{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T07:44:53Z","timestamp":1767339893902,"version":"3.40.5"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,10,7]],"date-time":"2020-10-07T00:00:00Z","timestamp":1602028800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,10,7]],"date-time":"2020-10-07T00:00:00Z","timestamp":1602028800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Adv Rheumatol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Hemorrhoid disease (HD) is one of the most common gastrointestinal complaints worldwide, affecting 4.4% of the general population in the United States. Since antiphospholipid syndrome (APS) may lead to intra-abdominal thrombosis, one may expect that this condition can impact the risk for HD development. Additionally, as APS patients are more prone to thrombosis and treatment with anticoagulants may increase risk of bleeding, one may also infer that rates of HD complications may be higher in this scenario. Nevertheless, no data in these regards have been published until now. The objective of the present study is to evaluate frequency of HD and describe its complications rates in antiphospholipid syndrome APS patients.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>We consecutively invited patients who fulfilled APS criteria to undergo proctological examination. After examination, patients were divided in two groups, based on the presence of HD, and compared regarding different clinical manifestations and antiphospholipid profile. We performed the analysis of the data, using chi-square and Mann Whitney U when applicable and considering a significance level of 0.05. Multivariate regression analysis included age and variables with <jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.10 in the bivariate analysis.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Forty-one APS patients agreed to undergo proctological examination. All were female and overall median age was 43 (36\u201349). Seventeen (41.4%) patients were diagnosed with HD, with the following frequency distribution: 7 internal (41.2%), 4 external (23.5%) and 5 mixed hemorrhoids (29.4%). Of the internal hemorrhoids, 5 patients were classified as grade I (71.4%), 1 grade II (14.3%), and 1 grade IV (14.3%). Prior gestation (<jats:italic>p<\/jats:italic>\u2009=\u20090.067) and constipation (<jats:italic>p<\/jats:italic>\u2009=\u20090.067) correlated with a higher frequency of HD. In multivariate analysis, constipation remained as an important risk factor (OR 3.92,CI95% 1.03\u201314.2,<jats:italic>p<\/jats:italic>\u2009=\u20090.037). Five out of 17 patients (29.4%) reported anal bleeding, but it did not correlate with warfarin dose (<jats:italic>p<\/jats:italic>\u2009=\u20090.949). Surgical treatment was indicated for 10 patients (58.8%). Other anorectal findings were anal fissure, plicoma, condyloma and one chlamydial retitis.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>We found an unexpected high frequency of hemorrhoids in APS patients, with a great proportion requiring surgical treatment.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s42358-020-00153-5","type":"journal-article","created":{"date-parts":[[2020,10,7]],"date-time":"2020-10-07T10:03:16Z","timestamp":1602064996000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Anorectal diseases in patients with Antiphospholipid syndrome: a cross-sectional study"],"prefix":"10.1186","volume":"60","author":[{"given":"E.","family":"Cunha","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9771-9016","authenticated-orcid":false,"given":"V.","family":"Guzela","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0235-8834","authenticated-orcid":false,"given":"G. G. M.","family":"Balbi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4486-9894","authenticated-orcid":false,"given":"C.","family":"Sobrado","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0381-1808","authenticated-orcid":false,"given":"D.","family":"Andrade","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,10,7]]},"reference":[{"issue":"August 2005","key":"153_CR1","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1111\/j.1538-7836.2006.01753.x","volume":"4","author":"S Miyakis","year":"2006","unstructured":"Miyakis S, Lockshin MD, Atsumi T, Derksen RHWM, Groot PGDE, Koike T. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome. J Thromb Haemost. 2006;4(August 2005):295\u2013306.","journal-title":"J Thromb Haemost"},{"key":"153_CR2","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1055\/s-0035-1568144","volume":"29","author":"Z Sun","year":"2016","unstructured":"Sun Z, Migaly J. Review of hemorrhoid disease: presentation and management. Clin Colon Rectal Surg. 2016;29:22\u20139.","journal-title":"Clin Colon Rectal Surg"},{"key":"153_CR3","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1111\/codi.14975","volume":"22","author":"R van Tol","year":"2020","unstructured":"van Tol R, Kleijnen J, Watson A, Jongen J, Altomare D, Qvist N, et al. European society of ColoProctology: guideline for haemorrhoidal disease. Colorectal Dis. 2020;22:650\u201362.","journal-title":"Colorectal Dis"},{"key":"153_CR4","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1056\/NEJMcp1204188","volume":"371","author":"D Jacobs","year":"2014","unstructured":"Jacobs D. Hemorrhoids. N Engl J Med. 2014;371:944\u201351.","journal-title":"N Engl J Med"},{"key":"153_CR5","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/0016-5085(90)90828-O","volume":"98","author":"J Johanson","year":"1990","unstructured":"Johanson J, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation: an epidemiologic study. Gastroenterology. 