Hemorrhoids Have Been Quietly Humiliating Gastroenterologists

Almost half of all 50-year-olds have active hemorrhoid symptoms, and yet somewhere along the way, GI largely underowned this territory — often unnecessarily.

The AGA's new clinical practice update makes a pointed argument: most hemorrhoid disease — grades 1 and 2, and many grade 3 cases — can and should be managed in the gastroenterologist’s office. Rubber band ligation success rates run 66% and 94%, and infrared coagulation is right there with it in the short term. The authors are direct: "Both hemorrhoid banding and infrared coagulation are safe, effective, and easy to perform in the office setting." Neither requires sedation. Neither requires an OR.

Here’s the sneaky part: significant pain usually isn’t from hemorrhoids themselves unless they’re acutely thrombosed. Sharp pain on defecation? That’s most likely an anal fissure — which coexists with hemorrhoids up to 20% of the time and needs to be treated first.

The mechanism question is largely structural: vascular cushions in the anal canal enlarge and descend with age, straining, and constipation — which is why fiber and behavioral changes matter. That includes limiting prolonged toilet time — in one study, to a surprisingly specific 3-minute target — which actually improved prolapse and bleeding.

Surgical referral is warranted for grade 4 disease, for grade 3 hemorrhoids that fail banding, or when there’s significant associated external disease — but not before office-based options are exhausted.

Source: American Gastroenterological Association

Marrying Well Might Be a Literal Life Strategy

Spouses who marry into long-lived families appear to live longer too — and inherited genetics don't seem to explain it.

Danish researchers tracked nearly 10,000 people who married into longevity-enriched families (sibships where essentially everyone lived past 90) and compared them to matched controls from the general population. The longevity-enriched families (LEF) spouses showed up to a 25% reduction in all-cause mortality, fewer hospitalizations across multiple disease categories, lower rates of lifestyle-related cancers, and notably less alcohol-related disease — roughly a one-third reduction in those under 60. The survival edge even persisted after divorce.

Here's the sneaky part: the spouses themselves didn't come from long-lived families. Their Family Longevity Selection Scores clustered right around zero — population average. Education differences explained very little too.

The proposed mechanisms are assortative mating (healthier people selecting healthier partners at baseline — suggested by modestly lower pre-marriage medication use among LEF spouses) and behavioral convergence over time. The authors are careful here, writing that findings are "consistent with phenotypic assortative mating, convergence of health behaviors within couples, or a combination of both" — causality remains unestablished.

Worth sitting with: partnership context is an underused lens in longitudinal health. This study can't tell physicians what to do with that — but it adds observational weight to the idea that who someone builds a life with may matter more than charts currently capture.

Source: BMC Medicine

A Third of Kids Are Taking Supplements — and the Mix Is Shifting

Melatonin use in children and adolescents nearly doubled — one of several notable shifts in supplement use.

A nationally representative analysis published in Pediatrics Open Science tracked supplement use in more than 12,500 children and adolescents across 3 NHANES cycles (2015 to 2023). About 35% reported using dietary supplements — a figure that remained stable over time. But the mix changed. Zinc use increased from 1.0% to 2.6%. Iron more than doubled. Melatonin rose from 1.4% to 2.5%, with higher use among adolescent boys.

Overall use of alternative medicines increased numerically but did not reach statistical significance (p = .19). Still, the largest increases within that category were seen in probiotics and fiber supplements.

The reasons behind these trends are not definitive. The authors suggest increases in vitamin D and zinc may reflect greater awareness of potential immune and cardiovascular benefits, while rising iron use in adolescent girls may track increasing rates of iron deficiency anemia. Melatonin, commonly used for sleep, raises safety concerns given evidence that its actual content often exceeds labeled amounts.

The clinical takeaway: supplement use is common enough to ask about routinely. While weight-loss and bodybuilding supplements remain uncommon, they are disproportionately associated with serious adverse events in adolescents.

Source: Pediatrics Open Science

The clinical literature. Applied to the patients in your waiting room.