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Reviews on Recent Clinical Trials


ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

Review Article

Classifications and Clinical Assessment of Haemorrhoids: The Proctologist’s Corner

Author(s): Arcangelo Picciariello*, Petr V. Tsarkov, Vincenzo Papagni, Sergey Efetov, Daniel R. Markaryan, Inna Tulina and Donato F. Altomare

Volume 16, Issue 1, 2021

Published on: 12 March, 2020

Page: [10 - 16] Pages: 7

DOI: 10.2174/1574887115666200312163940

Price: $65


Background: Haemorrhoidal disease (HD) is a benign condition affecting a considerable part of adult population. HD can be considered a social and economic burden with high impact on patients’ lifestyle. Several new techniques and devices have been proposed for HD treatment; however, preoperative assessment is essential and the use of classification system is recommended.

Methods: In the last two decades many studies described the preoperative assessment and several attempts of classification for HD. This review focuses on the most relevant studies found in literature where classification systems and clinical evaluation with differential diagnosis have been evaluated.

Results: The knowledge of classification systems and differential diagnosis for HD has been shown to play a central role in the clinical assessment and the best treatment choice. Although there are new challenging techniques and devices for HD treatment, a preoperative assessment is always mandatory.

Conclusion: Preoperative clinical evaluation is essential for HD patient treatment and outcome. Classification systems are useful for the therapeutic choice and researches on new medical or surgical treatments. In fact, the international guidelines advise several therapeutic options depending on the severity of the HD.

Keywords: Haemorrhoids, clinical assessment, patient outcome, classification, anal examination, anoscopy, haemorrhoids anoscopy.

