Reprint of: Why are hemorrhoids symptomatic? the pathophysiology and etiology of hemorrhoids

[Perception and knowledge of hemorrhoidal disease among healthcare professionals in Spain]

INTRODUCTION

Hemorrhoidal disease (HD) is a public health problem in our clinics and in the quality of life of patients, therefore it is necessary to analyze the actions in the management of HD by healthcare professionals in Spain.

MATERIAL AND METHODS

Observational, descriptive and cross-sectional study with data collection through a 28-question survey using a Google® form. 240 surveys were received. Quantitative variables were represented with means and standard deviation and qualitative variables with percentages.

RESULTS

Two hundred and forty surveys were analyzed. Sixty-five percent of respondents were women, with a mean age of 48±12years. Ninety-three percent of the professionals had 21-30years of clinical experience, with more than 70% being family physicians. Fifty-nine percent considered that HD is adequately diagnosed in primary care, but there was a negative impact on follow-up during the COVID-19 pandemic, as 90% considered it inadequate. Forty-two percent of participants were not familiar with the Goligher classification, while 20% knew it and used it in their practice. The most commonly prescribed combination was the use of topical corticosteroids, bulk-forming laxatives, phlebotonics or venoactive drugs, and non-pharmacological measures (12.1%), with diosmin/hesperidin being the most prescribed venoactive agent (63%). Thirty-nine point six percent stated that HD is undertreated. Eighty-nine percent of physicians acknowledged not using any algorithm or protocol for the diagnosis, treatment, and follow-up of HD in their practice, and 89% stated that they were not trained in their workplaces. Seventy-five percent of doctors believed that one of the main limitations hindering the follow-up of the disease was the lack of time during consultations.

CONCLUSIONS

Approximately 3 out of 5 professionals believe they adequately manage HD, and only 1 out of 5 respondents acknowledge knowing and using the Goligher classification in their clinical practice. Furthermore, 2 out of 5 assert that HD is undertreated in primary care. The prescription patterns for HD are heterogeneous, involving multiple combinations. The vast majority of professionals do not follow any established protocol for managing the disease. The survey highlights the need for training our professionals in the diagnosis, treatment, and follow-up of HD to ensure that our patients receive the highest possible quality of healthcare.

Natural Products with Potential Effects on Hemorrhoids: A Review

Hemorrhoid disease is a common anorectal disorder affecting populations worldwide, with high prevalence, treatment difficulties, and considerable treatment costs. Compared to other treatment options, medical therapy for hemorrhoids offers minimal harm, more dignity to patients, and is more economical. Unfortunately, there are few chemical hemorrhoid medications available clinically, which makes the search for efficacious, cost-effective, and environmentally friendly new medication classes a focal point of research. In this context, searching for available natural products to improve hemorrhoids exhibits tremendous potential. These products are derived from nature, predominantly from plants, with a minor portion coming from animals, fungi, and algae. They have excellent coagulation pathway regulation, anti-inflammatory, antibacterial, and tissue regeneration activities. Therefore, we take the view that they are a class of potential hemorrhoid drugs, prevention products, and medication add-on ingredients. This article first reviews the factors contributing to the development of hemorrhoids, types, primary symptoms, and the mechanisms of natural products for hemorrhoids. Building on this foundation, we screened natural products with potential hemorrhoid improvement activity, including polyphenols and flavonoids, terpenes, polysaccharides, and other types.

In Silico Exploration of Potential Phytoconstituents from the Bark Extract of Boswellia serrata for Hemorrhoidal Disease: Molecular Docking and Molecular Dynamics Analysis

Boswellia serrata Roxb. Ex Colebr is a popular medicinal plant used traditionally in herbal medicinal preparations to treat a variety of diseases. The purpose of the present investigation was to investigate the anti-hemorrhoidal property of the bark extract of B. serrata (BS). For this, the sequential Soxhlet extraction method was carried out by using different solvents such as hexane, chloroform, and methanol. After the extraction, the obtained dry extracts were tested for quantitative determinations such as total alkaloid content (TAC), total flavonoid content (TFC), total phenol content (TPC), and total tannin content (TTC) for all the extracts. Moreover, in vitro antioxidant activity was measured using 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging activity and scavenging activity against 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid (ABTS). Methanolic bark extract showed the highest TPC (67.10±1.83), TFC (372.73±4.45), TAC (9.732±1.06), and TTC (48.932±1.82), as well as the antioxidant assays DPPH (IC50=9.88 μg/ml) and ABTS (IC50=15.09 μg/ml). In this study, both LC-MS and GC-MS were performed to identify the chemical composition of all the extracts. Consequently, 19 compounds were identified by GC-MS and 27 compounds were identified by LC-MS analysis. The identified phytoconstituent(s) that could potentially interact with the target protein cyclooxygenase-2 (COX-2) (PDB: 4RRW) using molecular dynamics simulation and in silico docking were studied. Three compounds that have passed in drug-likeness and ADME-Tox properties are having more docking score than the standard. In this study, camptothecin, justicidin B, and taxiphyllin are identified as potential lead compounds with anti-hemorrhoidal properties and may be helpful in the process of drug development and discovery of novel drugs. Hence, these results demonstrate that BS is a good source of pharmacologically active components with potential applications against hemorrhoidal disease.