was evaluated by the visual analogue scale (VAS). The association between preoperative psychological states (anxiety or depression) and postoperative pain was analyzed using a generalized additive mixed model. Results A total of 340 patients eventually provided complete data and were included in our study. The average age was 43.3 ± 14.4 years, and 62.1% of patients were women. In total, 14.9% of patients had presurgical anxiety and 47.1% had presurgical depression. Postsurgical pain reached a peak point 1-2 days after surgery and went down to a very low level around 4-5 days after surgery. More excision of hemorrhoids could lead to more pain experience after surgery. Presurgical depression was associated with postsurgical pain. Patients who had presurgical depression had higher pain scores after surgery (2.3 ± 1.9 vs. 3.3 ± 1.9, p = 0.025). Conclusion Preoperative depression and the amount of excisional hemorrhoids are positively related to postsurgical pain.
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Affiliation(s)
- Geng Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanjue Wu
- Department of Clinical Nutrition, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Cao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Zhou
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Linfang Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Correspondence: Linfang Wang
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Kacholi DS, Mvungi Amir H. Herbal remedies used by traditional healers to treat haemorrhoids in Tabora region, Tanzania. PHARMACEUTICAL BIOLOGY 2022; 60:2182-2188. [PMID: 36307997 PMCID: PMC9629089 DOI: 10.1080/13880209.2022.2136204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 09/20/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
CONTEXT Haemorrhoids are one of the most common gastrointestinal disorders in humans. In Tanzania, particularly in the Tabora region, medicinal plants (MPs) are used by traditional healers (THs) to treat haemorrhoids, but no study has explicitly attempted to compile these treatments. OBJECTIVE This study documents MPs used by THs of the Tabora region in Tanzania to treat haemorrhoids. MATERIALS AND METHODS A semi-structured questionnaire was used to gather ethnobotanical data from 44 THs on MPs used to treat haemorrhoids, parts used, preparation methods and administration routes. The collected ethnobotanical data were analysed by computing percentage frequencies and relative frequency citations. RESULTS Twenty-six MPs belonging to 19 families and 25 genera, used to manage haemorrhoids, were documented. Fabaceae was the dominant family (four species), whereas shrubs constituted a high proportion (38.46%) of the MPs, and the root was the most (30.3%) utilized plant part. Decoction (38.5%) and topical application (53.8%) were the most preferred preparation and administration techniques. Most MP materials (76.9%) were sourced from the wild. Aloe vera (L.) Burm.f. (Asphodelaceae) (68%), followed by Allium sativum L. (Alliaceae) (66%) and Psidium guajava L. (Myrtaceae) (66%) were the most utilized MPs. Among the recorded MPs, 12 are reported for the first time for the treatment of haemorrhoids. The recorded MPs are believed to possess anti-inflammatory properties that aid in managing inflammation associated with bowel diseases, including haemorrhoids. CONCLUSIONS This study has documented valuable MPs used to manage haemorrhoids and provides a basis for further studies to discover efficient and affordable anti-haemorrhoid drugs.
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Affiliation(s)
- David Sylvester Kacholi
- Department of Biological Sciences, Dar es Salaam University College of Education, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Halima Mvungi Amir
- Department of Biological Sciences, Dar es Salaam University College of Education, University of Dar es Salaam, Dar es Salaam, Tanzania
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Wang Z, Wu X, Li Y, Huang J, Shi R, Wang J. Top 100 most-cited articles on hemorrhoids: A bibliometric analysis and visualized study. Front Surg 2022; 9:1021534. [PMID: 36439542 PMCID: PMC9691775 DOI: 10.3389/fsurg.2022.1021534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Hemorrhoids have a significant incidence in people and are becoming a common public health problem. This study provides a bibliometric and visualized analysis of the most influential literature in the field. The aim is to reveal trends in the field of hemorrhoids and to provide a reference for researchers. Methods The 100 most frequently cited studies in the field of hemorrhoids were collected