Comparison of Centella with Flavonoids for Treatment of Symptoms in Hemorrhoidal Disease and After Surgical Intervention: A Randomized Clinical Trial.
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
14 05 2020
14 05 2020
Historique:
received:
28
06
2019
accepted:
20
04
2020
entrez:
16
5
2020
pubmed:
16
5
2020
medline:
15
12
2020
Statut:
epublish
Résumé
Phlebotonics' effects were evaluated to reduce time-to-stop bleeding and anal irritation in 130 patients who complained of hemorrhoidal disease (HD); bleeding and pain after hemorrhoidectomy (31 patients) and hemorrhoidal thrombosis (34 patients) in the short time. Sixty patients were randomized to receive the routine treatment (both conservative and surgical) (control Group C). The treated group (both conservative and surgical) was divided into two subgroups: one treated with flavonoids (Group A, n = 73), the other with Centella (Group B, n = 66). Time-to-stop bleeding was checked at baseline and checkups (0 up to day 42). Healing was estimated with Kaplan-Meier method, the Kruskal-Wallis test estimated changes in the VAS scores. The HD median time-to-stop bleeding was 2 weeks for Groups A and B; 3 weeks for Group C. VAS scores comparison among Groups (irritation): A vs C, p = 0.007; B vs C, p = 0.041; and A vs B, p = 0.782 resulted respectively. As for operated hemorrhoids, the time-to-stop bleeding was 3 and 4 weeks in Groups A and B and 5 in Group C. Histopathology showed an association between flavonoids and piles' fibrosis (p = 0.008). Phlebotonics in HD, as well as after surgery, showed significant beneficial effects. Flavonoids are the most effective phlebotonics against bleeding and anal irritation.
Identifiants
pubmed: 32409760
doi: 10.1038/s41598-020-64772-0
pii: 10.1038/s41598-020-64772-0
pmc: PMC7224176
doi:
Substances chimiques
Flavonoids
0
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
8009Références
Vysloužil, K., Zbořil, P., Skalický, P. & Vomácková, K. Effect of hemorrohoidectomy on anorectal physiology. Int. J. Colorectal Dis. 25, 259–265, https://doi.org/10.1007/s00384-009-0810-3 (2010).
doi: 10.1007/s00384-009-0810-3
pubmed: 19844729
Everhart, J. E. The burden of digestive diseases in the United States. In: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Everhart, J, E., ed. US Government Printing Office, Washington, DC US:NIH Publication No. 09-6443 65–68 (2008).
Davis, B. R., Lee-Kong, S. A., Migaly, J., Feingold, D. L. & Steele, S. R. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the management of hemorrhoids. Dis. Colon. Rectum. 61, 284–292 (2018).
doi: 10.1097/DCR.0000000000001030
Rivadeneira, D. E. et al. Practice parameters for the management of hemorrhoids. Dis. Colon. Rectum. 54(9), 1059–1064, https://doi.org/10.1097/DCR.0b013e318225513d (2011).
doi: 10.1097/DCR.0b013e318225513d
pubmed: 21825884
Lyu, S. Y., Rhim, J. Y. & Park, W. B. Antiherpetic activities of flavonoids against herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) in vitro. Arch. Pharm. Res. 28(11), 1293–1301 (2005).
doi: 10.1007/BF02978215
Kar, S., Krishnan, A. & Shivkumar, P. V. Pregnancy and Skin. J. Obstet. Gynaecol. India. 62(3), 268–275, https://doi.org/10.1007/s13224-012-0179-z (2012).
doi: 10.1007/s13224-012-0179-z
pubmed: 23730028
pmcid: 3444563
Ye, H. et al Pathway Analysis Revealed Potential Adverse Health Impacts of Flavonoids that Bind Estrogen Receptors. Int J Environ Res Public Health. 26, 13(4), 373 (2016 Mar).
Alonso-Coello, P. et al. Meta-analysis of flavonoids for the treatment of hemorrhoids. Br. J. Surg. 93, 909–920, https://doi.org/10.1002/bjs.5378 (2006).
doi: 10.1002/bjs.5378
pubmed: 16736537
Anderson, J. W. et al. Health benefits of dietary fiber. Nutr. Rev. USA 67(4), 188–205, https://doi.org/10.1111/j.1753-4887.2009.00189.x (2016).
doi: 10.1111/j.1753-4887.2009.00189.x
Bernstein, A. M., Titgemeier, B., Kirkpatrick, K., Golubic, M. & Roizen, M. F. Major cereal grain fibers and psyllium in relation to cardiovascular health. Nutrients. 5(5), 1471–1487 (2013).
doi: 10.3390/nu5051471
López, J. C. et al. Plantago ovata consumption and colorectal mortality in Spain, 1995–2000. J. Epidemiol. 19(4), 206–211 (2009).
doi: 10.2188/jea.JE20080059
Marchesi, J. R. et al The gut microbiota and host health: a new clinical frontier. Gut. 65(2), 330–9, https://doi.org/10.1136/gutjnl-2015-309990. Epub 2015 Sep 2. Review (2016).
