Portuguese Society of Gastroenterology Consensus on the Diagnosis and Management of Hemorrhoidal Disease

Abstract

Hemorrhoidal disease (HD) is a frequent health problem with considerable repercussions on patients’ quality of life. However, much of the clinical practice related to HD is based on knowledge without scientific evidence and supported largely by empirical experience of the physician who deals with this pathology. As in other countries, the goal of this consensus is to establish statements supported by solid scientific evidence and whose purpose will be to standardize and guide the diagnosis and management of HD both in the general population and in some particular groups of patients.

Polidocanol foam sclerotherapy in the treatment of hemorrhoidal disease in patients with bleeding disorders: a multicenter, prospective, cohort study

“…Hemorrhoidal disease (HD) is one of the most common proctologic diseases [ 1 – 5 ]. The management of HD should be guided by patients’ preference, comorbidities, disease grade, and treatment efficacy and safety [ 1 , 6 – 14 ].…”

“…For symptomatic internal HD grades I to III refractory to conservative management, an office-based procedure should be offered as first line treatment [ 1 , 7 , 15 – 17 ]. Rubber band ligation (RBL) has been recommended as the gold standard treatment due to higher efficacy and lower recurrence rate [ 1 , 11 , 15 , 18 , 19 ]. However, high post-procedural bleeding rates (ranging from 3.5% to-50%), including late bleeding, have been reported [ 1 , 15 , 18 , 20 ].…”

“…Rubber band ligation (RBL) has been recommended as the gold standard treatment due to higher efficacy and lower recurrence rate [ 1 , 11 , 15 , 18 , 19 ]. However, high post-procedural bleeding rates (ranging from 3.5% to-50%), including late bleeding, have been reported [ 1 , 15 , 18 , 20 ]. Sclerotherapy is associated with lower bleeding rates but is more recurrence-prone [ 1 , 15 , 21 – 24 ].…”

“…However, high post-procedural bleeding rates (ranging from 3.5% to-50%), including late bleeding, have been reported [ 1 , 15 , 18 , 20 ]. Sclerotherapy is associated with lower bleeding rates but is more recurrence-prone [ 1 , 15 , 21 – 24 ]. The innovative use of polidocanol as a foam has drawn attention in recent years because of its improved sclerosing capacity, superior efficacy, the need for fewer office-based sessions and less complications, including bleeding and pain [ 15 , 21 – 23 , 25 , 26 ].…”

“…Hemorrhoidal bleeding is both a major symptom and a treatment complication [ 1 , 4 , 5 ]. Patients with congenital or acquired (induced by antithrombotic therapy) bleeding disorders (BD) are vulnerable groups, with higher risk of bleeding.…”