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Godeberge P, Csiki Z, Zakharash M, Opot EN, Shelygin YA, Nguyen TT, Amir A, Konaté I, Momoh M, Chirol J, Blanc-Guillemaud V, Donglin R. An international observational study assessing conservative management in hemorrhoidal disease: results of CHORALIS (aCute HemORrhoidal disease evALuation International Study). J Comp Eff Res 2024:e240070. [PMID: 39132755 DOI: 10.57264/cer-2024-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024] Open
Abstract
Aim: Real-world evidence on the management of hemorrhoidal disease (HD) is limited. This international study collected clinical practice data on the effectiveness of conservative treatments for acute HD on symptoms and quality of life (QoL), providing perspectives of treatment modalities from different continents. Patients & methods: The 4-week observational prospective CHORALIS study involved adult outpatients consulting for spontaneous complaints of hemorrhoids (graded using Goligher classification) and prescribed conservative treatments according to usual clinical practice. Assessments were: anal pain/discomfort (visual analog scale [VAS]), other signs/symptoms (patient questionnaire), Patient Global Impression of Change (PGI-C) questionnaire and disease-specific QoL (HEMO-FISS-QoL questionnaire). Results: Of 3592 participants, 3505 were analyzed (58.4% male; age 40.5 ± 13.7 years; history of HD in 48.4%; 72.1% Goligher grade I and II). Pain and discomfort were the most common symptoms. Most treatments were venoactive drugs (VADs; 90.9%), particularly micronized purified flavonoid fraction (MPFF; 73.7%) and diosmin (14.6%). All VAD-based therapies improved signs/symptoms (number/intensity/frequency of pain, discomfort, bleeding, swelling, itching and soiling) and QoL. MPFF was associated with a significantly greater proportion of patients with no symptoms (48.8 vs diosmin 34.4%, p < 0.001), pain disappearance (69.7 vs diosmin 52.8%, p < 0.001), treatment impact at 1 week rated on PGI-C as 'very much better' (30.5 vs diosmin 17.9%, p < 0.001) and shorter times to improvement (mean ± SD 3.9 ± 1.5 days vs diosmin 4.2 ± 1.7 days). Conclusion: In this prospective real-world study of patients with acute HD, conservative therapies consisting mainly of VADs, including MPFF, improved the clinical signs and symptoms of disease, as well as QoL. This study evidence supports clinical advantages associated with VADs, mostly MPFF, for effectively managing acute HD.
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Affiliation(s)
- Philippe Godeberge
- Department of Gastroenterology, Institut Mutualiste Montsouris, Paris Descartes University, 42 Bd Jourdan, 75014, Paris, France
| | - Zoltan Csiki
- University of Debreceni, Faculty of Medicine, Nagyerdei krt. 94, 4032, Debrecen, Hungary
- Debreceni Clinic, Nagyerdei krt. 98, 4032, Debrecen, Hungary
| | - Mykhailo Zakharash
- Department of Surgery, No.1 Bogomolets National Medical University, Tarasa Shevchenko Blvd, 13, Kyiv, Ukraine
| | - Elly Nyaim Opot
- University of Nairobi, Faculty of Health Sciences, Department of Surgery, Kenyatta National Hospital, PO Box 19676-00202, Nairobi, Kenya
| | - Yuri A Shelygin
- Ryzhikh National Medical Research Centre of Coloproctology, Ulitsa Salyama Adilya, 2, Moscow, 123423, Russia
| | - Trung Tin Nguyen
- University Medical Center, 215 Hong Bang Street, Ward 11, District 5, Ho Chi Minh, Vietnam
| | - Ashraf Amir
- International Medical Center Hospital, Hail Street, Al-Ruwais, PO Box 2172 Jeddah 21451, Saudi Arabia
| | - Ibrahima Konaté
- Faculty of Health Sciences University Gaston Berger, PO Box 234, Saint-Louis, Senegal
| | - Moses Momoh
- Department of Surgery, University of Benin, PMB1111 Ugbowo Lagos Express Road, Benin, Nigeria
| | - Joanna Chirol
- Servier Medical Affairs, 35 rue de Verdun, 92284 Suresnes Cedex, France
| | | | - Ren Donglin
- The Sixth Affiliated Hospital of Sun Yat-Sen University, 17 Shougouling Rd, Tianhe District, Guangzhou, Guangdong Province, 510507, China
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Yaghoobi Notash A, Sadeghian E, Heshmati A, Sorush A. Effectiveness of Local Botulinum Toxin Injection for Perianal Pain after Hemorrhoidectomy. Middle East J Dig Dis 2022; 14:330-334. [PMID: 36619264 PMCID: PMC9489436 DOI: 10.34172/mejdd.2022.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 05/11/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Hemorrhoidectomy is commonly associated with post-operative perianal pain. Local botulinum toxin injection by relaxing the smooth muscles of the perianal sphincter and reducing anal pressure can be effective in decreasing post-operative pain. This study evaluates the effectiveness of local botulinum toxin injection in controlling pain after hemorrhoidectomy. Methods: This study was a double-blind, randomized clinical trial. A total of 40 patients undergoing hemorrhoidectomy who were referred to Shariati Hospital in 2019- 2020 were enrolled as participants and divided into two groups. In one group, injection of botulinum toxin was done in intersphincteric area, and in the other group, there was no intervention after hemorrhoidectomy. SPSS software version 24 was used to analyze the data. Results: Local botulinum toxin injection (MASPORT® 500) significantly reduced post-operative perianal pain on the first, third, fifth, and seventh days after the operation compared with the second group (P<0.05). The mean pain scores in the first, third, fifth, and seventh days in the first and second groups were 7.60 (±0.88) versus 8.25 (±1.16), 40.5 (±0.88) versus 6.05 (±0.99), 2.45 (±0.51) versus 3.05 (±0.68), and 2.05 (±0.39) versus 1.70 (±0.57), respectively. Furthermore, pain during defecation was significantly lower for the experimental group (P<0.05). Conclusion: Local botulinum toxin injection effectively improves post-operative pain after hemorrhoidectomy. Further studies are needed to prove the clinical value of local botulinum toxin injection.
