IntroductionThis study was conducted to determine the frequency of complaints in a cohort of patients with symptomatic hemorrhoidal disease (HD) treated with micronized purified flavonoid fraction (MPFF, Detralex). MPFF was selected for conservative treatment in this population owing to its proven effects on hemorrhoidal symptoms in a large number of patients.MethodsThis multicenter, non-interventional study was part of the international CHORUS survey (Chronic venous and HemORrhoidal diseases evalUation for improvement of Scientific knowledge), conducted in nine centers in different regions of Russia with the participation of 80 coloproctologists. The study enrolled consecutive patients with complaints of hemorrhoids. All were prescribed MPFF-based conservative treatment. The effect of treatment on HD clinical signs and symptoms was assessed at two follow-up visits performed 5–7 days and 25–30 days after enrollment. Surgical and minimally invasive treatment could be performed from day 7 onwards if required.ResultsA total of 1952 patients were enrolled. Over the entire period of observation, MPFF-based conservative treatment was effective in 1489 (76.3%) patients in eliminating the main clinical manifestations of disease, i.e., bleeding and prolapse of internal nodes. Invasive treatment was performed in 68 (3.5%) patients with grade IV hemorrhoids and was combined with MPFF conservative treatment in 395 (20.2%) patients with grades I–III hemorrhoids.ConclusionConservative therapy with MPFF was beneficial for relieving hemorrhoidal symptoms in the majority of patients. MPFF-based treatment was most effective in patients with grade I and II hemorrhoids before irreversible degenerative changes in ligaments of the hemorrhoidal plexuses have occurred. It was also beneficial in preventing disease relapse in patients with more advanced HD and for promoting optimal conditions in the postoperative period.FundingServier.

Background and Aim The CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research) was conducted to provide data on patients presenting with hemorrhoidal disease (HD) in clinical practice and to explore the frequency with which it coexists with chronic venous disease (CVD) and shared risk factors. Methods This international, noninterventional study enrolled adult patients attending a consultation for hemorrhoidal complaints. The questionnaire completed by physicians established the subjects' demographic and lifestyle characteristics and collected information on HD grade and symptoms and signs of CVD. Results A total of 5617 patients were analyzed. Symptoms commonly reported were bleeding (71.8%), pain (67.4%), swelling (55.0%), itching (44.1%), and prolapse (36.2%). Multivariate analysis revealed the variables with the strongest association with HD severity were older age, higher CVD CEAP (Clinical manifestations, Etiologic factors, Anatomic distribution of disease, and underlying Pathophysiology) class, constipation, and male gender (all P < 0.0001). Elevated BMI was a risk factor for HD recurrence. Among women, number of births had a significant association with both HD grade and recurrence. The presence of CVD, reported in approximately half the patients (51.2%), was strongly associated with advanced grade of HD (P < 0.0001). Treatments most commonly prescribed were venoactive drugs (94.3%), dietary fiber (71.4%), topical treatment (70.3%), analgesics (26.3%), and surgery (23.5%). Conclusions CHORUS provides a snap shot of current profiles, risk factors, and treatments of patients with HD across the globe. The coexistence of HD and CVD in more than half the study population highlights the importance of examining for CVD among patients with a hemorrhoid diagnosis, particularly when shared risk factors are present.

Статья посвящена актуальной проблеме роста распространенности геморроидальной болезни в современном обществе. Подробно описан патогенез заболевания и клинические проявления геморроя. Особое внимание уделено диагностическим мероприятиям по выявлению заболевания и терапии, включающей диету, налаживание работы кишечника, нормализацию микроциркуляции в системе геморроидальных сплетений при назначении флеботропных препаратов. Среди них важное место занимают комбинированные топические препараты, оказывающие тромболитическое, противовоспалительное и гемостатическое действие.

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AIM: analysis of approaches to the treatment of different stages of hemorrhoids to clarify what factors provides the choice of a method of treatment modality.PATIENTS AND METHODS: the study is based on the analysis of clinical and instrumental examination of 804 patients with stage I-IV hemor-rhoids. It included 412 (51.2%) females aged 19-83 (44.8±13.2) years. RESULTS: micronized purified flavonoid fraction (MPFF) in combination with dietary fiber intake and topical treatment effectively reduces the severity of the main clinical manifestations of hemorrhoids. Due to this, in 200 (24.8%) cases of stage I-IV hemorrhoids, doctors chose conservative treatment in connection with the achieved positive clinical effect. The combination of systemic phlebotropic therapy (MPFF) with minimally invasive and surgery was carried out in 355(44.2%) and 249 (31.0%) cases of stage II-IV hemorrhoids, respectively. Minimally invasive procedures were performed in patients with a minimal changes of external hemorrhoidal piles. In 210 (54.7%) cases, surgery was performed in patients with a significant changes of external hemorrhoidal piles.CONCLUSION: multimodal treatment of hemorrhoids with the use of MPFF, shows its effectiveness for elimination of the main clinical manifesta-tions of the disease in hemorrhoids stage I-II. Patients with stage III and IV hemorrhoids require the use of a minimally invasive procedures and excisional surgery. The choice of the method is influenced not only by the hemorrhoid stage, but also by the anatomical features. The use of MPFF allows to remove the acute changes and to select an optimal method of minimally invasive or surgical procedure individually.