Schiano di Visconte, M., Nicolì, F., Del Giudice, R. & Cipolat Mis, T. Effect of a mixture of diosmin, coumarin glycosides, and triterpenes on bleeding, thrombosis, and pain after stapled anopexy: a prospective, randomized, placebo-controlled clinical trial. Int. J. Colorectal Dis. 32(3), 425–431 (2017).
doi: 10.1007/s00384-016-2698-z
Perera, N. et al. Phlebotonics for haemorrhoids (Review). Cochrane Database Syst. Rev. 15(8), CD004322, https://doi.org/10.1002/14651858.CD004322.pub3 (2012).
doi: 10.1002/14651858.CD004322.pub3
Corsale, I. et al. Flavonoid mixture (diosmin, troxerutin, RutinS hesperidin, quercetin) in the treatment of I–III degree hemorroidal disease: a double-blind multicenter prospective comparative study. Int J Colorectal Dis. 33(11),1595–1600, https://doi.org/10.1007/s00384-018-3102-y. (2018 Jun 22).
Kim, H. P., Park, H., Son, K. H., Chang, H. W. & Kang, S. S. Biochemical pharmacology of bioflavonoids: implications for anti-inflammatory action. Arch. Pharm. Res. 31(3), 265–73 (2008).
doi: 10.1007/s12272-001-1151-3
Chobotova, K., Vernallis, A. B. & Majid, F. A. Bromelain’s activity and potential as an anti-cancer agent: Current evidence and perspectives. Cancer Letters. 290(2), 148–156 (2010).
doi: 10.1016/j.canlet.2009.08.001
Boyle, S. P. et al. Bioavailability and efficiency of Rutin as antioxidant: a human supplementation study. Eur. J. Clin. Nutr. 54(10), 774–82 (2000).
doi: 10.1038/sj.ejcn.1601090
Basile, M., Gidaro, S., Pacella, M., Biffignandi, P. M. & Gidaro, G. S. Parenteral troxerutin and carbazochrome combination in the treatment of post-hemorrhoidectomy status: a randomized, double-blind, placebo-controlled, phase IV study. Curr. Med. Res. Opin. 17(4), 256–61 (2001).
doi: 10.1185/0300799019117018
Cho, J. W., Cho, S. Y., Lee, S. R. & Lee, K. S. Onion extract and quercetin induce matrix metalloproteinase-1 in vitro and in vivo. Int. J. Mol. Med. 25(3), 347–352 (2010).
doi: 10.3892/ijmm_00000350
Cesarone, M. R. et al. Evaluation of treatment of diabetic microangiopathy with total triterpenic fraction of Centella asiatica: a clinical prospective randomized trial with a microcirculatory model. Angiology. 52(Suppl 2), S49–54 (2001).
doi: 10.1177/000331970105202S10
Lu, L. et al. Asiaticoside induction for cell-cycle progression, proliferation and collagen synthesis in human dermal fibroblasts. Int. J. Dermatol. 43(11), 801–7 (2004).
doi: 10.1111/j.1365-4632.2004.02047.x
Johanson, J. F. & Sonnenberg, A. The prevalence of hemorrhoids and chronic constipation: an epidemiologic study. Gastroenterology 98(2), 380–386 (1990).
doi: 10.1016/0016-5085(90)90828-O
Evans, P. & Halliwell, B. Micronutrients: oxidants/antioxidants status. Br. J. Nutr. 85(Suppl 2), S67–S74 (2001).
doi: 10.1079/BJN2000296
Gowri, S. S., Pavitha, S. & Vasantha, K. Free radical scavenging capacity and antioxidant activity of young leaves and barks of Acacia nilotica Del. Int. J. Pharm. Pharm. Sci. 3(1), 160–164 (2011).
