Hemorrhoids Are Associated With Diverticulosis Not Constipation or Dietary Fiber Intake
Douglas K. Rex, MD, MASGE, reviewing Sninsky JA, et al. Clin Gastroenterol Hepatol 2022 Feb 14.
This was a case-control study of patients undergoing screening colonoscopy between 2013 and 2015. Patients completed a detailed diet and bowel habit questionnaire, and a research assistant recorded the number, location, size, and depth of diverticula. Internal hemorrhoids in the rectum were rated as small, medium, large, or absent.
Among 616 patients, 58% had internal hemorrhoids, of which 55% were medium or large. Forty-two percent had diverticulosis. Patients with diverticulosis were more likely to have internal hemorrhoids (odds ratio [OR], 1.64), and when only medium or large hemorrhoids were considered, the association with diverticulosis increased to an OR of 2.21. There was also an association with the number of diverticula. Thus, patients with >10 diverticula had the highest risk of internal hemorrhoids (OR, 3.33). Hemorrhoids were not associated with the number of bowel movements, Bristol stool types, dietary fiber intake, or laxative use.
COMMENTThe authors suggest that the lack of association between internal hemorrhoids and dietary factors, but their association with diverticular disease, is consistent with recent genome-wide association studies showing that both hemorrhoids and diverticulosis are associated with changes in loci for extracellular matrix and connective tissue. These authors suggest these changes are more important than diet or bowel movement factors in internal hemorrhoid development.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Sninsky JA, Galanko J, Sandler RS, Peery A. Diverticulosis is associated with internal hemorrhoids on colonoscopy: possible clues to etiology. Clin Gastroenterol Hepatol 2022 Feb 14. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2022.02.020)
