title: Flavonoids mixture (diosmin, troxerutin, hesperidin) in the treatment of acute hemorrhoidal disease: a prospective, randomized, triple-blind, controlled trial.
abstract: BACKGROUND
  The role of a mixture of phlebotonics in the treatment of acute hemorrhoid crisis is investigated to test their efficacy.
  
  
  METHODS
  One hundred and thirty-four consecutive patients with an acute hemorrhoidal crisis recruited in five colorectal units entered the study. Sixty-six of them were randomized to receive a mixture of diosmin, troxerutin and hesperidin (group A), and 68 a placebo (group B). The main symptoms, the use of oral painkillers and the Bristol scale score were recorded at each scheduled visit and compared using both Student's t test for independent samples and the ANOVA models for repeated measures. The presence of edema, prolapse and thrombosis were also recorded and compared using the Chi-square test. Furthermore, the trend of proportions during the time of the evaluations was assessed by the Chi-square test for linear trend.
  
  
  RESULTS
  Pain, bleeding and the proportion of patients who reported persistence of edema and thrombosis decreased significantly after 12 days of treatment in group A. After 6 days, the number of paracetamol tablets taken by patients in group A was significantly lower than the amount of flavonoid mixture.
  
  
  CONCLUSIONS
  The use of a mixture of diosmin, troxerutin and hesperidin is a safe and effective mean of managing symptoms of acute hemorrhoidal disease. Furthermore, in patients receiving treatment, there was faster control and lower persistence of edema and thrombosis.
authors.affiliation: General Surgery and Liver Transplantation Unit, Department of Emergency and Organ Transplantation, "A. Moro" University, Policlinico. Piazza G. Cesare, 11, 70124, Bari, Italy, ivanagi83@yahoo.it.
authors.forename: I
authors.initials: I
authors.lastname: Giannini
authors.forename: A
authors.initials: A
authors.lastname: Amato
authors.forename: L
authors.initials: L
authors.lastname: Basso
authors.forename: N
authors.initials: N
authors.lastname: Tricomi
authors.forename: M
authors.initials: M
authors.lastname: Marranci
authors.forename: G
authors.initials: G
authors.lastname: Pecorella
authors.forename: S
authors.initials: S
authors.lastname: Tafuri
authors.forename: D
authors.initials: D
authors.lastname: Pennisi
authors.forename: D F
authors.initials: DF
authors.lastname: Altomare
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000925:Anticoagulants / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D004145:Diosmin / Q000008:administration & dosage*; D004338:Drug Combinations; D004487:Edema / Q000453:epidemiology / Q000209:etiology; D015340:Epidemiologic Research Design; D005260:Female; D006484:Hemorrhoids / Q000150:complications / Q000188:drug therapy*; D006569:Hesperidin / Q000008:administration & dosage*; D006801:Humans; D006896:Hydroxyethylrutoside / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D012005:Rectal Prolapse / Q000453:epidemiology / Q000209:etiology; D012107:Research Design; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult
chemical_list: D000700:Analgesics; D000925:Anticoagulants; D004338:Drug Combinations; D006896:Hydroxyethylrutoside; D004145:Diosmin; C005865:troxerutin; D006569:Hesperidin