Skip to main content
Erschienen in: International Journal of Colorectal Disease 11/2018

22.06.2018 | Original Article

Flavonoid mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) in the treatment of I–III degree hemorroidal disease: a double-blind multicenter prospective comparative study

verfasst von: Italo Corsale, Paolo Carrieri, Jacopo Martellucci, Alessandro Piccolomini, Luigi Verre, Marco Rigutini, Sonia Panicucci

Erschienen in: International Journal of Colorectal Disease | Ausgabe 11/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

We evaluated the efficacy of new flavonoids mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) to reduce bleeding from I–III degrees hemorrhoidal disease in the short and medium time.

Methods

One hundred fifty-four consecutive patients with hemorrhoidal disease recruited in four colorectal units were enrolled to the study. Exclusion criteria were allergy to the flavonoids, inflammatory bowel disease, obstructed defecation syndrome, pregnancy and puerperium, associated anal disease or hemorrhoidal thrombosis, proctologic surgical procedures within 1 year before recruitment, contemporary cancer or HIV, previous pelvic radiotherapy, patients receiving oral anticoagulant therapy, or contemporary administration of other therapy for hemorrhoids. Patients with inability to understand the study or mental disorders were also excluded.

Results

Seventy-eight were randomized to receive the mixture of diosmin, troxerutin, rutin, hesperidin, and quercetin (study group, SG), and 76 a mixture of diosmin in combination with hesperidin, diosmetin, isoroifolin, and linarin in purified micronized fraction (control group, CG). Bleeding, number of pathological piles, and Golligher’s grade were assessed at each scheduled visit and compared using the Chi-square test. During the study period, bleeding improved after 1 and 6 months both in the SG (79.5 and 70.5%) and in the CG (80.2 and 75%) without significant differences between two groups. Satisfaction degree after 6 months was greater in the patients of the SG (4.05) towards the CG (3.25): this result was statistical significant (p 0.003).

