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Abstract
Introduction Hemorrhoidal disease is a common problem that arises when hemorrhoidal structures become engorged and/or prolapse through the anal canal. Both conservative and invasive treatment options are diverse and guidance to their implementation is lacking. Methods A Delphi consensus process was used to review current literature and draft relevant statements. These were reconciliated until sufficient agreement was reached. The grade of evidence was determined. These guidelines were based on the published literature up to June 2020. Results Hemorrhoids are normal structures within the anorectal region. When they become engorged or slide down the anal canal, symptoms can arise. Every treatment for symptomatic hemorrhoids should be tailored to patient profile and expectations. For low-grade hemorrhoids, conservative treatment should consist of fiber supplements and can include a short course of venotropics. Instrumental treatment can be added case by case : infrared coagulation or rubber band ligation when prolapse is more prominent. For prolapsing hemorrhoids, surgery can be indicated for refractory cases. Conventional hemorrhoidectomy is the most efficacious intervention for all grades of hemorrhoids and is the only choice for non-reducible prolapsing hemorrhoids. Conclusions The current guidelines for the management of hemorrhoidal disease include recommendations for the clinical evaluation of hemorrhoidal disorders, and their conservative, instrumental and surgical management.
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Salgueiro P, Caetano AC, Oliveira AM, Rosa B, Mascarenhas-Saraiva M, Ministro P, Amaro P, Godinho R, Coelho R, Gaio R, Fernandes S, Fernandes V, Castro-Poças F. Portuguese Society of Gastroenterology Consensus on the Diagnosis and Management of Hemorrhoidal Disease. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2020; 27:90-102. [PMID: 32266306 PMCID: PMC7113592 DOI: 10.1159/000502260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/21/2019] [Indexed: 12/17/2022]
Abstract
Hemorrhoidal disease (HD) is a frequent health problem with considerable repercussions on patients' quality of life. However, much of the clinical practice related to HD is based on knowledge without scientific evidence and supported largely by empirical experience of the physician who deals with this pathology. As in other countries, the goal of this consensus is to establish statements supported by solid scientific evidence and whose purpose will be to standardize and guide the diagnosis and management of HD both in the general population and in some particular groups of patients.
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Affiliation(s)
- Paulo Salgueiro
- Serviço Gastroenterologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Ana Célia Caetano
- Serviço de Gastrenterologia, Hospital de Braga, Braga, Portugal
- Instituto de Investigações em Ciência da Vida e Saúde, Escola de Medicina, Universidade do Minho, Braga, Portugal
| | - Ana Maria Oliveira
- Serviço Gastroenterologia, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Bruno Rosa
- Serviço de Gastrenterologia, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | | | - Paula Ministro
- Serviço de Gastrenterologia, Hospital de São Teotónio, Viseu, Portugal
| | - Pedro Amaro
- Serviço de Gastrenterologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rogério Godinho
- Serviço de Gastrenterologia, Hospital do Espírito Santo, Évora, Portugal
| | - Rosa Coelho
- Serviço de Gastrenterologia, Centro Hospitalar de São João, Porto, Portugal
| | - Rúben Gaio
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Samuel Fernandes
- Serviço de Gastrenterologia, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa Norte, Portugal
| | - Vítor Fernandes
- Serviço de Gastrenterologia, Hospital Garcia de Orta, Almada, Portugal
| | - Fernando Castro-Poças
- Serviço Gastroenterologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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