{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:42Z","timestamp":1792022442199,"version":"4.4.0"},"reference-count":107,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,12]],"date-time":"2023-03-12T00:00:00Z","timestamp":1678579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>To date, the exact pathophysiology of haemorrhoids is poorly understood. The different philosophies on haemorrhoids aetiology may lead to different approaches of treatment. A pathogenic theory involving a correlation between altered anal canal microflora, local inflammation, and muscular dyssynergia is proposed through an extensive review of the literature. Since the middle of the twentieth century, three main theories exist: (1) the varicose vein theory, (2) the vascular hyperplasia theory, and (3) the concept of a sliding anal lining. These phenomena determine changes in the connective tissue (linked to inflammation), including loss of organization, muscular hypertrophy, fragmentation of the anal subepithelial muscle and the elastin component, and vascular changes, including abnormal venous dilatation and vascular thrombosis. Recent studies have reported a possible involvement of gut microbiota in gut motility alteration. Furthermore, dysbiosis seems to represent the leading cause of bowel mucosa inflammation in any intestinal district. The alteration of the gut microbioma in the anorectal district could be responsible for haemorrhoids and other anorectal disorders. A deeper knowledge of the gut microbiota in anorectal disorders lays the basis for unveiling the roles of these various gut microbiota components in anorectal disorder pathogenesis and being conductive to instructing future therapeutics. The therapeutic strategy of antibiotics, prebiotics, probiotics, and fecal microbiota transplantation will benefit the effective application of precision microbiome manipulation in anorectal disorders.<\/jats:p>","DOI":"10.3390\/jcm12062198","type":"journal-article","created":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T03:03:57Z","timestamp":1678676637000},"page":"2198","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Altered Gut Microbic Flora and Haemorrhoids: Could They Have a Possible Relationship?"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4603-2011","authenticated-orcid":false,"given":"Vincenzo Davide","family":"Palumbo","sequence":"first","affiliation":[{"name":"Euro-Mediterranean Institute of Science and Technology, 90139 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Tutino","sequence":"additional","affiliation":[{"name":"General Surgery 3 O.U., Molinette Hospital, University Hospital Citt\u00e0 della Salute e della Scienza di Torino, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Messina","sequence":"additional","affiliation":[{"name":"Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90129 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Santarelli","sequence":"additional","affiliation":[{"name":"General Surgery 3 O.U., Molinette Hospital, University Hospital Citt\u00e0 della Salute e della Scienza di Torino, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casimiro","family":"Nigro","sequence":"additional","affiliation":[{"name":"Department of Surgery, Universit\u00e0 degli Studi di Roma \u201cTor Vergata\u201d, 00173 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Lo Secco","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, University of Torino, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7754-1022","authenticated-orcid":false,"given":"Chiara","family":"Piceni","sequence":"additional","affiliation":[{"name":"General Surgery 3 O.U., Molinette Hospital, University Hospital Citt\u00e0 della Salute e della Scienza di Torino, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Montanari","sequence":"additional","affiliation":[{"name":"General Surgery 3 O.U., Molinette Hospital, University Hospital Citt\u00e0 della Salute e della Scienza di Torino, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Barletta","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolina","family":"Venturelli","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girolamo","family":"Geraci","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastiano","family":"Bonventre","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attilio Ignazio","family":"Lo Monte","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.3748\/wjg.v18.i17.2009","article-title":"Hemorrhoids: From basic pathophysiology to clinical management","volume":"18","author":"Lohsiriwat","year":"2012","journal-title":"World J. 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