Conclusions

Use of flavonoids mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) is a safe and effective mean of managing bleeding from hemorrhoidal disease and minimal adverse events are reported.
Literatur
1.
Zurück zum Zitat Lohsiriwat V (2015) Treatment of hemorrhoids: a coloproctologist’s view. World J Gastroenterol 21:9245–9252CrossRef Lohsiriwat V (2015) Treatment of hemorrhoids: a coloproctologist’s view. World J Gastroenterol 21:9245–9252CrossRef
2.
Zurück zum Zitat Alonso-Coello P, Zhou Q, Martinez Zapata MJ, Mills E, Heels Ansdell D, Johanson JF, Guyatt G (2006) Meta analysis of flavonoids for the treatment of haemorrhoids. Br J Surg 93:909–920CrossRef Alonso-Coello P, Zhou Q, Martinez Zapata MJ, Mills E, Heels Ansdell D, Johanson JF, Guyatt G (2006) Meta analysis of flavonoids for the treatment of haemorrhoids. Br J Surg 93:909–920CrossRef
3.
Zurück zum Zitat Meyer OC (1994) Safety and security of Daflon 500 mg in venous insufficiency and in hemorrhoidal disease. Angiology 45:579–584CrossRef Meyer OC (1994) Safety and security of Daflon 500 mg in venous insufficiency and in hemorrhoidal disease. Angiology 45:579–584CrossRef
4.
Zurück zum Zitat Altomare DF, Roveran A, Pecorella G, Gaj F, Stortini E (2006) The treatment of hemorrhoids: guidelines of the Italian Society of Colorectal Surgery. Tech Coloproctol 10:181–186CrossRef Altomare DF, Roveran A, Pecorella G, Gaj F, Stortini E (2006) The treatment of hemorrhoids: guidelines of the Italian Society of Colorectal Surgery. Tech Coloproctol 10:181–186CrossRef
5.
Zurück zum Zitat Rivadeneira DE, Steele SR, Ternent C (2011) Practice parameters for the management of hemorrhoids. Dis Colon Rectum 54:1059–1064CrossRef Rivadeneira DE, Steele SR, Ternent C (2011) Practice parameters for the management of hemorrhoids. Dis Colon Rectum 54:1059–1064CrossRef
7.
Zurück zum Zitat Longo A (2002) Stapled anopexy and stapled hemorrhoidectomy: two opposite concepts and procedures. Dis Colon um 45:571–572CrossRef Longo A (2002) Stapled anopexy and stapled hemorrhoidectomy: two opposite concepts and procedures. Dis Colon um 45:571–572CrossRef
8.
Zurück zum Zitat Alonso-Coello P, Zhou Q, Martinez-Zapata MJ, Mills E, Heels-Ansdell D, Johanson JF (2006) Meta-analysis of flavonoids for the treatment of haemorrhoids. Br J Surg 93:909–920CrossRef Alonso-Coello P, Zhou Q, Martinez-Zapata MJ, Mills E, Heels-Ansdell D, Johanson JF (2006) Meta-analysis of flavonoids for the treatment of haemorrhoids. Br J Surg 93:909–920CrossRef
9.
Zurück zum Zitat Jiang ZM, Cao JD (2006) The impact of micronized purified flavonoid fraction on the treatment of acute haemorrhoidal episodes. Curr Med Res Opin 22:1141–1147CrossRef Jiang ZM, Cao JD (2006) The impact of micronized purified flavonoid fraction on the treatment of acute haemorrhoidal episodes. Curr Med Res Opin 22:1141–1147CrossRef
10.
Zurück zum Zitat Ba-bai-ke-re MM, Huang HG, Re WN, Fan K, Chu H, Ai EH (2011) How we can improve patients’ comfort after Milligan-Morgan open haemorrhoidectomy. World J Gastroenterol 17:1448–1156CrossRef Ba-bai-ke-re MM, Huang HG, Re WN, Fan K, Chu H, Ai EH (2011) How we can improve patients’ comfort after Milligan-Morgan open haemorrhoidectomy. World J Gastroenterol 17:1448–1156CrossRef
11.
Zurück zum Zitat Misra MC, Parshad R (2000) Randomized clinical trial of micronized flavonoids in the early control of bleeding from acute internal haemorrhoids. Br J Surg 87:868–872CrossRef Misra MC, Parshad R (2000) Randomized clinical trial of micronized flavonoids in the early control of bleeding from acute internal haemorrhoids. Br J Surg 87:868–872CrossRef
12.
Zurück zum Zitat Perera N, Liolitsa D, Iype S, Croxford A, Yassin M, Lang P, Ukaegbu O, van Issum C (2012). Phlebotonics for haemorrhoids. Cochrane Database Syst Rev, 2012 Aug 15;(8):CD004322. Perera N, Liolitsa D, Iype S, Croxford A, Yassin M, Lang P, Ukaegbu O, van Issum C (2012). Phlebotonics for haemorrhoids. Cochrane Database Syst Rev, 2012 Aug 15;(8):CD004322.
13.
Zurück zum Zitat Ho Y-H, Tan M, Seow-Choen F (2000) Micronized purified flavonoid fraction compared favorably with rubber band ligation and fiber alone in the management of bleeding hemorrhoids: randomized controlled trial. Dis Colon Rectum 43:66–69CrossRef Ho Y-H, Tan M, Seow-Choen F (2000) Micronized purified flavonoid fraction compared favorably with rubber band ligation and fiber alone in the management of bleeding hemorrhoids: randomized controlled trial. Dis Colon Rectum 43:66–69CrossRef
14.
Zurück zum Zitat Alonso P, Marzo M, Mascort JJ, Hervas A, Vinas L, Ferrus J (2002) Clinical practice guidelines for the management of patients with rectal bleeding. Gastroenterol Hepatol 25:605–632CrossRef Alonso P, Marzo M, Mascort JJ, Hervas A, Vinas L, Ferrus J (2002) Clinical practice guidelines for the management of patients with rectal bleeding. Gastroenterol Hepatol 25:605–632CrossRef
15.
