Parvez Sheikh

Abstract :

The current issue of the Journal of Comparative Effectiveness Research contains two articles reporting results of
international web-based surveys: one in individuals with chronic venous disease (CVD) [1], and the other in those
with hemorrhoidal disease [2].
CVD is an umbrella term that describes conditions characterized by long-standing morphological and functional
venous abnormalities[3], while hemorrhoidal disease is characterized by abnormally enlarged anal venous cushions[4].
Both conditions have complex pathophysiological mechanisms that are not yet fully understood, with neither
condition having a single cause [5–7]; however, both involve venous abnormalities [7]. As highlighted by the articles
published in this issue, patients with these two conditions have similar comorbidities: allergy, asthma, depression,
diabetes, hypertension and psoriasis were commonly reported in both studies [1,2]. There is also an overlap in risk
factors, with increasing age, obesity, pregnancy and sitting or standing for prolonged periods of time increasing the
risk for both conditions [8,9]. It is therefore perhaps unsurprising that CVD was reported in over half of the patients
with hemorrhoidal disease in the large CHORUS study [7]. In the survey published in this issue, hemorrhoidal
disease was reported by 28% of those with CVD, compared with only 10% of the general population [1]. Similarly,
49% of patients reporting hemorrhoidal disease also suffered heavy legs or varicose veins, versus 24% of the general
population [6]. Thus, if a physician is treating a patient for one condition, it may be prudent for them to also
investigate the other.

Published Online:

For full text: Future Medicine; https://doi.org/10.2217/cer-2020-0214