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Affiliation(s)
- Aidin Yaghoobi Notash
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Sadeghian
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author: Ehsan Sadeghian, MD Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Shariati Hospital, Jalal-e-Al-eAhmad Hwy, Tehran, Iran Tel:+98 21 8490 Fax:+98 21 88633039
| | - Alireza Heshmati
- General Surgeon, Kurdistan University of Medical Sciences, Sanadaj, Iran
| | - Ahmadreza Sorush
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Baig Z, Abu-Omar N, Harington M, Gill D, Nathan Ginther D. Be Kind to Your Behind: A Systematic Review of the Habitual Use of Bidets in Benign Perianal Disease. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:1633965. [PMID: 35685735 PMCID: PMC9173983 DOI: 10.1155/2022/1633965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/20/2022] [Indexed: 11/24/2022]
Abstract
Background Benign perianal disease carries significant morbidity and financial burden on the healthcare system. Given that sitz baths are recommended as a treatment modality, we considered whether using a continuous stream of water, in the form of a bidet, offers a convenient and effective alternative. Bidet use is the predominant form of perianal hygiene in Asia, but its role in perianal disease is unknown. Purpose To critically analyze and systematically review the current evidence regarding the effect of habitual bidet use on symptoms of benign perianal disease. Data Sources. A database search was conducted on MEDLINE and Epub Ahead of Print, Embase, ClinicalTrials.gov, the Cochrane Library, and ProQuest Dissertations. All studies on bidet use in pruritus ani, hemorrhoids, or anal fissures were included. Data Extraction. The studies were screened and critically analyzed by two independent reviewers in line with PRISMA guidelines. Results Two prospective trials and 1 cross-sectional study found that habitual use of bidets had no impact on the odds of developing hemorrhoids or hemorrhoidal symptoms. One RCT concluded that using bidets was non-inferior to sitz bath for post-hemorrhoidectomy pain. Two prospective trials and 1 cross-sectional study determined that habitual bidet use may increase the odds of developing pruritus ani. Two case series found that habitual bidet use may cause perianal burns or anterior anal fissures. A meta-analysis was not performed because only a limited number of studies were available, and they were of variable quality. Conclusion The current evidence does not identify using bidets as a treatment modality for perianal disease, and further research is warranted to study this increasingly utilized technology.
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Affiliation(s)
- Zarrukh Baig
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Nawaf Abu-Omar
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Michael Harington
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Dilip Gill
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
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Rectal Ulcer After Rectal Washing With a Bidet Toilet. ACG Case Rep J 2022; 9:e00754. [PMID: 35187188 PMCID: PMC8849414 DOI: 10.14309/crj.0000000000000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
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IYO TORU, ASAKURA KEIKO, OMAE KAZUYUKI. Effect of the Cleanliness of Spray Nozzle on the Concentration of Microorganisms in the Spray Water in Warm-Water Bidet Toilet Seats. Biocontrol Sci 2022; 27:153-162. [DOI: 10.4265/bio.27.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- TORU IYO
- Department of Health Science, Kitasato University School of Allied Health Sciences
| | - KEIKO ASAKURA
- Department of Environmental and Occupational Health, School of Medicine, Toho University
| | - KAZUYUKI OMAE
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
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Oie S, Kawai S. Microbial contamination of hands with or without the use of bidet toilets (electric toilet seats with water spray) after defecation. JOURNAL OF WATER AND HEALTH 2022; 20:271-275. [PMID: 35100172 DOI: 10.2166/wh.2021.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Bidet toilets (electric toilet seats with water spray) are increasing in popularity worldwide. However, the extent of reduction of microbial contamination of the hands with the use of bidet toilets after defecation is unclear. Microbe contamination of the hands with and without the use of bidet toilets after defecation was examined in 32 nursing students. Double gloves were worn on the dominant hand and four layers of toilet paper were used to wipe the buttocks after defecation, and microbe contamination of the second glove (outer glove) of the double gloves was examined. The volunteers were free to select the flow volume, wash time of the bidet, and the type of bidet. Without the use of a bidet toilet, the average value ± standard deviation of the number of microbes attached to the gloves was 39,499.3 ± 77,768.3 colony forming units (cfu)/glove; however, it was 4,146.9 ± 11,427.7 cfu/glove when the bidet toilet was used. The number of microbes adhering to gloves was significantly reduced when a bidet toilet was used (p < 0.00001, Wilcoxon signed-rank test).