Iqbal, P., Ahmed, D. & Asghar, M. N. A comparative in vitro antioxidant potential profile of extracts from different parts of Fagonia cretica. Asian Pac. J. Trop. Med. 7(Suppl 1), S473–S480 (2014).
doi: 10.1016/S1995-7645(14)60277-7
Faujdar, S., Sati, B., Sharma, S., Pathak, A. K. & Kumar Paliwal, S. Phytochemical evaluation and anti-hemorrhoidal activity of bark of Acacia ferruginea. J. Traditional Complementary Medicine. 9, 85–89, https://doi.org/10.1016/j.jtcme.2018.02.003 (2019).
doi: 10.1016/j.jtcme.2018.02.003
Rabiskova, M. et al. Coated chitosan pellets containing rutin intended for the treatment of inflammatory bowel disease: In vitro characteristics and in vivo evaluation. Int. J. Pharmaceutics 422, 151–159 (2012).
doi: 10.1016/j.ijpharm.2011.10.045
Beatriz Gull_on, T. A., Lú-Chau, M. T., Moreira, J. M. & Lema, G. E. Rutin: A review on extraction, identification and purification methods, biological activities and approaches to enhance its bioavailability Trends in Food Science &. Technology 67, 220–235, https://doi.org/10.1016/j.tifs.2017.07.008 (2017).
doi: 10.1016/j.tifs.2017.07.008
Torres-Rego, M. et al. Anti-inflammatory activity of aqueous extract and bioactive compounds identified from the fruits of Hancornia speciosa Gomes (Apocynaceae). BMC Complementary Alternative Med. 16, 275 (2016).
doi: 10.1186/s12906-016-1259-x
Yoo, H., Ku, S. K., Baek, Y. D. & Bae, J. S. Anti-inflammatory effects of rutin on HMGB1-induced inflammatory responses in vitro and in vivo. Inflamm. Res. 63, 197–206 (2014).
doi: 10.1007/s00011-013-0689-x
Kim, H. Y. et al. Protective effects of rutin through regulation of vascular endothelial growth factor in allergic rhinitis. Am. J. Rhinology Allergy 29, 87–94 (2015).
doi: 10.2500/ajra.2015.29.4195
Antignani, P. & Caliumi, C. Medical treatment of chronic venous insufficiency. Vascular Disease. Prevention 4, 117–124 (2007).
Petruzzellis, V. et al. Oxerutins (Venoruton®): Efficacy in chronic venous insufficiency a double-blind, randomized, controlled study. Angiology 53, 257–263 (2002).
doi: 10.1177/000331970205300302
Aziz, Z., Tang, W. L., Chong, N. J. & Tho, L. Y. A systematic review of the efficacy and tolerability of hydroxyethylrutosides for improvement of the signs and symptoms of chronic venous insufficiency. J. Clin. Pharm. Therapeutics 40, 177–185 (2015).
doi: 10.1111/jcpt.12247
La Torre, F. & Nicolai, A. P. Clinical use of micronized purified flavonoid fraction for treatment of symptoms after hemorrhoidectomy: results of a randomized, controlled, clinical trial. Dis. Colon. Rectum 47, 704–710, https://doi.org/10.1007/s10350-003-0119-1 (2004).
doi: 10.1007/s10350-003-0119-1
pubmed: 15037936
LARN Nutrients and energy intake levels for the Italian population. Revision Bologna 22–23, www.sinu.it/documenti/20121016_LARN_bologna_sintesi_prefinale.pdf . (2012).
Schoenfeld, D. A. Sample-Size Formula for the Proportional-Hazards Regression Model. Biometrics 39(2), 499–503 (1983 Jun).
Sitia, H. N., Jalilb, J., Asmadid, A. Y. & Kamisaha, Y. Roles of rutin in cardiac remodeling. J. Funct. Foods 64, 103606, https://doi.org/10.1016/j.jff.2019.103606 (2020).
doi: 10.1016/j.jff.2019.103606
Li, X. et al. Inhibition of autophagy via activation of PI3K/Akt/mTOR pathway contributes to the protection of hesperidin against myocardial ischemia/reperfusion injury. Int. J. Mol. Med. 42(4), 1917–1924, https://doi.org/10.3892/ijmm.2018.3794 (2018).
doi: 10.3892/ijmm.2018.3794
pubmed: 30066841
pmcid: 6108872
Gomez-Sintes, R., Ledesma, M. D. & Boya, P. Lysosomal cell death mechanisms inaging. Ageing Res. Rev. 32, 150–168, https://doi.org/10.1016/j.arr.2016.02.009 (2016).
doi: 10.1016/j.arr.2016.02.009
pubmed: 26947122
Dunlop, E. A. & Tee, A. R. mTOR and autophagy: A dynamic relationship governed by nutrients and energy. Semin. Cell Developmental Bioliology 36, 121–129, https://doi.org/10.1016/j.semcdb.2014.08.006. (2014).
doi: 10.1016/j.semcdb.2014.08.006.