from the Web of Science(WOS), and were analyzed in terms of the annual publication, types of literature, countries, institutions, authors, journals, and keywords. During the study, we used a combination of VosViewer, Carrot2, Microsoft Excel, and Tableau tools to better present the visual information. Results A total of 4,481 articles were retrieved, of which 3,592 were of the Article and Review types, among which we selected the 100 most frequently cited. A large amount of highly cited literature on hemorrhoid surgery emerged from 1990 to 2010, and the interest of researchers in hemorrhoid surgery seems to have waned after 2010. The sources of highly cited literature in the field of hemorrhoids are predominantly Western, with the United States. and the United Kingdom accounting for almost half of the publications worldwide. However, countries with higher prevalence populations do not have significant research on hemorrhoids. St. Mark's Hospital has published the largest number of influential articles in the field of hemorrhoid disease. Kamm MA and Phillips RKS are the most authoritative authors in the field. Diseases of the Colon & Rectum and the British Journal of Surgery are the most influential journals in this field. The highly cited literature covers a wide range of disciplines, with Thomson's classic “The nature of hemorrhoids” receiving the most attention among the studies focusing on hemorrhoids. Keyword and clustering analysis revealed that The most famous focus in the field of hemorrhoid research is the evolution of stapled hemorrhoidectomy (SH) and Milligan-morgan hemorrhoidectomy (MMH). Conclusions This study is the first to explore developments in the field of hemorrhoids, and it helps surgeons quickly understand global trends in the field of hemorrhoids. In recent years, the development of hemorrhoids seems to have hit a bottleneck, with scholarly interest in the field of waning, especially in surgery Procedures. The theory of inferior anal cushion migration has proven to be the most influential theory in the field, but after studies based on SH and MMH, more high-quality evidence is needed to continue advancing the field of hemorrhoids. The results of this study are intended to add to the attention and interest of scholars in this area and provide a reference for further research.
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Affiliation(s)
| | | | | | | | - Rong Shi
- Correspondence: Rong Shi Jing Wang
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Getachew M, Belayneh A, Kebede B, Alimaw Y, Biyazin Y, Abebaw A, Abebe D. Medicinal plants used for management of hemorrhoids in Ethiopia: A systematic review. Heliyon 2022; 8:e10211. [PMID: 36033288 PMCID: PMC9403375 DOI: 10.1016/j.heliyon.2022.e10211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/18/2022] [Accepted: 08/02/2022] [Indexed: 11/27/2022] Open
Abstract
Background Hemorrhoids have been reported to beset human beings since the earliest history of mankind. Utilization of herbal medicines is ever increasing as the demand for natural remedies is growing. In Ethiopia, many patients commonly use herbal medicines for hemorrhoids management despite lack of organized information at country level. This systematic review was aimed to document reports about utilization of medicinal plants for hemorrhoids management in Ethiopia. Method A web-based systematic literature search was carried out through electronic databases like PubMed, Google Scholar, Web of Sciences, Science Direct, and websites of different organizations. All studies with complete ethnobotanical information were included in this review without regard to methodology and publication year. Results A total of 23 articles were included in this systematic review. Majority (41.7%) of studies were reported from Oromia region followed by Amhara (33.3%) regional state. A total of 50 medicinal plants have been reported where Fabaceae and Solanaceae represent the most commonly used families. Herbs were the most (38%) commonly used medicinal plants followed by shrubs (34%) and trees (26%). Leaf (44%) and root (24%) were the first and second most commonly used plant parts, respectively. Most of the medicinal remedies (36%) were prepared by pounding the fresh part of the plant. Besides, 56.1% of the herbal preparations were administered through topical route. Conclusion and recommendations Numerous medicinal plants from various families have been documented in this review as anti-hemorrhoidal remedies. Further studies could be anticipated in the search for new, effective, and safe plant-based medications from medicinal plants discussed in this review.
