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NICE Clinical Knowledge Summary (CKS) on haemorrhoids recommends that patients with persistent or troublesome symptoms should be examined and may require referral to a colorectal specialist

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As previously discussed, bacterial products, collectively known as PAMPs and MAMPs, derived from the gut, reach the liver via portal circulation and systemic circulation through the mesenteric lymph nodes, and may induce an inflammatory response by activating Toll-like receptors (TLRs)