PhD conferral Sara Zwier Kuiper

Keywords: Haemorrhoidal disease; Haemorrhoids; patient-centred management; patient-reported outcome measures

"Patient-centred Haemorrhoidal Disease Management"

Haemorrhoidal disease (HD) is the most common anal condition in the Netherlands. Despite the fact that many people suffer from this ailment, relatively little high-quality research is conducted. Therefore, the scientific evidence for the treatment of this burdensome disease is limited. For all grades of HD, the general practitioner recommends laxation and a high-fiber diet as the first treatment step. In case of persistent symptoms or higher HD grades, hemorrhoids are treated in the hospital using a rubber band (rubber band ligation) that cuts off the blood supply to the hemorrhoids. However, for one in three patients (about 15,000 per year), this treatment is not adequate and the symptoms re-occur. Both repeated rubber band ligation and surgical interventions can provide relief, choosing either to excise the hemorrhoids (hemorrhoidectomy) or to suspend them from surrounding tissue (mucopexy). This thesis describes the study protocol for a randomized trial of the most (cost-)effective treatment strategy for recurrent hemorrhoids, comparing rubber band ligation, hemorrhoidectomy, and mucopexy.

The most common symptoms of hemorrhoids are blood loss, prolapse, pain, itching, and fluid loss, and can have a negative impact on the patient's quality of life. The severity of these symptoms and the burden on a patient's life can be measured using a Patient-Reported Outcome Measure (PROM). A PROM is an instrument that provides a broader understanding of a patient's disease burden, without the healthcare provider's intervention. To test the symptom burden of complaints of hemorrhoids, the PROM-Haemorrhoidal Impact and Satisfaction Score (PROM-HISS) was developed. This thesis describes the design, validation, and translation of this instrument into English. The PROM-HISS can be used successfully for scientific purposes and daily clinical practice.

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