1990;98:380\u20136.","journal-title":"Gastroenterology."},{"key":"153_CR6","doi-asserted-by":"publisher","first-page":"9245","DOI":"10.3748\/wjg.v21.i31.9245","volume":"21","author":"V Lohsiriwat","year":"2015","unstructured":"Lohsiriwat V. Treatment of hemorrhoids: a coloproctologist\u2019s view. World J Gastroenterol. 2015;21:9245\u201352.","journal-title":"World J Gastroenterol"},{"key":"153_CR7","doi-asserted-by":"publisher","first-page":"227","DOI":"10.4082\/kjfm.2014.35.5.227","volume":"35","author":"J Lee","year":"2014","unstructured":"Lee J, Kim H, Kang J, Shin J, Song Y. Factors associated with hemorrhoids in Korean adults: Korean national health and nutrition examination survey. Korean J Fam Med. 2014;35:227\u201336.","journal-title":"Korean J Fam Med"},{"key":"153_CR8","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1002\/bjs.1800810707","volume":"81","author":"P Loder","year":"1994","unstructured":"Loder P, Kamm M, Nicholls R, Phillips R. Haemorrhoids: pathology, pathophysiology and aetiology. Br J Surg. 1994;81:946\u201354.","journal-title":"Br J Surg"},{"key":"153_CR9","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1111\/j.1572-0241.2005.00359.x","volume":"101","author":"P Alonso-Coello","year":"2006","unstructured":"Alonso-Coello P, Mills E, Heels-Ansdell D, L\u00f3pez-Yarto M, Zhou Q, Johanson J, et al. Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101:181\u20138.","journal-title":"Am J Gastroenterol"},{"key":"153_CR10","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1007\/s00296-011-2313-0","volume":"33","author":"K Klack","year":"2013","unstructured":"Klack K, de Carvalho JF. Dietetic issues in antiphospholipid syndrome. Rheumatol Int. 2013;33:823\u20134.","journal-title":"Rheumatol Int"},{"key":"153_CR11","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1016\/j.gcb.2009.05.007","volume":"33","author":"R Nelson","year":"2009","unstructured":"Nelson R, Thorson A. Risk of bleeding following hemorrhoidal banding in patients on antithrombotic therapy. Gastroenterol Clin Biol. 2009;33:463\u20135.","journal-title":"Gastroenterol Clin Biol"},{"key":"153_CR12","doi-asserted-by":"publisher","first-page":"2009","DOI":"10.3748\/wjg.v18.i17.2009","volume":"18","author":"V Lohsiriwat","year":"2012","unstructured":"Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012;18:2009\u201317.","journal-title":"World J Gastroenterol"},{"key":"153_CR13","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1007\/s11926-014-0426-7","volume":"16","author":"K Saunders","year":"2014","unstructured":"Saunders K, Erkan D, Lockshin M. Perioperative management of antiphospholipid antibody-positive patients. Curr Rheumatol Rep. 2014;16:426.","journal-title":"Curr Rheumatol Rep"},{"key":"153_CR14","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1007\/s00595-012-0365-8","volume":"43","author":"T Yano","year":"2013","unstructured":"Yano T, Nogaki T, Asano M, Tanaka S, Kawakami K, Matsuda Y. Outcomes of case-matched injection sclerotherapy with a new agent for hemorrhoids in patients treated with or without blood thinners. Surg Today. 2013;43:854\u20138.","journal-title":"Surg Today"},{"key":"153_CR15","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1007\/s10151-016-1481-z","volume":"20","author":"S Atallah","year":"2016","unstructured":"Atallah S, Maharaja G, Martin-Perez B, Burke J, Albert M, Larach S. Transanal hemorrhoidal dearterialization (THD): a safe procedure for the anticoagulated patient? Tech Coloproctol. 2016;20:461\u20136.","journal-title":"Tech Coloproctol"}],"container-title":["Advances in Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42358-020-00153-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42358-020-00153-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42358-020-00153-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,7]],"date-time":"2021-10-07T01:37:47Z","timestamp":1633570667000},"score":1,"resource":{"primary":{"URL":"https:\/\/advancesinrheumatology.biomedcentral.com\/articles\/10.1186\/s42358-020-00153-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,7]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["153"],"URL":"https:\/\/doi.org\/10.1186\/s42358-020-00153-5","relation":{},"ISSN":["2523-3106"],"issn-type":[{"type":"electronic","value":"2523-3106"}],"subject":[],"published":{"date-parts":[[2020,10,7]]},"assertion":[{"value":"29 July 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 September 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 October 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Ethics Committee of the Hospital das Cl\u00ednicas from University of S\u00e3o Paulo (approval #2.368.484) and patients signed written informed consents, which have been archived in the Rheumatology department.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"51"}}