HIGH-RESOLUTION ANOSCOPY IN THE EVALUATION OF THE EFFECTIVENESS OF CONSERVATIVE TREATMENT FOR CHRONIC HEMORRHOIDS

AIM: to assess the effectiveness of micronized purified flavonoid fraction (MPFF) in conservative treatment for chronic hemorrhoids according to high-resolution anoscopy (HRA).

PATIENTS AND METHODS: the study included 192 patients with chronic hemorrhoids, stage III. The general recommendation for all patients was dietary fibers for soft stools. The main group included 96 patients treated with MPFF for 2 months, 96 controls used dietary fibers only. The treatment effectiveness was evaluated due to high-resolution anoscopy data and clinical manifestation of the disease. The calculation of the drug intake compliance was carried out as well.

RESULTS: patients of the main group showed significant clinical improvement after treatment in prolapse correction (66% vs 27%; p=0.001), in pain intensity decrease (5 times vs 1.5 times; p=0.03), in bleeding incidence (4 times vs 1.5 times; p=0.001). HRA showed significant reduction of inflammation (from type 2 to type 1) in main group in 50% and 20% in controls (p=0.02). Compliance with the MPFF in main group 1 was 74%, the total compliance of dietary fiber intake in both groups was 66.3%.

CONCLUSIONS: combination of MPFF with dietary fiber intake significantly reduces clinical manifestations of chronic hemorrhoids stage III and HRA shows significant reduction of inflammation in hemorrhoid piles in these cases.

1. Shelygin Y.A., Frolov S.A., Titov A.Y., Blagodarny L.A. et al. The Russian Association of coloproctology clinical guidelines for the diagnosis and treatment of hemorrhoids. Koloproktologia. 2019; v. 18, no. 1 (67), pp. 7-38. https://doi.org/10.33878/2073-75562019-18-1-7-38 (In Russ.).

2. Shelygin Y.A., Veselov A.V., Serbina A.A. Main directions of organization of a specialized coloproctological medical care. Koloproktologia. 2017; no. 1, pp. 76-81. https://doi.org/10.33878/2073-7556-2017-0-1-76-81 (In Russ.).

3. Blagodarny L.A. What an outpatient doctor must know about conservative therapy of haemorrhoid. Statsionarozameshchayushchiye tekhnologii: Ambulatornaya khirurgiya. 2016; no. 3-4, pp. 30-33. https://www.a-surgeon.ru/jour/article/view/56. (in Russ.).

4. Abramowitz L, Weyandt GH, Havlickova B, Matsuda Y, et al. The diagnosis and management of haemorrhoidal disease from a global perspective. Aliment Pharmacol Ther. 2010 May;31(Suppl 1):1-58. doi: 10.1111/j.1365-2036.2010.04278.x

5. Rivkin V.L. Modern views on the pathogenesis, treatment and types of hemorrhoids. Consilium Medicum. 2017; no. 19 (7.1. Surgery): 57-61. (in Russ.).

6. Blagodarny L.A. The effectiveness of phlebotropic drugs. Results of meta-analysis (based on Cochrane Central register of controlled trials). Moscow, Russia; 2015; 24 p. (in Russ.).

7. Corsale I, Carrieri P, Martellucci J, Piccolomini A, et al. Flavonoid mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) in the treatment of I-III degree hemorroidal disease: a double-blind multicenter prospective comparative study. Int J Colorectal Dis. 2018 Nov;33(11):1595-1600. doi: 10.1007/s00384-018-3102-y [Epub ahead of print].

8. Belik B.M., Kovalev A.N., Khatlamadzhiyan A.L. Administration of phlebotropic drugs during complex treatment of acute hemorrhoids. Koloproktologia. 2018;(2):48-54. (In Russ.).

9. Giannini I, Amato A, Basso L, Tricomi N, et al. Flavonoids mixture (diosmin, troxerutin, hesperidin) in the treatment of acute hemorrhoidal disease: a prospective, randomized, triple-blind, controlled trial. Tech Coloproctol. 2015 Jun;19(6):339-45. doi: 10.1007/s10151015-1302-9.

10. Khitaryan A.G., Alibekov A.Z., Kovalev S.A., Shatov I.A. et al. Is there a place for high-resolution anoscopy in the diagnostics of inflammatory changes in patients with chronic hemorrhoids? Koloproktologia. 2018;(4):58-64. https://doi.org/10.33878/20737556-2018-0-4-58-65. (in Russ.).

11. Wexner SD, Duthie GS, et al. Constipation. Etiology, evaluation and management. 2 nd ed. Springer-Verlag London; 2006; 272 p. doi: 10.1007/978-1-84628-275-1

12. ABDA, KBV. Zukunftskonzept Arzneimitte lversorgung. 2011a. Retrieved 31 May 2016, from http://www.abda.de/fileadmin/assets/Pressetermine/2011/ABDA_KBV/Zukunftskonzept_07_10_2011_KBV_ABDA_Homepage.pdf.