Portuguese Society of Gastroenterology Consensus on the Diagnosis and Management of Hemorrhoidal Disease

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.

Keywords: Consensus; Hemorrhoidal disease; Portugal.

Conflict of interest statement

P. Salgueiro and P. Amaro received fees as speakers from Angelini Farmacêutica Lda.

Copyright © 2019 by S. Karger AG, Basel.

Figures

Fig. 1

Algorithm for the management of patients with suspected hemorrhoidal disease. a Colonoscopy is indicated in patients over the age of 50 years (earlier if there is family history of CRC or another condition predisposing to CRC) or if any alarm symptom is present; b consider using a symptom-based score, such as Sodergren score, to evaluate the severity of the HD; c advise avoiding excessive straining and limit the time at defecation; d medical management is enough for most patients. Some cases may require office-based treatment. RBL may be difficult to perform in such small vascular cushions; e the adopted type of surgical technique will depend on local expertise and should be a joint decision between the doctor and the patient; f studies have suggested a potential benefit of antibiotic prophylaxis in these patients owing to the risk of bacteremia after sclerotherapy; g there are no trials evaluating office-based therapies in pregnant women; therefore, they should probably be avoided during this period; h surgical treatment is effective in the prevention of recurrence and symptom control when applied during the first 48–72 h after symptoms onset. HD, hemorrhoidal disease; RBL, rubber band ligation; IRC, infrared coagulation.