Graptophyllum pictum Extract in the Treatment of Experimental Hemorrhoids: Effects on Vascular Leakage and Matrix Metalloproteinase-9 Levels

Abstract

BACKGROUND: The micronized purified flavonoid fraction, which has been shown to be effective for the treatment of hemorrhoids, is too expensive for Indonesian patients and is not included in the National Formulary. AIM: The aim of this study was to investigate the effects of Graptophyllum pictum extract (GPE), a phlebotropic drug, as it is a cheaper and safer alternative medication for the treatment of hemorrhoids. MATERIALS AND METHODS: Twenty-eight male Wistar rats were randomly divided into four groups. Hemorrhoids were induced in groups 2, 3, and 4 using 6% croton oil. After induction, group 1 (negative control) and group 2 (positive control) were administered normal saline, whereas groups 3 and 4 were administered 100 mg/kg BW and 300 mg/kg BW GPE, respectively. On the 9th day, blood samples were collected to measure serum matrix metalloproteinase (MMP)-9 levels. The anus, containing the internal and external sphincters, was resected. Vascular leakage was measured based on edema and extravascular leukocyte count. The edema was measured using the rectoanal coefficient. RESULTS: The highest rectoanal coefficient was observed in groups 2 (3.13 ± 0.85) and 3 (2.46 ± 0.41); that in group 4 (2.60 ± 0.34) was significantly lower than that in group 2 (p < 0.05). The highest leukocyte count was observed in groups 2 (1003.28 ± 99.30) and 3 (900.14 ± 48.09); that in group 4 (835.85 ± 42.65) was significantly lower than that in group 2 (p < 0.05). The highest mean serum MMP-9 level was observed in groups 2 (1840.25 ±437.84) and 3 (525.78 ± 577.33); that in group 4 (1122.03±675.76) was significantly lower than that in group 2 (p < 0.05). CONCLUSIONS: GPE effectively reduced vascular leakage (edema and extravascular leukocyte count) and MMP-9 level in this experimental model of hemorrhoids.