Flavonoids mixture (diosmin, troxerutin, hesperidin) in the treatment of acute hemorrhoidal disease: a prospective, randomized, triple-blind, controlled trial
Abstract:The use of a mixture of diosmin, troxerutin and hesperidin is a safe and effective mean of managing symptoms of acute hemorrhoidal disease. Furthermore, in patients receiving treatment, there was faster control and lower persistence of edema and thrombosis.
“…Analysis of the literature revealed one RCT (Giannini et al ., ), including 134 patients, assessing the efficacy of the oral intake of flavonoids vs placebo in patients with acute ‘haemorrhoidal crisis’. 5.3 Surgical procedures (i.e. SH and haemorrhoidectomy) can be considered in patients with thrombosed haemorrhoids.…”
Aim
The goal of this European Society of ColoProctology project was to establish a multidisciplinary, international guideline for haemorrhoidal disease (HD) and to provide guidance on the most effective (surgical) treatment for patients with HD.
Methods
The development process consisted of six phases. In phase one we defined the scope of the guideline. The patient population included patients with all stages of haemorrhoids. The target group for the guideline was all practitioners treating patients with haemorrhoids and, in addition, healthcare workers and patients who desired information regarding the treatment management of HD. The guideline needed to address both the diagnosis of and the therapeutic modalities for HD. Phase two consisted of the compilation of the guideline development group (GDG). All clinical members needed to have affinity with the diagnosis and treatment of haemorrhoids. Further, attention was paid to the geographical distribution of the clinicians. Each GDG member identified at least one patient in their country who could read English to comment on the draft guideline. In phase three review questions were formulated, using a reversed process, starting with possible recommendations based on the GDG’s knowledge. In phase four a literature search was performed in MEDLINE (Ovid), PubMed, Embase (Ovid) and the Cochrane Database of Systematic Reviews. The search was focused on existing systematic reviews addressing each review question, supplemented by other studies published after the time frame covered by the systematic reviews. In phase five data of the included papers were extracted by the surgical resident (RT) and checked by the methodologist (JK) and the GDG. If needed, meta‐analysis of the systematic reviews was updated by the surgical resident and the methodologist using Review Manager. During phase six the GDG members decided what recommendations could be made based on the evidence found in the literature using GRADE.
Results
There were six sections: (i) symptoms, diagnosis and classification; (ii) basic treatment; (iii) outpatient procedures; (iv) surgical interventions; (v) special situations; (vi) other surgical techniques. Thirty‐four recommendations were formulated.
Conclusion
This international, multidisciplinary guideline provides an up to date and evidence based summary of the current knowledge of the management of HD and may serve as a useful guide for patients and clinicians.
“…Analysis of the literature revealed one RCT (Giannini et al ., ), including 134 patients, assessing the efficacy of the oral intake of flavonoids vs placebo in patients with acute ‘haemorrhoidal crisis’. 5.3 Surgical procedures (i.e. SH and haemorrhoidectomy) can be considered in patients with thrombosed haemorrhoids.…”
Aim
The goal of this European Society of ColoProctology project was to establish a multidisciplinary, international guideline for haemorrhoidal disease (HD) and to provide guidance on the most effective (surgical) treatment for patients with HD.
Methods
The development process consisted of six phases. In phase one we defined the scope of the guideline. The patient population included patients with all stages of haemorrhoids. The target group for the guideline was all practitioners treating patients with haemorrhoids and, in addition, healthcare workers and patients who desired information regarding the treatment management of HD. The guideline needed to address both the diagnosis of and the therapeutic modalities for HD. Phase two consisted of the compilation of the guideline development group (GDG). All clinical members needed to have affinity with the diagnosis and treatment of haemorrhoids. Further, attention was paid to the geographical distribution of the clinicians. Each GDG member identified at least one patient in their country who could read English to comment on the draft guideline. In phase three review questions were formulated, using a reversed process, starting with possible recommendations based on the GDG’s knowledge. In phase four a literature search was performed in MEDLINE (Ovid), PubMed, Embase (Ovid) and the Cochrane Database of Systematic Reviews. The search was focused on existing systematic reviews addressing each review question, supplemented by other studies published after the time frame covered by the systematic reviews. In phase five data of the included papers were extracted by the surgical resident (RT) and checked by the methodologist (JK) and the GDG. If needed, meta‐analysis of the systematic reviews was updated by the surgical resident and the methodologist using Review Manager. During phase six the GDG members decided what recommendations could be made based on the evidence found in the literature using GRADE.
Results
There were six sections: (i) symptoms, diagnosis and classification; (ii) basic treatment; (iii) outpatient procedures; (iv) surgical interventions; (v) special situations; (vi) other surgical techniques. Thirty‐four recommendations were formulated.
Conclusion
This international, multidisciplinary guideline provides an up to date and evidence based summary of the current knowledge of the management of HD and may serve as a useful guide for patients and clinicians.
“…The HT has several management lines, and the tendency for conservative treatment is not improper [2,5,6,7]; however most of the authors prefer thrombectomy (elliptical excision) with local anesthetics [1][2][3][4][5]8]. It is important to mention the role of phlebotonics as diosmine, troxerutin and hesperidin with encouraging results but not definite yet [9]. The ligation guided by doppler has no applicability for HT, given that it is only indicated on minor grades haemorrhoids and even in that instance it fails having complications as pain, hemorrage and hemorrhoidal prolapse [10].…”
“…Согласно национальным и международным клиническим руководствам, применение комбинированных флеботонических препаратов позволяет повысить эффективность терапии и снизить риски рецидива заболевания [17][18][19][20][21][22]. Значимость флеботропных препаратов в лечении хронической венозной недостаточности достаточно изучена, что позволяет их широко использовать в симптоматической терапии, в то время как эффективность флеботонических препаратов в лечение геморроя до сих пор обсуждается, несмотря на имеющиеся результаты проведенных исследований [23][24][25][26][27][28][29].…”
Section: в статье представлены результаты консервативной терапии пациunclassified
“…Значимость флеботропных препаратов в лечении хронической венозной недостаточности достаточно изучена, что позволяет их широко использовать в симптоматической терапии, в то время как эффективность флеботонических препаратов в лечение геморроя до сих пор обсуждается, несмотря на имеющиеся результаты проведенных исследований [23][24][25][26][27][28][29]. Флеботропные препараты повышают тонус венозной стенки, благоприятно влияют на микроциркуляцию, улучшают венозный кровоток и лимфатический дренаж за счет увеличения частоты и амплитуды перистальтики лимфатических сосудов, купируют воспалительные реакции за счет подавления адгезии лейкоцитов к эндотелию, препятствуя их миграции в перивазальное пространство и блокируя выброс цитокинов и протеолитических энзимов [20,30,31].…”
Section: в статье представлены результаты консервативной терапии пациunclassified
The article presents the results of conservative therapy in patients with acute hemorrhoids over a 7-day follow-up period. A prospective, randomized study was based on the evidence base for the efficacy of the micronized purified flavonoid fraction (MPFF) used for the treatment of patients with hemorrhoidal disease. The use of MPFF in patients with acute hemorrhoids showed a statistically significant reduction of pain intensity, analgesics consumption, and intensity of bleeding.
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