Micronized purified flavonidic fraction compared favorably with rubber band ligation and fiber alone in the management of bleeding hemorrhoids

Randomized controlled trial

Abstract

PURPOSE: The aim of this study was to assess the role of micronized purified flavonidic fraction in the management of bleeding nonprolapsed hemorrhoids. METHODS: Patients were randomly assigned to receive ispaghula husk alone, rubber band ligation plus ispaghula husk, or micronized purified flavonidic fraction plus ispaghula husk. Other colorectal diseases were excluded by colonoscopy. Blinded observers noted the time for bleeding to stop completely, recurrences, and treatment complications. RESULTS: A total of 162 patients were randomly assigned with no significant differences in the age and gender distributions among the groups. Hemorrhoidal bleeding was relieved most expediently in the micronized purified flavonidic fraction plus ispaghula husk group (ispaghula husk alone n=66, mean (standard error of the mean) 10.6 (2.3) days; rubber band ligation plus ispaghula husk n=57, 5.6 (1.1) days; micronized purified flavonidic fraction plus ispaghula husk (n=39, 3.9 (1.2) days;P=0.03). However, there were no significant differences in the recurrences at six months of follow-up (ispaghula husk alone n=8 (12 percent); rubber band ligation plus ispaghula husk n=12 (21 percent); micronized purified flavonidic fraction plus ispaghula husk n=2 (5.1 percent);P=0.075). No complications or side-effects were noted. CONCLUSIONS: micronized purified flavonidic fraction used with fiber supplements rapidly and safely relieved bleeding from nonprolapsed hemorrhoids.

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References

  1. 1.

    Moesgaard F, Neilsen MI, Hansen JB, Knudsen JT. High-fiber diet reduces bleeding and pain in patients with hemorrhoids: a double-blind trial of Vi-Siblin®. Dis Colon Rectum 1992;25:454–6.

    Google Scholar 

  2. 2.

    Jensen SL, Harling H, Tange G, Shokouh-Amiri MH, Nielsen OV. Maintenance bran therapy for prevention of symptoms after rubber band ligation of third degree haemorrhoids. Acta Chir Scand 1988;154:395–8.

    Google Scholar 

  3. 3.

    Godeberge P. Daflon 500 mg is significantly more effective than placebo. Phlebology 1992;7(Suppl 2):61–3.

    Google Scholar 

  4. 4.

    Ho YH, Foo CL, Seow-Choen F, Goh HS. Prospective randomized controlled trial of a micronized flavonidic fraction to reduce bleeding after haemorrhoidectomy. Br J Surg 1995;82:1034–5.

    Google Scholar 

  5. 5.

    Labrid C, Duhault J, Vix C. Pharmacological properties of Daflon 500 mg. J Int Med 1987;85(Suppl):30–6.

    Google Scholar 

  6. 6.

    Lonchampt M, Guardiola B, Sicot N, Bertrand M, Perdix L, Duhault J. Protective effect of purified flavonoid fraction against reactive oxygen radicals. In vivo and in vitro study. Arzneimittelforschung 1989;39:882–5.

    Google Scholar 

  7. 7.

    Damon M, Flandre O, Michel F, Perdix L, Labrid C, Crastes de Paulet A. Effect of chronic treatment with a purified flavonoid fraction on inflammatory granuloma in rat. Study of prostaglandin E2 and F2 alpha and thromboxane B2 release and histological changes. Arzneimittelforschung 1987;37:1149–53.

    Google Scholar 

  8. 8.

    Di Perri T, Auteri A. Action of S 5682 on the complement system. In vivo and in vitro studies. Int Angiol 1988;7(Suppl 2):11–5.

    Google Scholar 

  9. 9.

    Labrid CL, Perdix L. Mechanisms of oedema: activity of Daflon 500 mg. Phlebology 1992;44:1013–32.

    Google Scholar 

  10. 10.

    Behar A, Lagrue B, Cohen-Balakia F, Baillet J. Study of capillary filtration by double labelling I131-albumin and Tc99m red cells. Application to the pharmacodynamic activity of Daflon 500. Int Angiol 1988;8(Suppl 2):35–8.

    Google Scholar 

  11. 11.

    Korthuis RJ, Gute DC. Postischemic leukocyte/endothelial cell interactions and microvascular barrier disruption in skeletal muscle: cellular mechanisms and effect of Daflon 500 mg. Int J Microcirc Clin Exp 1997;17(Suppl 1):11–7.

    Google Scholar 

  12. 12.

    Friesenecker B, Tsai AG, Allegra C, Intaglietta M. Oral administration of purified micronized flavonoid fraction suppresses leukocyte adhesion in ischaemia-reperfusion injury: in vivo observations in the hamster skin fold. Int J Microcirc Clin Exp 1994;14:50–5.

    Google Scholar 

  13. 13.

    Duhault J, Pillion G. Mecaisme d'action Daflon 500 mg sur le tonus veineux noradrenergique. Art Veines 1992;11:217–8.

    Google Scholar 

  14. 14.

    Cotonat A. Lymagogue and pulsatile activities of Daflon 500 mg on canine thoracic lymph duct. Int Angiol 1989;8(Suppl 4):15–8.

    Google Scholar 

  15. 15.

    Lau WY, Chow HP, Poon GP, Wong SH. Rubber band ligation of three primary hemorrhoids in a single session: a safe and effective procedure. Dis Colon Rectum 1982;25:336–9.

    Google Scholar 

  16. 16.

    Bartizal J, Slosberg PA. An alternative to hemorrhoidectomy. Arch Surg 1977;112:534–6.

    Google Scholar 

  17. 17.

    Jensen SL, Harling H, Arseth-hansen P, Tange G. The natural history of symptomatic haemorrhoids. Int J Colorectal Dis 1989;4:41–4.

    Google Scholar 

  18. 18.

    Lewis AA, Rogers HS, Leighton M. Trial of maximal anal dilatation and elastic band ligation as alternatives to haemorrhoidectomy in the treatment of large prolapsing haemorrhoids. Br J Surg 1983;70:54–6.

    Google Scholar 

  19. 19.

    Steinberg DM, Liegois H, Alexander-Williams J. Long term review of the results of rubber band ligation of haemorrhoids. Br J Surg 1975;62:144–6.

    Google Scholar 

  20. 20.

    Newstead GL. Logical clinical decisions in the investigation and management of non-urgent rectal bleeding. Gastroenterol Jpn 1991;26(Suppl 3):107–10.

    Google Scholar 

  21. 21.

    Wechter DG, Luna GK. An unusual complication of rubber band ligation of hemorrhoids. Dis Colon Rectum 1987;30:137–40.

    Google Scholar 

Download references

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Correspondence to Mr. Yik-Hong Ho.

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Ho, YH., Tan, M. & Seow-Choen, F. Micronized purified flavonidic fraction compared favorably with rubber band ligation and fiber alone in the management of bleeding hemorrhoids. Dis Colon Rectum 43, 66–69 (2000). https://doi.org/10.1007/BF02237246

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Key words

  • Anus
  • Colonoscopy
  • Gastrointestinal bleed
  • Piles