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.

OBJECTIVE. Determine the frequency of clinical manifestations of hemorrhoids and constipation in people seeking advice about hemorrhoids. In the course of the treatment of patients with hemorrhoids phlebotropic evaluate the effectiveness of therapy micronized purified flavonoid fraction (MPFF). MATERIALS AND METHODS. This multicenter study, including screening and observation part, which is part of the International Research «CHORUS» (Chronic venous and hemorrhoid diseases evaluation and scientific research), conducted in nine centers in different regions of Russia, 80 doctors of Coloproctology. In the screening group included 2668 patients who had investigated the incidence of constipation, as a risk factor for hemorrhoids. Conservative treatment, the foundation of which was, Moffitt therapy, received 1952 patients with stage I-IV hemorrhoids. Evaluating the effectiveness of the treatment was evaluated on the basis of a questionnaire. RESULTS. The questionnaire shows that constipation suffered - 766 (28,8 %) patients. Violation of defecation patterns and changes in stool consistency was observed in 1155 (43,9%) and 633 (25.5 %), respectively. At the same time, 288 (11,1 %) indicated a tendency to loose stools and diarrhea. Conservative treatment, the foundation of which is phlebotropic MPFF therapy conducted in patients of observational group has shown its efficiency in all grades of hemorrhoids. During the entire observation period of conservative treatment was effective in 1489 (76,3 %) patients. Surgical treatment was performed in 463 (23 %) patients grade I-IV hemorrhoids, the main part of patients with grade III -199 (43,1 %) and grade IV hemorrhoids - 68 (64,2 %). CONCLUSION. Conservative treatment of hemorrhoid disease, which is the basis on phlebotropic MPFF therapy, is effective at all stages of hemorrhoids, but in patients with grade III and grade IV disease requires surgical treatment.

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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.

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.