ORIGINAL ARTICLE   

Acta Phlebologica 2019 April;20(1):15-9

DOI: 10.23736/S1593-232X.19.00439-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Sulodexide in the treatment of grade II and III hemorrhoids: a retrospective study

Nicola LIZZA ✉, Monica URBANI, Laura UKOVICH

Unit of Surgery, Sanatorio Triestino, Medical and Surgical Clinic, Trieste, Italy

BACKGROUND: Vasoactive drugs can play a part in the resolution of hemorrhoidal pathology by acting on the endothelium and on the vascular inflammatory cause. Sulodexide, a glycosaminoglycan with antithrombotic and anti-inflammatory action, is used in the treatment of chronic venous disease and in hemorrhoids, both acute and chronic.
METHODS: In this retrospective study, 69 patients with hemorrhoids of various grades (I-IV) and treated for 30 days with oral sulodexide 500 ULS/day, were analyzed. The efficacy of the treatment was measured by an objective assessment of the clinician and a subjective assessment of the patient using the CORECTS questionnaire (ColoRectal Evaluation of Clinical Therapeutics Scale).
RESULTS: Considering all patients treated (grades I-IV), an improvement in the clinical picture and symptoms at the end of therapy was observed in 88% of cases, with a percentage of complete remission of the disease of 32%. Specifically, in patients with grade II hemorrhoids an improvement was observed in 93% of cases, with 64% healed, while in those with grade III hemorrhoids the improvement reached 90% of cases with 6% presenting complete remission. Sulodexide significantly reduced all signs and symptoms analyzed by the clinician, such as edema (from 97% to 71%, P<0.001), bleeding (from 72% to 13%, P<0.001), prolapse (from 21% to 2%, P<0.001) and hemorrhoidal thrombosis (from 14% to 0%, P<0.01). Patients also reported a significant improvement (P<0.001) measured by CORECTS score in pain (from 2.9 to 0.5), itching (from 4.1 to 1.3), swelling (from 5.8 to 2.1), bleeding (from 4.0 to 0.8), discomfort (from 5.5 to 1.8) and wellbeing (from 6.0 to 2.0), giving an average overall opinion on the therapy of 7.4/10. In 71% of patients the opinion was “good” or “very good” (89% in grade II and 60% in grade III).
CONCLUSIONS: The results of the study, albeit limited in number, confirmed that sulodexide is an effective and safe conservative therapeutic option in the less severe forms of hemorrhoids (grade II) and with a potential role in the more severe forms (grade III) as a support for surgical treatment.

KEY WORDS: Glycosaminoglycans; Hemorrhoids; Therapeutics