Long-term result after rubber band ligation for haemorrhoids.

PURPOSE: Rubber band ligation (RBL) is a well-known and recognised outpatient procedure utilised for the treatment of symptomatic internal haemorrhoids. This paper describes a retrospective study which analyses the short- and long-term results of a personal series of patients. MATERIALS AND METHODS: A consecutive group of 206 patients with symptomatic internal second- and third-degree haemorrhoids were treated with RBL as outpatients from 1982 to 1989. Two or three piles were legated in a single session. All patients were systematically visited after 1 month and 1 year. Respectively after 10 and 17 years, all the patients were contacted to obtain a telephone follow-up. RESULTS: The short-term follow-up at 1 month and at 1 year showed that 46% of the patients experienced moderate anal pain for 24 h post procedure. Two patients had severe pain (1%) and were admitted in the hospital to be submitted to an operative haemorrhoidectomy within a few days. Only 2.4% of the patients experienced rectal bleeding after a week, and 20% had a second session of RBL after 1 month. At 1 year follow-up, 90% of the patients with second-degree piles and 75% of patients with third-degree piles reported no residual symptoms. The long-term telephone follow-up at 10 and 17 years collected the history of 138 patients (67%). A group of 69% was asymptomatic, 28% had residual symptoms, and 3% needed further surgery. CONCLUSION: RBL is a safe and effective treatment for symptomatic internal haemorrhoids. Our long-term follow-up demonstrated good long-term results for internal second- and third-degree haemorrhoids.

Isolated H. pylori duodenal colonization and idiopathic duodenal ulcers.

OBJECTIVE: To evaluate whether some duodenal ulcers (DU) classified as idiopathic according to standard criteria may be causally related to isolated duodenal colonization by H. pylori. METHODS: We studied consecutive ambulatory patients undergoing upper gastrointestinal endoscopy in a secondary care setting. Gastric and duodenal biopsies for diagnosing H. pylori infection were taken from all patients. Independently from the findings of duodenal biopsies, DU patients without gastric infection were classified as having idiopathic ulcers, and underwent urea C13 breath test and subsequent eradication therapy. Endoscopy was repeated 6 months after eradication treatment. RESULTS: Among 608 DU patients, 42 (6.9%) were classified as idiopathic: 24 (3.9%) were free from gastric and duodenal infection (group A) and 18 (3.0%) (group B) had isolated duodenal colonization. Urea C13 breath test was positive in one (4.2%) group A patient and in 3 (16.7%) group B patients. After eradication therapy, DU were detected in 14 out of 20 group A patients (70%) (four patients did not perform control endoscopy) and in 2 group B patients (11.1%): OR 18.66, 95% CI 3.23-107.82, P= 0.002. The difference was still detectable after multivariate analysis taking into account possible confounding factors: OR 15.79, 95% CI 2.48-100.53, P= 0.001. CONCLUSIONS: Isolated duodenal colonization by H. pylori is detectable in a substantial proportion of patients with so-called idiopathic DU, and eradication therapy is effective in these patients.