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Affiliation(s)
- Shigeharu Oie
- Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, 1-1-1, Daigakudori, Sanyo-Onoda 756-0884, Japan E-mail:
| | - Shinya Kawai
- Faculty of Pharmaceutical Sciences, Sanyo-Onoda City University, 1-1-1, Daigakudori, Sanyo-Onoda 756-0884, Japan E-mail:
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Itami A, Hori S, Misawa S. Decontamination effect of neutral electrolysed water for spray nozzles of electric warm-water bidet toilet seats in the healthcare setting. Infect Prev Pract 2021; 3:100143. [PMID: 34368750 PMCID: PMC8336319 DOI: 10.1016/j.infpip.2021.100143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/14/2021] [Indexed: 11/28/2022] Open
Abstract
Background There has been an increasing demand for more sanitary bidet seats in many healthcare settings because of concerns regarding potential contamination of the spray nozzles of warm-water bidet toilet seats. This contamination is thought to possibly serve as a reservoir for horizontal transmission of drug-resistant bacteria. Aim This study was performed to determine the optimal Pseudomonas aeruginosa decontamination conditions and verify the effectiveness of these decontamination conditions. Methods An in vitro test of rinsing with neutral electrolysed water was performed using seven strains of P. aeruginosa. The decontamination effect of the neutral electrolysed water was verified by a field test involving an analysis of the number of bacteria isolated from samples collected from the spray nozzles and the sprayed water from 10 toilet seats at the internal medicine ward of Juntendo University Hospital. Findings The in vitro test results showed that the decontamination effect of neutral electrolysed water tended to be higher with higher free chlorine concentrations in the nozzle-cleaning water and shorter intervals of rinsing. The field test involving the hospital ward toilets showed that routine physical cleaning was satisfactorily effective. Conclusion The study results suggest that the risk of horizontal transmission of drug-resistant bacteria via the use of bidet toilet seats in hospitals can be reduced by general cleaning and appropriate control of the free chlorine concentration in the nozzle-cleaning water.
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Affiliation(s)
- Aiko Itami
- Department of Infection Control Science, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Research Institute, TOTO Ltd., Chigasaki, Kanagawa, Japan
| | - Satoshi Hori
- Department of Infection Control Science, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Shigeki Misawa
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
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Sheikh P, Régnier C, Goron F, Salmat G. The prevalence, characteristics and treatment of hemorrhoidal disease: results of an international web-based survey. J Comp Eff Res 2020; 9:1219-1232. [PMID: 33079605 DOI: 10.2217/cer-2020-0159] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: This international study assessed the characteristics and treatment of individuals with hemorrhoids. Materials & methods: Online survey among nationally representative populations of adults from Brazil, Czech Republic, France, Hungary, Italy, Romania, Russia and Spain, that identified participants who self-reported having hemorrhoidal disease. Results: Hemorrhoid prevalence was 11% (1725/16015); most respondents had low-severity disease (71%). Compared with the general population, participants with hemorrhoidal disease had more comorbidities (mean 3.1 vs 1.3) and included more women who had been pregnant (81 vs 68%). Common initial signs/symptoms were pain (60%), bleeding (47%) and discomfort (43%). Hemorrhoid respondents who consulted a physician were more likely to undergo interventions and take medications. Conclusion: The prevalence of hemorrhoidal disease in the adult population is 11%, mostly low-severity disease.
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Affiliation(s)
- Parvez Sheikh
- Department of Colorectal Surgery, Saifee Hospital, Mumbai, India
| | | | - Fabienne Goron
- Harris Interactive, 5 Avenue du Château, 94300 Vincennes, France
| | - Ghislaine Salmat
- Harris Interactive, 5 Avenue du Château, 94300 Vincennes, France
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