Conservative Treatment in all Grades of Hemorrhoidal Disease? Benefits of MPFF*

Overview

Hemorrhoidal disease (HD) is a common medical problem affecting nearly 40% of adults. Internal HD affects the anal cushions located above the dentate line in the anal canal, and is graded according to severity based on the extent to which the diseased anal cushions (hemorrhoids) descend, or prolapse, into the anal canal or exit the anus.

In most patients, the prolapse is not sufficient to require surgery or an outpatient procedure (e.g., rubber band ligation [RBL] or sclerotherapy), and conservative medical treatment is therefore an important first option in managing HD.

Medical management cannot cure prolapse, irreducibility or strangulation, but bleeding can be controlled to a large extent

by targeted medical therapy, along with supportive treatment that includes laxatives and dietary adjustment.

Several venoactive drugs have been used to treat HD, but the clinical evidence for the efficacy of many of these treatments is unclear.

This recent review summarizes the clinical evidence of the efficacy of MPFF (micronized purified flavonoid fraction) in the treatment of acute HD (appearing within the past 7 days), and as an adjunct following hemorrhoidectomy or outpatient procedures. Also discuss the acceptability of MPFF and its position in current guidelines.

Evidence of MPFF treatment in HD

Several systematic reviews and meta-analyses have also found evidence for the efficacy of flavonoids, MPFF and other venoactive drugs in the treatment of HD. A Cochrane meta-analysis found that venoactive treatments were associated with statistically significant improvements in bleeding and overall symptoms in acute HD, and improvements in bleeding after hemorrhoidectomy in favor of MPFF treatment (p = 0.008). Quantitative analysis of pooled results indicated that 7 days of MPFF treatment was associated with a 90% reduction in the risk of bleeding (p < 0.001), significant reductions in discharge and leakage (p < 0.001). Consistent and statistically significant quantitative evidence was also found for overall improvement in symptoms, as assessed by patients and investigators (p < 0.001).

Many studies reported that treatment outcomes in patients undergoing hemorrhoidectomy were significantly better for those who received MPFF than those who did not. These results indicate that MPFF is effective in the relief of bleeding and the main symptoms occurring in patients after hemorrhoidectomy.

MPFF has also been studied as an adjunct to nonsurgical procedures, including IPC, RBL and sclerotherapy, in patients with internal HD with a statistically significant relief of pain, discomfort and t bleeding during defecation after the procedures.

Conclusion

Systematic review of the literature indicates that micronized purified flavonoid fraction (MPFF) can reduce

bleeding, pain, anal discomfort, anal discharge and pruritus in patients with acute HD, and can reduce pain,

bleeding duration and the requirement for analgesics in patients undergoing surgery for HD.

MPFF has been shown to be effective and well tolerated in all grades of HD, either as a first-line treatment in

combination with dietary modifications, or as an adjunct in patients recovering from hemorrhoidectomy and after procedures.

The real evidence base for the efficacy of conservative therapy in HD is, in general, currently relevant only for MPFF.

Based on the available clinical evidence, current national guidelines and extensive clinical experience in treating

HD patients, MPFF is appropriate and effective for all grades of HD.

MPFF* (micronized purified flavonoid fraction)

SCAC 07/22 CVD/EH 001 MPAD