Hemorrhoids as a risk factor for colorectal adenomas on colonoscopy

Abstract

Background and study aims Colorectal premalignant polyps and hemorrhoids are important findings in colonoscopy; however, the association between them is unclear. Therefore, we investigated the association between the presence and severity of hemorrhoids and the detection of precancerous colorectal polyps on colonoscopy. Patients and methods This retrospective, single-center, cross-sectional study enrolled patients who underwent colonoscopy at Toyoshima Endoscopy Clinic between May 2017 and October 2020. The association between hemorrhoids and other outcomes (patient age, sex, withdrawal time for colonoscopy, expert endoscopist, number of adenomas per colonoscopy, detection rates of adenoma, advanced neoplasia, clinically significant serrated polyp, and sessile serrated lesion) was assessed using a binomial logistic regression model. Results A total of 12,408 patients were enrolled in this study. Hemorrhoids were identified in 1,863 patients. Univariable analysis showed that patients with hemorrhoids were older (61.0 vs. 52.5 years, P < 0.001), had a higher number of adenomas per colonoscopy (1.16 vs. 0.756, P < 0.001) than those without hemorrhoids. Multivariable analyses also demonstrated that hemorrhoids were associated with a higher number of adenomas per colonoscopy (odds ratio [OR]: 1.061; P = 0.002), regardless of patient age, sex, and expert endoscopist. Among patients with hemorrhoids, severe hemorrhoids with a mucosal elevation ≥ 10 mm were associated with a higher number of adenomas per colonoscopy than mild hemorrhoids (OR: 1.112, P = 0.044), regardless of patient age, sex, and expert endoscopist. Conclusions Hemorrhoids, especially severe ones, are associated with a high number of adenomas. Complete colonoscopy should be performed in patients with hemorrhoids.

Spectrum of Diagnoses in Female Patients With Proctologic Symptoms Presenting to the Surgery Unit of a Tertiary Care Center

“…In chronic untreated hemorrhoids, the bleeding can be so profuse that patients develop anemia. Recently, it has been reported that untreated hemorrhoids are associated with a higher risk of colorectal adenomas [14].…”

Causal associations between human gut microbiota and hemorrhoidal disease: A two-sample Mendelian randomization study

“…The exact cause of HEM is not fully understood, but several factors, including prolonged sitting or standing, chronic constipation or diarrhea, straining during bowel movements, obesity, pregnancy, a family history of hemorrhoids, and aging, can contribute to the development accompanied by weakened connective tissue support and degeneration of the hemorrhoidal plexus. [7,8] Multiple studies have highlighted the significant role of the intestinal microbiome in preserving intestinal homeostasis. [9] An imbalance in the gut microbiome can lead to benign intestinal diseases such as inflammatory bowel diseases and irritable bowel syndrome.…”

“…The exact cause of HEM is not fully understood, but several factors, including prolonged sitting or standing, chronic constipation or diarrhea, straining during bowel movements, obesity, pregnancy, a family history of hemorrhoids, and aging, can contribute to the development accompanied by weakened connective tissue support and degeneration of the hemorrhoidal plexus. [ 7 , 8 ]…”