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Revista Mexicana de Coloproctología Enfermedades del Ano, Recto y Colon

2026, Number 1

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Rev Mex Coloproctol 2026; 22 (1)

Clinical characterization of hemorrhoidal disease and its coexistence chronic venous disease in Mexican patients: A subanalysis of the CHORUS study

Reachi LR, Flores CSO, Espinosa MDR, Rodríguez CR, Jalife MA, Enríquez VME, López AJÁ, Escotto SI, Gutiérrez DCA, Nuricumbo VA, Sánchez Ramírez, Hugo; Flores PCM, López UA

Language: Spanish
References: 23
Page: 6-17
PDF size: 793.87 Kb.


ABSTRACT

Introduction: Hemorrhoidal Disease (HD) and Chronic Venous Disease (CVD) share multiple risk factors and potential pathophysiological mechanisms. Although the international CHORUS study demonstrated a high prevalence of coexistence between the two conditions, specific data on the Mexican population remain limited. The objective of this subanalysis was to describe the clinical profile of Mexican patients with HD and to analyze its relationship with CVD. Material and methods: an observational, cross-sectional, non-interventional subanalysis of the CHORUS study was conducted among adult patients presenting with symptoms consistent with HD in outpatient settings in Mexico. Sociodemographic and clinical variables, anorectal symptoms, hemorrhoid classification according to Goligher, the presence and severity of CVD as classified by CEAP, and prescribed treatments were collected. Descriptive and univariate analyses were performed, along with multivariate logistic regression models. Results: a total of 465 patients were included, with a mean age of 51.0 ± 14.9 years and a mean body mass index of 28.9 ± 5.7 kg/m². Most patients had grade I (52.7%) or II (35.1%) HD, while grades III and IV accounted for 11.0% and 1.3%, respectively. The most common symptoms were anal pain (71.2%), swelling (66.2%), and itching (61.7%), while 71.2% had previously undergone consultation for hemorrhoids. The prevalence of CVD was high, with clinical signs consistent with this condition identified in 76.9% of patients according to the CEAP classification. The most common categories were C1 (21.5%) and C2 (19.4%), although advanced stages were also observed. In the univariate analysis, hemorrhoidal severity was significantly associated with age ≥ 35 years, prolonged standing, smoking, estrogen use, a history of childbirth, and higher CEAP severity. In the multivariate analysis, age ‹ 35 years (OR: 0.572; p = 0.034), female sex (OR: 0.632; p = 0.015), a CEAP classification ≤ C1 (OR: 0.276; p = 0.024), and standing ≤ 2 hours/day (OR: 0.539; p = 0.019) were independently associated with lower severity of HD. Treatment was predominantly conservative, with a notable use of venoactive drugs (93.2%), particularly purified and micronized flavonoid fraction (92.7%). Conclusions: the Mexican population with HD exhibits a high burden of symptoms and a high prevalence of coexisting stroke. These findings reinforce the need for a comprehensive approach and suggest possible shared pathophysiological mechanisms between the two conditions.


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