Graphical Abstract
Gallo G, Sacco R, Sammarco G. Epidemiology of hemorrhoidal Disease.Hemorrhoids Coloproctology Cham: Springer. 2018; Vol. 2.
Riss S, Weiser FA, Schwameis K, et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis 2012; 27(2): 215-20.
[] [PMID: 21932016]
Jacobs D. Clinical practice. Hemorrhoids. N Engl J Med 2014; 371(10): 944-51.
[] [PMID: 25184866]
Altomare DF, Giuratrabocchetta S. Conservative and surgical treatment of haemorrhoids. Nat Rev Gastroenterol Hepatol 2013; 10(9): 513-21.
[] [PMID: 23752820]
Johanson JF, Sonnenberg A. Constipation is not a risk factor for hemorrhoids: A case-control study of potential etiological agents. Am J Gastroenterol 1994; 89(11): 1981-6.
[PMID: 7942722]
Picciariello A, Rotelli MT. Nutritional Support After Surgery for Proctologic Diseases. Nutritional Support after Gastrointestinal Surgery Springer. 2019.
Alonso-Coello P, Zhou Q, Martinez-Zapata MJ, et al. Meta-analysis of flavonoids for the treatment of haemorrhoids. Br J Surg 2006; 93(8): 909-20.
[] [PMID: 16736537]
Altomare DF, Picciariello A, Pecorella G, et al. Italian Haemorrhoid Survey Group. Surgical management of haemorrhoids: An Italian survey of over 32 000 patients over 17 years. Colorectal Dis 2018; 20(12): 1117-24.
[] [PMID: 30004171]
Madoff RD, Fleshman JW. Clinical practice committee, american gastroenterological association. American gastroenterological association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology 2004; 126(5): 1463-73.
[] [PMID: 15131807]
Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol 2012; 18(17): 2009-17.
[] [PMID: 22563187]
Aigner F, Gruber H, Conrad F, et al. Revised morphology and hemodynamics of the anorectal vascular plexus: Impact on the course of hemorrhoidal disease. Int J Colorectal Dis 2009; 24(1): 105-13.
[] [PMID: 18766355]
Alonso-Coello P, Mills E, Heels-Ansdell D, et al. Fiber for the treatment of hemorrhoids complications: A systematic review and meta-analysis. Am J Gastroenterol 2006; 101(1): 181-8.
[] [PMID: 16405552]
Altomare DF, Rinaldi M, La Torre F, et al. Red hot chili pepper and hemorrhoids: the explosion of a myth: Results of a prospective, randomized, placebo-controlled, crossover trial. Dis Colon Rectum 2006; 49(7): 1018-23.
[] [PMID: 16708161]
Sammarco G, Trompetto M, Gallo G. Thrombosed external haemorrhoids: A Clinician’s Dilemma. Rev Recent Clin Trials 2019; 14(4): 232-4.
[] [PMID: 31560294]
Schubert MC, Sridhar S, Schade RR, Wexner SD. What every gastroenterologist needs to know about common anorectal disorders. World J Gastroenterol 2009; 15(26): 3201-9.
[] [PMID: 19598294]
Ganz RA. The evaluation and treatment of hemorrhoids: A guide for the gastroenterologist. Clin Gastroenterol Hepatol 2013; 11(6): 593-603.
[] [PMID: 23333220]
Alonso-Coello P, Castillejo MM. Office evaluation and treatment of hemorrhoids. J Fam Pract 2003; 52(5): 366-74.
[PMID: 12737769]
Felz MW, Winburn GB, Kallab AM, Lee JR. Anal melanoma: An aggressive malignancy masquerading as hemorrhoids. South Med J 2001; 94(9): 880-5.
[] [PMID: 11592745]
Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal disease: A comprehensive review. J Am Coll Surg 2007; 204(1): 102-17.
[] [PMID: 17189119]
Rajab TK, Bordeianou LG, von Keudell A, Rajab H, Zhou H. Digital rectal examination and anoscopy. N Engl J Med 2018; 378(22)e30
[] [PMID: 29847759]
Talley NJ. How to do and interpret a rectal examination in gastroenterology. Am J Gastroenterol 2008; 103(4): 820-2.
[] [PMID: 18397419]
Cho SD, Groves E, Lao VV. History of high-resolution anoscopy. Clin Colon Rectal Surg 2018; 31(6): 336-46.
[] [PMID: 30450017]
Rivadeneira DE, Steele SR, Ternent C, Chalasani S, Buie WD, Rafferty JL. Standards practice task force of the american society of colon and rectal surgeons. Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum 2011; 54(9): 1059-64.
[] [PMID: 21825884]
Boehm C. Differential diagnosis of hemorrhoids. Dis Colon Rectum 1965; 8: 73.
[] [PMID: 14255019]
Poggio JL. Premalignant lesions of the anal canal and squamous cell carcinoma of the anal canal. Clin Colon Rectal Surg 2011; 24(3): 177-92.
[] [PMID: 22942800]
Leonard D, Beddy D, Dozois EJ. Neoplasms of anal canal and perianal skin. Clin Colon Rectal Surg 2011; 24(1): 54-63.
[] [PMID: 22379406]
Goligher J, Duthie H, Nixon H. Surgery of the anus, rectum and colon. 5th ed. London Balliere Tindall In: 1984.
Gallo G, Martellucci J, Sturiale A, et al. Consensus statement of the Italian society of colorectal surgery (SICCR): Management and treatment of hemorrhoidal disease. Tech Coloproctol 2020; 24(2): 145-64.
[] [PMID: 31993837]
Gerjy R, Lindhoff-Larson A, Nyström PO. Grade of prolapse and symptoms of haemorrhoids are poorly correlated: Result of a classification algorithm in 270 patients. Colorectal Dis 2008; 10(7): 694-700.
[] [PMID: 18294262]
Rubbini M, Ascanelli S, Fabbian F. Hemorrhoidal disease: Is it time for a new classification? Int J Colorectal Dis 2018; 33(6): 831-3.
[] [PMID: 29705941]
Nyström PO, Qvist N, Raahave D, Lindsey I, Mortensen N. Stapled or Open Pile Procedure (STOPP) trial study group. Randomized clinical trial of symptom control after stapled anopexy or diathermy excision for haemorrhoid prolapse. Br J Surg 2010; 97(2): 167-76.
[] [PMID: 20035531]
Rørvik HD, Styr K, Ilum L, et al. Hemorrhoidal disease symptom score and short health scaleHD: New tools to evaluate symptoms and health-related quality of life in hemorrhoidal disease. Dis Colon Rectum 2019; 62(3): 333-42.
[] [PMID: 30451751]
Elbetti C, Giani I, Novelli E, Fucini C, Martellucci J. The single pile classification: A new tool for the classification of haemorrhoidal disease and the comparison of treatment results. Updates Surg 2015; 67(4): 421-6.
[] [PMID: 26547759]
Morgado PJ, Suárez JA, Gómez LG, Morgado PJ Jr. Histoclinical basis for a new classification of hemorrhoidal disease. Dis Colon Rectum 1988; 31(6): 474-80.
[] [PMID: 3378471]
Gaj F, Trecca A. PATE2000: Una nuova classificazione della malattia emorroidaria proposta dalla SICP-UCP. Italian J Coloproctol 2001; 1: 3-4.
Lunniss PJ, Mann CV. Classification of internal haemorrhoids: A discussion paper. Colorectal Dis 2004; 6(4): 226-32.
[] [PMID: 15206963]

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