Aesculus Hippocastanum (Aescin, Horse Chestnut) in the Management of Hemorrhoidal Disease: Review

• Published in: Turkish Journal of Colorectal Disease
• Main Authors: Fikret Ezberci, Ethem Ünal
• Format: Article
• Language: English
• Published: Turkish Society of Colon and Rectal Surgery 2018-06-01
• Subjects: Hemorrhoid; horse chestnut; aescin; aesculus hippocastanum; medical treatment
• Online Access: https://www.journalagent.com/z4/download_fulltext.asp?pdir=krhd&ppdf=2&plng=eng&un=KRHD-16442

Medical treatment is very important in the relief of symptoms and pain related to hemorrhoidal disease, even in advanced cases with absolute surgical indication. Medical remedies containing components such as flavonoids, diosmin, calcium dobesilate, oxerutin, and horse chestnut (Aesculus hippocastanum, Hippocastanaceae family) are commonly used in the medical management of hemorrhoidal disease. The primary active constituent found in horse chestnut seed extract, aescin, is a mixture of triterpene saponins present in two forms, alpha and beta, which are distinguished by their water solubility and melting points; other constituents include bioflavonoids (quercetin and kaempferol), proanthocyanidin A2 (an antioxidant), and the coumarins fraxin and aesculin. The antiedematous, antiinflammatory and venotonic properties observed are due exclusively to aescin. Its venotonic effect was shown to be mediated by its sensitizing activity on ion channels in the vessel wall, especially to calcium, which results in an increase in contractility. It has also been proposed that enhanced release of prostaglandin F2 antagonizes the vasodilatory effects of histamine and serotonin, and venous wall damage is reduced by antagonizing proteoglycan degradation, which aids in the preservation of connective tissue integrity. Horse chestnut extract, which owes its antiseptic, venotonic, vasoprotective, and antiinflammatory properties to its aescin content, has emerged as an important agent that can facilitate the treatment of every stage of hemorrhoidal disease. In this review, we investigated these effects as well as its more recently studied apoptotic and antioxidant effects in light of experimental and clinical studies published in the literature.