Cryotherapy of hemorrhoids: scientific practice or genuine hoax?

cryotherapy of hemorrhoids,cryotherapy,elastic ligation,outpatient treatment of hemorrhoidsCryotherapy of hemorrhoids: science or market?

Searching for medical information and advice on the Internet is really complicated for those who are not subject matter experts. Very frequently, one comes across pages, hosted even by prestigious national newspapers such as the daily La Repubblica (as in the case we are now going to discuss), which report a mix of true news (although of less than excellent quality) and genuine "hoaxes."

Such is the case with the article. "Hemorrhoids the enemy of vacations: eradicating the problem is possible." published in the Rome pages of the well-known newspaper.

The title is really catchy: how nice, maybe I can blow 'em to hell and have a great vacation! If a doctor could offer a quick, painless, last-minute solution of this kind, he would become a benefactor of humanity, as well as a very rich one.

Unfortunately, such a promise is, very often, waffling.

But back to the article. The first part makes us a little anxious: health problems that afflict us daily and do not go on vacation, 60% of the population over 50 suffer from them, tend to worsen with high temperatures, at the seaside or in the mountains, discomfort that in the long run is impossible to live with. All true, for goodness sake: how very true, no one better than a coloproctologist, who listens to hundreds of stories of desperate patients every week, can know this.

But here, suddenly comes, bright and saving, the solution: fortunately, it is a problem that "the new frontiers of medicine make it possible to eradicate at the root with non-invasive interventions." Gosh, the sufferer must have thought: and I'm standing here doing nothing?

Indeed, it is true that there are minimally invasive and very effective treatments for treating hemorrhoidal disease. We have also discussed this in various articles.

However, reading the next few lines begins to raise some doubts, especially to those with a sharp ear. " Dr. XY gives us guidelines to follow for an ideal diet...fruits, vegetables, whole foods...two liters of water...good rule of no smoking": what, that's it? The poor patient may begin to feel disappointed.
But no, watch out: Dr. XY offers us the saving solution: hemorrhoid cryotherapy. Cryotherapy of hemorrhoids "is emerging as one of the best and least invasive remedies... after years of study and experimentation, Dr. XY has developed a special expertise in this treatment and now conducts his practice in Rome, as well as in Milan, Bologna, Vicenza and Rimini... the ideal solution to say goodbye to hemorrhoids in just a few minutes... why live with such an annoying problem when you can eliminate it in a simple and painless way?"

Gee... the patient will think: this is not a doctor, he is a saint. The link to Dr. XY 's website will allow us to contact him without any problems. And the famous Facebook "Like" button will reveal to us that this article has excited as many as 65,000 people.

Congratulations Dr. XY.

Too bad it is a hoax.

Cryotherapy of hemorrhoids: truth and hoaxes

Cryotherapy of hemorrhoids is not among the methods provided for in the international guidelines on the treatment of hemorrhoids, compiled by the National Guidelines Cleringhouse of the U.S. Department of Health of the U.S. Government Department of Health-the most globally accredited guidelines, drawn up, in the case of hemorrhoids, by the American Society of Colon and Rectal Surgeons; which, in section 4, tell us that the majority of patients with grade I, II and III hemorrhoids can be effectively treated with outpatient procedures such as elastic ligation, sclerosis and infrared coagulation; and of all of them, elastic ligation is typically the most effective solution. 1

But if cryotherapy of hemorrhoids is the most effective, painless and fast solution how come American Proctologists don't talk about it? Are they crazy? Or are we Italians, and in particular Dr. XY, are better than everyone else?
The next article, from 2012, from the National Guideline Cleringhouse2 provides a beautiful synoptic table on the best treatments according to the degree of hemorrhoid pathology: once again, cryotherapy of hemorrhoids is completely ignored.

But let's move on. Health Professionals have an extra, really powerful weapon to evaluate the quality of medical information: Medline, the database of all scientific papers of some weight published in the world (also maintained by the U.S. government, specifically the U.S. National Library of Medicine).

If you enter the key in the search box. "cryotherapy of hemorrhoids", there are about sixty articles selected, and what they tell us is impressive. Let us choose a few of the most striking ones:

- "Necessary and unnecessary treatment options for hemorrhoids."3: The article is in German, but the abstract states, "Anal dilation, sphincterotomy, cryosurgery, bipolar diathermy, galvanic electrotherapy, and heat therapy should be regarded as obsolete given the poor or missing data reported for these methods." That is: anal dilation, sphincterotomy, CRIOCHIRURGY ... should be considered obsolete given the poor or missing published data for these methods.


- "Hemorrhoids: from basic pathophysiology to clinical management "4. This time it is a really heavy journal, the World Journal of Gastroenterology (impact factor 3.80 in 2015). The text of the article is free, so we can read it in full: we come to learn that "several clinical studies have revealed that it (hemorrhoid cryotherapy) is associated with prolonged pain, malodorous drainage, and a high incidence of persistence of the hemorrhoid mass. "5

Wow, what a success.

Returning to the Republic article, exploring the web page well, one realizes that it is likely sponsored by Dr. XY ("Content offered by Dr. XY," phone number follows). Splendid example of misleading advertising: a commercial packaged as if it were a scientific article, and chock full of inaccuracies and untrue information - dangerous moreover, directing the choice of an inexperienced and suffering person toward a clinical method that is not validated by the international medical community, expensive and little, if any, effective.

Meditate, gentlemen, and get informed before you follow the fatuous fires-and the charlatans.

(1) "Most patients with grade I, II, and III hemorrhoid disease in whom medical treatment fails may be effectively treated with office-based procedures, such as banding, sclerotherapy, and infrared coagulation. Hemorrhoid banding is typically the most effective option."
(2) "Expert commentary: Management of Hemorroids..."
(3) Necessary and unnecessary treatment options for hemorrhoids
(4) Hemorrhoids: from basic pathophysiology to clinical management
(5) "Several clinical trials revealed that it was associated with prolonged pain, foul-smelling discharge and a high rate of persistent hemorrhoidal mass."