Recurrence Rates and Pharmacological Treatment for Hemorrhoidal Disease: A Systematic Review
Issued Date
2023-01-01
Resource Type
ISSN
0741238X
eISSN
18658652
Scopus ID
2-s2.0-85141423884
Pubmed ID
36331754
Journal Title
Advances in Therapy
Volume
40
Issue
1
Start Page
117
End Page
132
Rights Holder(s)
SCOPUS
Bibliographic Citation
Advances in Therapy Vol.40 No.1 (2023) , 117-132
Suggested Citation
Lohsiriwat V., Sheikh P., Bandolon R., Ren D.L., Roslani A.C., Schaible K., Freitag A., Martin M., Yaltirik P., Godeberge P. Recurrence Rates and Pharmacological Treatment for Hemorrhoidal Disease: A Systematic Review. Advances in Therapy Vol.40 No.1 (2023) , 117-132. 132. doi:10.1007/s12325-022-02351-7 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/82734
Title
Recurrence Rates and Pharmacological Treatment for Hemorrhoidal Disease: A Systematic Review
Other Contributor(s)
Abstract
Introduction: Hemorrhoidal disease (HD) is characterized by prolapse of the inflamed and bleeding vascular tissues of the anal canal. Although HD is associated with a high recurrence rate, there is a lack of understanding around interventions that can reduce recurrence and improve outcomes for patients. As such, a systematic literature review (SLR) was conducted to summarize evidence on epidemiology, recurrence, and efficacy of interventions in HD. Methods: Real-world evidence (RWE) studies evaluating the incidence, prevalence, or recurrence of HD, as well as SLRs including a meta-analytic component reporting on the efficacy of systemic or topical pharmacological treatments for adults with HD, were included. Systematic searches were conducted in MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Database of Systematic Reviews. Results: The SLR identified 44 eligible publications. Consistent data were limited on the epidemiology of HD or HD recurrence. Specifically, incidence and prevalence reported across geographies were impacted by differences in data collection. Reported risk factors for HD were sedentary behavior, constipation, male gender, and age. Twenty-three RWE studies and one meta-analysis reported HD recurrence rates ranging from 0 to 56.5% following surgery or phlebotonics, with most (n = 19) reporting rates of 20% or less. In addition to time since treatment, risk factors for recurring disease were similar to those for HD in general. With respect to treatment, micronized purified flavonoid fractions significantly improved the main symptoms of HD compared to other pharmacological treatments. Conclusion: The SLRs did not identify any RWE studies reporting recurrence in patients receiving systemic or topical treatments, highlighting the need for future research in this area. Further, more studies are needed to understand the optimum duration of medical treatment to prevent recurrence. Graphical abstract: [Figure not available: see fulltext.]