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Recurrence Rates and Pharmacological Treatment for Hemorrhoidal Disease: A Systematic Review

Lohsiriwat V 1 , Sheikh P 2 , Bandolon R 3 , Ren DL 4 , Roslani AC 5 , Schaible K 6 Show all authors , Freitag A 7 , Martin M 7 , Yaltirik P 8 , Godeberge P 9

Affiliations 

  • 1 Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand. bolloon@hotmail.com
  • 2 Department of Colorectal Surgery, Saifee Hospital, Mumbai, India
  • 3 Southern Philippines Medical Center, Davao, Philippines
  • 4 Department of Colorectal Surgery, The Sixth Affiliated Hospital (Gastrointestinal and Anal Hospital), Sun Yat-Sen University, Guangzhou, China
  • 5 Department of Surgery, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
  • 6 Evidera, Waltham, MA, USA
  • 7 Evidera, London, UK
  • 8 Internal Medicine and Neuropsychiatry, Global Medical and Patient Affairs (GMPA), Servier, Suresnes, France
  • 9 Unité d'endoscopie et de proctologie, Clinique du Trocadéro, Paris, France
Adv Ther, 2023 Jan;40(1):117-132.
PMID: 36331754 DOI: 10.1007/s12325-022-02351-7

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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