Schirone, L. et al. A review of the molecular mechanisms underlying the development and progression of cardiac remodeling. Oxidative Medicine and Cellular Longevity 3920195, https://doi.org/10.1155/2017/3920195 (2017).
Hou, L.-S. et al. Rutin mitigates hepatic fibrogenesis and inflammation through targeting TLR4 and P2X7 receptor signaling pathway in vitro and in vivo. J. Funct. Foods 64, 103700, https://doi.org/10.1016/j.jff.2019.103700 (2020).
doi: 10.1016/j.jff.2019.103700
Sharma, S., Ali, A., Ali, J., Sahni, J. K. & Baboota, S. Rutin: Therapeutic potential and recent advances in drug delivery. Expert. Opin. Investigational Drugs. 22, 1063–1079, https://doi.org/10.1517/13543784.2013.805744 (2013).
doi: 10.1517/13543784.2013.805744
Khan, R. A. & Khan, M. R. & Sahreen, SCCl4-induced hepatotoxicity: Protective effect of rutin on p53, CYP2E1 and the antioxidative status in rat. BMC Complementary Alternative Medicine. 12, 178, https://doi.org/10.1186/1472-6882-12-178 (2012).
doi: 10.1186/1472-6882-12-178
pubmed: 23043521
Acquaviva, R. et al. Beneficial effects of Rutin and L-arginine coadministration in a rat model of liver ischemia-reperfusion injury. Am. J. Physiology-Gastrointestinal Liver Physiology. 296, G664–G670, https://doi.org/10.1152/ajpgi.90609.2008 (2009).
doi: 10.1152/ajpgi.90609.2008
Brusciano, L. et al Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids. Updates Surg., https://doi.org/10.1007/s13304-019-00694-5 (2019).
Brusciano, L. et al. An imaginary cuboid: chest, abdomen, vertebral column and perineum, different parts of the same whole in the harmonic functioning of the pelvic floor. Tech. Coloproctol. 23(6), 603–605, https://doi.org/10.1007/s10151-019-01996-x (2019).
doi: 10.1007/s10151-019-01996-x
pubmed: 31065825
Murad-Regadas, S. M. et al. Predictors of unsuccessful of treatment for fecal Incontinence biofeedback for fecal incontinence in female. Arq. Gastroenterol. 20(56(1)), 61–65, https://doi.org/10.1590/S0004-2803.201900000-17 (2019).
doi: 10.1590/S0004-2803.201900000-17
Norton, C., Gibbs, A. & Kamm, M. A. Randomized, controlled trial of anal electrical stimulation for fecal incontinence. Dis. Colon. Rectum. 49(2), 190–6 (2006).
doi: 10.1007/s10350-005-0251-1
Gambardella, C. et al. Predictive parameters to identify incontinent patients amenable for rehabilitation treatment: the muscular synergies evaluation. Arq. Gastroenterol. 56(4), 452–453, https://doi.org/10.1590/S0004-2803.201900000-76 (2019).
doi: 10.1590/S0004-2803.201900000-76
pubmed: 31618400
Altomare, D. F. et al. Red hot chili pepper and hemorrhoids: the explosion of a myth: results of a prospective, randomized, placebo-controlled, crossover trial. Dis. Colon. Rectum. 49, 1018–23, https://doi.org/10.1007/s10350-006-0532-3 (2006).
doi: 10.1007/s10350-006-0532-3
pubmed: 16708161
Agachan, F., Chen, T., Pfeifer, J., Reissman, P. & Wexner, S. D. A constipation scoring system to simplify evaluation and management of constipated patients. Dis. Colon. Rectum. 39(6), 681–5, https://doi.org/10.1007/bf02056950 (1996).
doi: 10.1007/bf02056950
pubmed: 8646957
Yadu Nandan, D. et al. Curative effect of Amorphophallus paeoniifolius tuber on experimental hemorrhoids in rats. J. Ethnopharmacology. 192, 183–191, https://doi.org/10.1016/j.jep.2016.07.042 (2016).
doi: 10.1016/j.jep.2016.07.042