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Affiliation(s)
- Melese Getachew
- Department of Pharmacy, College of Health Sciences, Debre Markos University, P.O Box 269, Debre Markos, Ethiopia
| | - Anteneh Belayneh
- Department of Pharmacy, College of Health Sciences, Debre Markos University, P.O Box 269, Debre Markos, Ethiopia
| | - Bekalu Kebede
- Department of Pharmacy, College of Health Sciences, Debre Markos University, P.O Box 269, Debre Markos, Ethiopia
| | - Yigardush Alimaw
- Department of Sociology, College of Social Science and Humanities, Debre Markos University, P.O Box 269, Debre Markos, Ethiopia
| | - Yalemgeta Biyazin
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Markos University, P.O Box 269, Debre Markos, Ethiopia
| | - Abtie Abebaw
- Department of Medical Laboratory Science, College of Health Sciences, Debre Markos University, P.O Box 269, Debre Markos, Ethiopia
| | - Dehnnet Abebe
- Department of Pharmacy, College of Health Sciences, Debre Markos University, P.O Box 269, Debre Markos, Ethiopia
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Kibret AA, Wolde HF, Moges AM, Aragie H, Teferi ET, Assefa YA, Melese EB, Melesse M, Worku YB, Belay DG, Molla MD, Adugna DG. Prevalence and associated factors of cancer pain among adult cancer patients evaluated at an oncology unit in the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia. FRONTIERS IN PAIN RESEARCH 2022; 3:1061239. [PMID: 36874932 PMCID: PMC9982129 DOI: 10.3389/fpain.2022.1061239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/30/2022] [Indexed: 02/19/2023] Open
Abstract
Introduction Globally, cancer is the second leading cause of death and was responsible for 9.6 million deaths in 2018. Worldwide, 2 million people experience pain every day, and cancer pain is one of the major neglected public health problems, especially in Ethiopia. Despite reporting the burden and risk factors of cancer pain as a principal importance, there are limited studies. Therefore, this study aimed to assess the prevalence of cancer pain and its associated factors among adult patients evaluated at the oncology ward in the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia. Methods An institution-based cross-sectional study was conducted from 1 January to 31 March 2021. A systematic random sampling technique was used to select the total sample size of 384 patients. Data were collected using pretested and structured interviewer-administered questionnaire. Bivariate and multivariate logistic regression models were fitted to identify the factors associated with cancer pain among patients with cancer. An adjusted odds ratio (AOR) with a 95% CI was computed to determine the level of significance. Results A total of 384 study participants were involved, with a response rate of 97.5%. The proportion of cancer pain was found to be 59.9% (95% CI 54.8-64.8). The odds of cancer pain were escalated by anxiety (AOR = 2.52, 95% CI 1.02-6.19), patients with hematological cancer (AOR = 4.68, 95% CI 1.30-16.74), gastrointestinal cancer (AOR = 5.15, 95% CI 1.45-18.2), and stages III and IV (AOR = 14.3, 95% CI 3.20-63.7). Conclusion The prevalence of cancer pain among adult patients with cancer in northwest Ethiopia is relatively high. Variables such as anxiety, types of cancer, and stage of cancer had a statistically significant association with cancer pain. Hence, to advance the management of pain, it is better to create more awareness regarding cancer-related pain and provide palliative care early on in the diagnosis of the disease.
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Affiliation(s)
- Anteneh Ayelign Kibret
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abebe Muche Moges
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hailu Aragie
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ephrem Tafesse Teferi
- Department of Internal Medicine School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Awoke Assefa
- Department of Occupational Therapy School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Endalkachew Belayneh Melese
- Department of Internal Medicine School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mequanint Melesse
- Department of Obstetrics and Gynecology School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yilkal Belete Worku
- Department of Internal Medicine School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Meseret Derbew Molla
- Department of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dagnew Getnet Adugna
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ashebir DZ, Gebreselassie HA. Pattern and Outcome of Colorectal and Perianal Surgery in a Referral Hospital, Addis Ababa, Ethiopia. Ethiop J Health Sci 2021; 31:985-992. [PMID: 35221615 PMCID: PMC8843155 DOI: 10.4314/ejhs.v31i5.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Colorectal and perianal surgery encompasses a broad range of procedures to address various pathologies arising from the colon and anorectum. Data regarding the pattern and outcome of colorectal and perianal disorders requiring surgery remains largely unknown in Ethiopia. METHODS A descriptive cross sectional one-year review was made and all patients who were admitted and operated for colorectal and perianal disorders were included in the study. Data was collected by chart review and analyzed by SPSS version 23. RESULT Colorectal and perianal surgeries accounted for 14.6% of the procedures in the study period. Males constituted the major share of the study population. The mean age for perianal and colorectal pathologies were 39.6±13.7 and 44.8± 16.2 years respectively. Among the colorectal disorders redundant sigmoid was the most common indication for admission 41(34.4%) followed by colorectal neoplasms 38(31.9%) while among the perianal conditions, fistula in ano was the most common pathology accounting for 69(43.4%) of admissions followed by hemorrhoids 35(22%). The overall incidence of post-operative complications in the colorectal and perianal procedure groups was found to be 29(24.4%) and 4(2.5%) respectively. There was no mortality in the perianal group whereas there were 11(9.2%) deaths in the colorectal procedure group. CONCLUSION Colorectal surgeries accounted for a fair share of procedures among the other specialty units. The morbidity and mortality associated with colorectal procedures is fairly high and warrants attention.
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