Zurück zum Zitat Madoff RD, Fleshman JW, Clinical Practice Committee, American Gastroenterological Association (2004) American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology 126:1463–1473CrossRef Madoff RD, Fleshman JW, Clinical Practice Committee, American Gastroenterological Association (2004) American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology 126:1463–1473CrossRef
16.
Zurück zum Zitat Cospite M (1994) Double blind, placebo-controlled evaluation of clinical activity and safety of Daflon 500 in the treatment of acute hemorrhoids. Angiology 45:566–573CrossRef Cospite M (1994) Double blind, placebo-controlled evaluation of clinical activity and safety of Daflon 500 in the treatment of acute hemorrhoids. Angiology 45:566–573CrossRef
17.
Zurück zum Zitat Godeberge PH (1992) Daflon 500 is significantly more effective than placebo in the treatment of hemorrhois. Phlebology 7:61–63 Godeberge PH (1992) Daflon 500 is significantly more effective than placebo in the treatment of hemorrhois. Phlebology 7:61–63
18.
Zurück zum Zitat Thanapongsathorn W, Vajrabukka T (1992) Clinical trial of oral diosmin (Daflon) in the treatment of hemorrhoids. Dis Colon Rectum 35:1085–1088CrossRef Thanapongsathorn W, Vajrabukka T (1992) Clinical trial of oral diosmin (Daflon) in the treatment of hemorrhoids. Dis Colon Rectum 35:1085–1088CrossRef
19.
Zurück zum Zitat Shelygin Y, Krivokapic Z, Frolov SA, Kostarev IV, Astashov VL, Vasiliev SV, Lakhin AV, Rodoman GV, Soloviev AO, Stoyko YM, Khitaryan AG, Nechay IA (2016) Clinical acceptability study of micronized purified flavonoid fraction 1000 mg tablets versus 500 mg tablets in patients suffering acute hemorrhoidal disease. Curr Med Res Opin 32:1821–1826CrossRef Shelygin Y, Krivokapic Z, Frolov SA, Kostarev IV, Astashov VL, Vasiliev SV, Lakhin AV, Rodoman GV, Soloviev AO, Stoyko YM, Khitaryan AG, Nechay IA (2016) Clinical acceptability study of micronized purified flavonoid fraction 1000 mg tablets versus 500 mg tablets in patients suffering acute hemorrhoidal disease. Curr Med Res Opin 32:1821–1826CrossRef
20.
Zurück zum Zitat Meshikhes AW (2004) Daflon for haemorrhoids: a prospective, multi-centre observational study. Surgeon 2:335–338CrossRef Meshikhes AW (2004) Daflon for haemorrhoids: a prospective, multi-centre observational study. Surgeon 2:335–338CrossRef
21.
Zurück zum Zitat Lyseng-Williamson KA, Perry CM (2003) Micronised purified flavonoid fraction: a review of its use in chronic venous insufficiency, venous ulcers and haemorrhoids. Drugs 63:71–100CrossRef Lyseng-Williamson KA, Perry CM (2003) Micronised purified flavonoid fraction: a review of its use in chronic venous insufficiency, venous ulcers and haemorrhoids. Drugs 63:71–100CrossRef
22.
Zurück zum Zitat Burnier M (2000) Long-term compliance with antihypertensive therapy: another facet of chronotherapeutics in hypertension. Blood Press Monit 5(Suppl 1):S31–S34CrossRef Burnier M (2000) Long-term compliance with antihypertensive therapy: another facet of chronotherapeutics in hypertension. Blood Press Monit 5(Suppl 1):S31–S34CrossRef
23.
Zurück zum Zitat Claxton AJ, Cramer J, Pierce C (2001) A systematic review of the associations between dose regimens and medication compliance. Clin Ther 23:1296–1310CrossRef Claxton AJ, Cramer J, Pierce C (2001) A systematic review of the associations between dose regimens and medication compliance. Clin Ther 23:1296–1310CrossRef
24.
Zurück zum Zitat Beena J, Jimmy J (2011) Patient medication adherence: measures in daily practice. Oman Med J 26:155–159CrossRef Beena J, Jimmy J (2011) Patient medication adherence: measures in daily practice. Oman Med J 26:155–159CrossRef
25.
Zurück zum Zitat Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353:487–497CrossRef Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353:487–497CrossRef
26.
Zurück zum Zitat Giannini I, Amato A, Basso L, Tricomi N, Marranci M, Pecorella G, Tafuri S, Pennisi D, Altomare DF (2015) Flavonoids mixture (diosmin, troxerutin, hesperidin) in the treatment of acute hemorrhoidal disease: a prospective, randomized, triple-blind, controlled trial. Tech Coloproctol 19:339–345CrossRef Giannini I, Amato A, Basso L, Tricomi N, Marranci M, Pecorella G, Tafuri S, Pennisi D, Altomare DF (2015) Flavonoids mixture (diosmin, troxerutin, hesperidin) in the treatment of acute hemorrhoidal disease: a prospective, randomized, triple-blind, controlled trial. Tech Coloproctol 19:339–345CrossRef
Metadaten
Titel
Flavonoid mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) in the treatment of I–III degree hemorroidal disease: a double-blind multicenter prospective comparative study
verfasst von
Italo Corsale
Paolo Carrieri
Jacopo Martellucci
Alessandro Piccolomini
Luigi Verre
Marco Rigutini
Sonia Panicucci
Publikationsdatum
22.06.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
International Journal of Colorectal Disease / Ausgabe 11/2018
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-018-3102-y

Weitere Artikel der Ausgabe 11/2018

International Journal of Colorectal Disease 11/2018 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.