Abnormalities in collagen composition may contribute to the pathogenesis of hemorrhoids: morphometric analysis.
OBJECTIVE
While hemorrhoidal disease is common, its etiology remains unclear. It has been postulated that disturbances in collagen lead to reduced connective tissue stability, and in turn to the development of hemorrhoidal disease. We aimed to compare the quality and quantity of collagen in patients with hemorrhoidal disease versus normal controls.


METHODS
Specimens from 57 patients with grade III or IV internal hemorrhoids undergoing hemorrhoidectomy between 2006 and 2011 were evaluated. Samples from 20 human cadavers without hemorrhoidal disease served as controls. Quality of collagen was analyzed by collagen I/III ratio, and quantity of collagen was determined by collagen/protein ratio. The study group was subdivided into gender and age subgroups.


RESULTS
The male:female ratios in the study and control groups were 30:27 and 10:10, respectively. Median age was significantly less in the study group [46.9 years (range 20-69)] compared to the control group [76 years (range 46-90)] with P < 0.05. Tissues from patients in the study group had significantly lower collagen I/III ratio as compared to the control group (4.4 ± 1.1 vs. 5.5 ± 0.6; P < 0.0001). Nevertheless, despite a trend toward lower collagen/protein ratio in the study group, it did not reach statistical significance (57 ± 42.4 vs. 73 ± 32.5 g/mg; P = 0.167). There was no difference in collagen I/III or collagen/protein ratios among different age groups and genders.


CONCLUSIONS
Hemorrhoidal tissues from patients with hemorrhoidal disease appear to have reduced mechanical stability as compared to normal controls.
Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
Y Y
YY
Nasseri
E
E
Krott
K M
KM
Van Groningen
M
M
Berho
M C
MC
Osborne
S
S
Wollman
E G
EG
Weiss
S D
SD
Wexner
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D016022:Case-Control Studies; D024042:Collagen Type I / Q000032:analysis*; D024061:Collagen Type III / Q000032:analysis*; D003238:Connective Tissue / Q000473:pathology*; D005260:Female; D061865:Hemorrhoidectomy; D006484:Hemorrhoids / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011506:Proteins / Q000032:analysis*; D012737:Sex Factors; D055815:Young Adult
D024042:Collagen Type I; D024061:Collagen Type III; D011506:Proteins