Groupe hospitalier Paris Saint-Joseph, Service de Proctologie Médico-Chirurgicale, 185, rue Raymond Losserand, 75014 Paris
Hemorrhoidal disease is a common condition and the most frequent reason for consultation in proctology. However, there is little data on hemorrhoidal disease in patients with chronic inflammatory bowel disease (IBD). Its incidence varies between 2% and 21% depending on the study but it is still probably underestimated. History taking and physical examination aim to: look for signs of IBD activity, distinguish symptoms of hemorrhoidal disease from those of IBD and assess the severity and impact of hemorrhoidal disease. Treatment of hemorrhoidal disease in patients with IBD should only be considered when the latter is fully controlled. Conservative treatment is the preferred initial approach and is not specific to IBD patients. In case of treatment failure, an office-based procedure can be proposed. The rubber band ligation is the most studied instrumental technique and appears to be relatively safe. Surgical hemorrhoidectomy has long been contraindicated in patients with IBD because of the risk of severe complications such as fistulas, stenosis, delayed wound healing, etc. ultimately leading to proctectomy. Then again, these results come from studies done before the anti-TNF era. In more recent studies, the complication rate was less than 10% and no patient required a proctectomy or temporary stoma. Nonetheless, it should be noted that preoperative patient selection was essential. More recently and because of the lesser restrictive postoperative care, patients are more likely to choose new minimally invasive hemorrhoidal surgical techniques rather than conventional hemorrhoidectomy, but the scientific data to support this choice are still limited.