This Piles day let's Vouch to strike the CORE of Hemorrhoidal Disease.

Human beings have suffered from hemorrhoids since they have started to walk, and hemorrhoids are described in both Old Testament and Buddhist scriptures. Some known mentioning of this affliction are the existence of doctors treating hemorrhoids in Egyptian palaces in 2500 BC, treatment records of both Edwin Smith Papyrus (1700 BC) and Ebers Papyrus (1500 BC), and treatment records in India, China, Greece, and Rome.

Piles / Hemorrhoids may come with Various Presentations

Acute

Chronic

Hemorrhoids has Strong linkages to Chronic Venous Disease(CVD)

Strong Association between hemorrhoidal disease and Chronic Venous Disease: Indian Sub-analysis of CHORUS Study

India: A recent study on the CHORUS (Chronic venous and HemORrhoidal diseases evalUation and Scientific research) India subset has confirmed an association between hemorrhoidal disease and Chronic Venous Disease (CVD).

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CVD and hemorrhoids - Lessons from CHORUS study

Hemorrhoidal disease (HD) is a common cause of anal pathology, but its exact prevalence is difficult to determine as patients are often reluctant to seek medical attention.1,2 Levels of spontaneous.

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On the basis of classification, hemorrhoids can be divided into external and internal. Internal hemorrhoids based on its severity grades from 1, 2, 3, to 4 (prolapsed).

Hemorrhoids revisited- understanding the diagnosis, risk factors, and management

Haemorrhoidal disease (HD) is one of the most commonly encountered disorders affecting mostly adults of 50 years or above [1]. Risk factors like straining to attain complete evacuation, .

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Treatment measures ranges from dietary measures to avoid constipation, venoactive drug and surgery.

Treatment of hemorrhoids - what meta-analysis says

India: A recent study on the CHORUS (Chronic venous and HemORrhoidal diseases evalUation and Scientific research) .

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Hemorrhoids management
can be both Medical or Surgical

MPFF in Hemorrhoids - What we know

India: A recent study on the CHORUS (Chronic venous and HemORrhoidal diseases evalUation and Scientific research) India subset has confirmed an association between....

Micronized Purified Flavonoid Fraction (MPFF) has a major role in Management of Piles / Hemorrhoids

MPFF, consists of micronized diosmin (90%) and other active flavonoids (hesperidin, diosmetin, linarin and isorhoifolin; 10%), shows clinical efficacy in the treatment of chronic venous disease 3 and Hemorrhoidal Disease (HD) 4–6

  • MPFF improves venous tone and lymphatic drainage by modulating noradrenergic signaling and reducing nore-pinephrine metabolism 7,8
  • It also reduces capillary hyper-permeability and improves capillary resistance in patients with abnormal capillary fragility, leading to further improvement of microcirculation 9,10

A systematic review of the literature indicates that micronized purified flavonoid fraction (MPFF) can reduce bleeding, pain, anal discomfort, anal discharge and pruritus in patients with acute HD, and can reduce pain,bleeding duration and the requirement for analgesics in patients undergoing surgery for HD.

Bleeding

Pain

Anal discomfort

Anal discharge

Pruritus

MPFF has been shown to be effective and well tolerated in all grades of HD, either as a first-line treatment in combination with dietary modifications, or as an adjunct in patients recovering from hemorrhoidectomy.

Guidelines Recommend Management of MPFF in HD Treatment

  • The Association of Colon & Rectal Surgeons of India (ACRSI) - Recommends In its clinical practice guidelines for the management of hemorrhoids, MPFF as a first-line treatment for grade I–II and selected/minor grade III hemorrhoids 11. MPFF treatment is strongly recommended (grade A), with an evidence level of 1 (indicating high-quality evidence from well-performed randomized trials).
  • The American Gastroenterological Association - Recognizes MPFF as the pharmacological treatment of reference, citing its efficacy in reducing the symptoms and signs of HD.
  • The Russian Association of Coloproctology - Gives MPFF a Grade B (Evidence level 1a) recommendation for the treatment of HD in its clinical guidelines for the diagnosis and treatment of hemorrhoids.

References:

* Kaidar-Person, O., Person, B., & Wexner, S. D. (2007). Hemorrhoidal disease: a comprehensive review. Journal of the American College of Surgeons, 204(1), 102-117. 1. https://pubmed.ncbi.nlm.nih.gov/28331268/ 2 Kaidar-Person, O., Person, B., & Wexner, S. D. (2007). Hemorrhoidal disease: a comprehensive review. Journal of the American College of Surgeons, 204(1), 102-117. 3. Rathore, Rajesh Kumar. "Comparative study of management of second and third degree Hemorrhoids with injection Sclerotherapy using Polidocanol." International Journal of Surgery 3.2 (2019): 145-147. 4. Kakkos SK, Nicolaides AN. Efficacy of micronized purified flavonoid fraction (DaflonR ) on improving individual symptoms, signs and quality of life in patients with chronic venous disease: a systematic review and meta-analysis of randomized double-blind placebo-controlled trials. Int. Angiol. 37(2), 143– 5. Aziz Z, Huin WK, Badrul Hisham MD, Tang WL, Yaacob S. Efficacy and tolerability of micronized purified flavonoid fractions (MPFF) for haemorrhoids: a systematic review and meta-analysis. Complement. Ther. Med. 39, 49–55 (2018). 6. Cospite M. Double-blind, placebo-controlled evaluation of clinical activity and safety of Daflon 500 mg in the treatment of acute hemorrhoids. Angiology 45(6 Pt 2), 566–573 (1994). 7. Cospite M. Double blind placebo controlled evaluation of clinical activity and safety of Daflon 500 mg in the treatment of acute haemorrhoids. Phlebology 9(Suppl. 1), 40–43 (1994). 8. Cotonat A, Cotonat J. Lymphagogue and pulsatile activities of Daflon 500 mg on canine thoracic lymph duct. Int. Angiol. 8(Suppl. 4),15–18 (1989). 9. Mchale NG, Hollywood MA. Control of lymphatic pumping: interest of Daflon 500 mg. Phlebology 9, 23–25 (1994). 10. Behar A, Lagrue G, Cohen-Boulakia F, Baillet J. Study of capillary filtration by double labelling I131-albumin and Tc99m red cells.Application to the pharmacodynamic activity of Daflon 500 mg. Int. Angiol. 7(Suppl. 2), 35–38 (1988). 11.Agarwal N, Singh K, Sheikh P, Mittal K, Mathai V, Kumar A. Executive summary - The Association of Colon & Rectal Surgeons of India (ACRSI) practice guidelines for the management of haemorrhoids-2016. Indian J. Surg. 79(1), 58–61 (2017). •• Updated practice guideline for managing hemorrhoids from the Association of Colon and Rectal Surgeons of India.