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

Area of Science:

• Gastroenterology
• Colorectal Surgery

Background:

• Hemorrhoidal disease (HD) is a common condition with a high recurrence rate.
• Understanding interventions to reduce HD recurrence and improve patient outcomes is limited.
• Epidemiology and recurrence data for HD are inconsistent across studies.

Purpose of the Study:

• To systematically review the literature on the epidemiology, recurrence, and efficacy of interventions for hemorrhoidal disease.
• To summarize real-world evidence (RWE) on HD incidence, prevalence, and recurrence.
• To evaluate the efficacy of pharmacological treatments for HD.

Main Methods:

• Conducted a systematic literature review (SLR) of RWE studies and SLRs with meta-analysis.
• Searched major databases including MEDLINE, Embase, CINAHL, and Cochrane.
• Included studies on adult patients with HD, focusing on incidence, prevalence, recurrence, and treatment efficacy.

Main Results:

• Identified 44 publications; consistent epidemiological data were limited.
• Reported HD risk factors include sedentary behavior, constipation, male gender, and age.
• Recurrence rates after surgery or phlebotonics ranged from 0-56.5%, with most studies reporting ≤20%.
• Micronized purified flavonoid fractions significantly improved HD symptoms compared to other treatments.

Conclusions:

• Limited RWE exists for recurrence rates with systemic or topical treatments for HD.
• Further research is needed to determine optimal medical treatment durations for preventing HD recurrence.
• Micronized purified flavonoid fractions represent a promising pharmacological intervention for HD symptom management.