AIM: to assess objective criteria for the prolapsed of internal hemorrhoids piles and to define the degree ofexternal hemorrhoids enlargement in comparison with the Goligher classification. PATIENTS AND METHODS: the clinical and anatomical status of patients with various forms of hemorrhoids was evaluated within the multicenter observation program «REVISION». The study is based on the analysis of clinical and instrumental examination of 1020 patients with stages I-IV of hemorrhoids aged 44.1±12.7 (18-81) years. The study included 506 (49.6%) females. RESULTS: the data obtained show an irregular increase of internal and external piles, which can be expressed in digital form. In patients with stage I-II, the presence of external pileswas detected in 64.7% and 55.7% and in stage III-IV was revealed in 77.7% and 93.5%. Compliance with Goligher classification and the degree of piles enlargementin patients with stages I and II was notedin 225 (84.6%) and 236 (72.2%) cases (p<0.001). In patients with stages III and IV this compliance was detected only in 211 (66.1%) and 58 (53.7%) cases (p<0.001). CONCLUSION: the study showed that the Goligher classification is an inadequate tool for assessing the surgical status of hemorrhoids and evaluating surgical outcomes. The degree of prolapse can be classified according to the size of the internal hemorrhoid piles relative to the sector of the circumference of the anal canal and to the displacement of the pilein relationshipwith the "dentate line". The size of the external hemorrhoid piles is determined similarly in accordance with the perianal region.

Hemorrhoids is one of the most common diseases in human. According to the latest data for 2017, the prevalence rates of hemorrhoids per 100 000 population in Russia are 410,3 in adults, 26.7 in children aged 15 to 17 years and 4,0 in children under 14 years old. Quality of life (QoL) is an important non-specific subjective parameter of well-being, representing an integrative characteristic of the physical, psychological, social and emotional status of the patient. Despite the high prevalence of hemorrhoids and the variety of modern methods of surgical treatment, there are very few studies addressing the QoL in this category of patients. There are significant differences between the patient and the Coloproctologist in the perception of HD, which, possibly, can lead to the hypertrophy of indications for surgical treatment. Understanding the effect of HD on social life and the concept of the well-being of a particular patient can help the doctor choose between conservative and surgical approaches in the treatment of hemorrhoids. On the other hand, due to the excessive shyness and mentality in our country, patients with HD tend to adapt to their disease, which leads to later seeking medical help and suboptimal efficacy of conservative therapy and minimally invasive surgical methods.This review presents the first Russian multicenter observational program EQUALISER (impact of different trEatment modalities on QUAlity of life of the patientS with acute and chronic hEmorRhoid disease) aimed at assessing the QoL of patients with HD, as well as the effect of the treatment method and types of surgical treatment on the social adaptation of the population.

Introduction. The effectiveness of the treatment of hemorrhoidal disease is based on the frequency of recurrence of hemorrhoid symptoms, the development of early and late postoperative complications, as well as the degree of patient satisfaction with the results of treatment. However, such an indicator as quality of life, which reflects the health of the patient, is not taken into account.Aim. Obtaining data on the influence of the method and type of treatment on the quality of life of patients suffering from acute or chronic hemorrhoids.Materials and methods. The analysis of the influence of the treatment method on the quality of life of patients suffering from acute or chronic hemorrhoids was carried out. The analysis included 1032 patients with stage I–IV hemorrhoids. The age of the patients was 44.8 ± 13.0 (18–94) years. The study included 509 (49.3%) men and 523 (50.7%) women.Results. Quality of life indicators before treatment in all groups are within the reference values, which is associated with adaptation of patients to the disease. After treatment, quality of life indicators naturally increase. However, in patients after hemorrhoidectomy, regardless of the nature of the technique, quality of life indicators are significantly lower than in patients of groups 1 and 2.Conclusions. Quality of life indicators in all groups before treatment are within the reference values and do not have statistically significant differences in the considered indicators. After the treatment, there is a statistically significant increase in the quality of life indicators in all scales. After hemorrhoidectomy, regardless of the nature of the technique, quality of life indicators are significantly lower than in patients of groups 1 and 2, which is associated with surgical trauma. Since the groups of patients are heterogeneous in terms of the stages of the disease, it can be assumed that for each stage of hemorrhoids, there is a subjective perception of the disease, which can be reflected in the quality of life indicators, which requires additional analysis of the results obtained.