Review Article
Volume 8 Issue 11 - 2021
Centella asiatica in the Conservative Treatment of Anal Fissure and Hemorrhoids in Comparison with Flavonoids
Massimo Chiaretti1*, Annalisa Italia Chiaretti1 and Giovanna Angela Carru2
1Department of General Surgery, Surgical Specialties and Organ Transplantation ‘Paride Stefanini’, University of Rome “La Sapienza”, Italy
2Health Department University Hospital, Policlinico Umberto I, Rome, Italy
*Corresponding Author: Massimo Chiaretti, Department of General Surgery, Surgical Specialties and Organ Transplantation ‘Paride Stefanini’, University of Rome “La Sapienza”, Italy.
Received: September 03, 2021; Published: October 12, 2021


Background: In this review, we report about therapeutic effects of Centella asiatica (Ca) in comparison with Flavonoids (Fs) to find out which of them best deals with some items such as bleeding and pain healing time in the treatment of outpatients with chronic Anal Fissure (AF) on one hand. On the other hand, we report about the same parameters in outpatients treated for hemorrhoidal disease (HD).

Methodology: Ninety-eight outpatients who complained of AF were randomly assigned to the treated group (either Fs or Ca) and control group [1]. The control group (group C, n = 32) underwent standard treatment. Patients assigned the treated group were divided into subgroups that were treated, additionally, either with Fs (group A, n = 30) or Ca (group B, n = 36) and observed over 8 weeks. In another study on 130 outpatients (who underwent hemorrhoidectomy and operated for hemorrhoidal thrombosis) bleeding and pain were studied [2]. The treated group (both conservative and surgical) was randomized into two subgroups: the one treated with Fs (group A), the other with Ca (group B). Sixty patients (the control group C, both conservative and surgical) received the standard treatment. Time-to-stop bleeding was checked at the start (day 0) up to day 42 (end of the 6th week).

Results: Outpatients complained of AF, the median time-to-stop bleeding in group A resulted in 1 week, in 3 weeks group B, and 4 weeks in group C respectively. Among groups, for the time-to-end-bleeding (A vs B: p-value = 0.022; A vs C: p-value < 0.001; B vs C: p-value = 0.070) significant differences were observed. As for the pain score, from day 0 up to the end of the 2nd week, on the one hand among groups A and B, and on the other hand among groups A vs C, and B vs C significant differences respectively were observed (A vs C: p-value = 0.004; B vs C: p-value 0.035). All patients healed within the end of 8th week [1].

The paper about patients with HD showed “time-to-stop bleeding of 2 weeks for groups A and B; 3 weeks for group C” [2]. As for the VAS score (irritation) comparison among groups (A vs C: p = 0.007; B vs C: p = 0.041; and A vs B: p = 0.782) respectively resulted [2]. The patients underwent hemorrhoidectomy, “the time-to-stop bleeding was 3 and 4 weeks in groups A and B and 5 in group C”, respectively [2]. “Histopathology showed a tight association between flavonoids and piles’ fibrosis (p = 0.008)” [2].

Discussion: “The outpatients with AF treated with either Fs or Ca experienced an earlier healing and disappearance of pain in comparison with patients underwent to the traditional treatment” [1]. Fs showed the most efficacy for bleeding. Ca showed the most efficacy for edemas. Fs and Ca did not show side effects.

Conclusion: The outpatients with AF as well as those with HD treated either with Fs or Ca (phlebotonics) experienced early pain disappearance in comparison with the standard treatment group respectively. In the treatment of HD as well as after anal surgery, Fs and Ca showed significant beneficial effects. Fs among phlebotonics are the most effective against bleeding and anal irritation in HD. As for the Ca, among phlebotonics, seems the most effective for tissues’ edema.

Keywords: Centella asiatica; Anal Fissure; Hemorrhoids; Flavonoids


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Citation: Massimo Chiaretti, et al. “Centella asiatica in the Conservative Treatment of Anal Fissure and Hemorrhoids in Comparison with Flavonoids”. EC Gastroenterology and Digestive System 8.11 (2021): 03-11.

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