Chronic Khat Chewing Induced High-Grade Hemorrhoidal Disease and Post-Operative Bleeding in Yemen.

Background: Khat contains alkaloids, tannins, and flavonoids with physiological and pathological effects. In Yemen, anorectal diseases, including hemorrhoids, are prevalent, and hemorrhoidectomy is frequently performed.

Purpose: This study evaluates the relationship between chronic khat chewing and high-grade hemorrhoidal disease, as well as post-operative complications such as bleeding and pain.

Patients and methods: This prospective cross-sectional study included 1,896 patients aged 16-85 years, meeting the inclusion criteria were included and followed for three months.

Patients were divided into two groups: Chronic khat chewers (n=1,492) and non-khat chewers (n=404) Data included khat habits, clinical assessments, digital rectal exams, anoproctoscopy, intraoperative findings, and post-operative outcomes.

Results: Chronic khat chewing was strongly associated with thrombosed grade IV hemorrhoidal disease. Among khat chewers, 90% had hemorrhoids, with 75% requiring hemorrhoidectomy or hemorrhoidopexy, compared to 25% in non-chewers, where half underwent hemorrhoidopexy. The odds ratio (OR) for hemorrhoids in khat chewers was 27.04. Gender-specific analysis showed a six-fold higher OR for hemorrhoids in khat-chewing females versus non-chewing females. Post-operative complications, including bleeding and severe pain, were significantly higher in male khat chewers (p < 0.05), while no significant differences were observed in females.

Conclusion: Chronic khat chewing is strongly associated with high-grade hemorrhoidal disease and increased post-operative complications. Mechanisms include chronic constipation, increased anal sphincter tone, and prolonged sitting. These findings highlight the need for public health strategies to reduce khat use and tailored clinical approaches to improve outcomes. Future research should focus on establishing causality, identifying confounders, dose-response relationships, and exploring gender-specific management strategies that target both mechanical and pharmacological factors to optimize surgical care and long-term outcomes.